Abuzeid O, Ibrahim M, Joseph S, Herbert J, Abuzeid M
Fellow, Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology, Stony Brook University, Long Island, New York, USA.
IVF Michigan Rochester Hills and Flint PC, Rochester Hills, Michigan, USA.
Facts Views Vis Obgyn. 2021 Jan 8;12(4):273-280.
To determine the safety and efficacy of hysteroscopic resection of uterine leiomyoma embedded at the base of a uterine septum.
This case series included 11 patients with infertility or recurrent pregnancy loss who were found to have a uterine septum (one septate and 10 sub-septate) and a uterine leiomyoma embedded at the base of the uterine septum. All patients underwent a hysteroscopic division of the uterine septum and hysteroscopic resection of the uterine leiomyoma. Safety was determined by any intra-operative complications, and any immediate or late postoperative complications. Efficacy was determined based on the findings on a postoperative trans-vaginal 3D ultrasound (TV 3D US) with a saline infusion sonohysterogram (SIH) and reproductive outcomes.
There were no reported intra-operative complications, or immediate or late postoperative complications. Eleven patients underwent TV 3D US with SIH; findings were normal in 8 (72.7%); 3 patients underwent a second operative hysteroscopy and subsequent TV 3D US with SIH were also normal. The analysis of reproductive outcomes was limited to patients who were < 40 years (9 patients). Seven patients conceived (77.8%), six delivered (66.7%) and one miscarried (14.3%).
Hysteroscopic myomectomy of a leiomyoma, which is embedded at the base of a uterine septum, can be safely performed at the same session of hysteroscopic division of the uterine anomaly. Improvement in reproductive outcomes is to be expected after such procedures.
确定宫腔镜切除位于子宫纵隔底部的子宫平滑肌瘤的安全性和有效性。
该病例系列包括11例不孕或复发性流产患者，这些患者被发现患有子宫纵隔（1例完全纵隔和10例不完全纵隔）以及位于子宫纵隔底部的子宫平滑肌瘤。所有患者均接受了宫腔镜子宫纵隔切开术和宫腔镜子宫平滑肌瘤切除术。通过任何术中并发症以及任何术后即刻或晚期并发症来确定安全性。根据术后经阴道三维超声（TV 3D US）联合生理盐水灌注超声子宫造影（SIH）的检查结果以及生殖结局来确定有效性。
未报告术中并发症、术后即刻或晚期并发症。11例患者接受了TV 3D US联合SIH检查；8例（72.7%）结果正常；3例患者接受了第二次宫腔镜手术，随后的TV 3D US联合SIH检查结果也正常。生殖结局分析仅限于年龄<40岁的患者（9例）。7例患者受孕（77.8%），6例分娩（66.7%），1例流产（14.3%）。
在宫腔镜子宫畸形切开术的同一手术过程中，可以安全地进行位于子宫纵隔底部的平滑肌瘤的宫腔镜肌瘤切除术。预期此类手术后生殖结局会有所改善。
