T 型子宫宫腔镜子宫整形术后的生殖结局：一项回顾性研究。
Reproductive outcome of hysteroscopic metroplasty for women with T-shaped uterus: a retrospective study.
机构信息
Department of Reproductive Surgery, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
出版信息
Reprod Health. 2022 Mar 28;19(1):78. doi: 10.1186/s12978-022-01381-2.
BACKGROUND
T-shaped uterus is a Müllerian malformation with unapparent clinical manifestations. Intrauterine adhesion and tuberculosis may lead to T-shaped uterus, too. Hysteroscopic metroplasty is a treatment option for T-shaped uterus, while the postoperative reproductive outcomes have not been thoroughly investigated. The aim of this study was to determine the reproductive outcome in Chinese women with T-shaped uterus who had hysteroscopic metroplasty with cold scissors.
METHODS
This retrospective cohort study was conducted in the reproductive surgery unit of a university-affiliated hospital. One hundred and eleven patients with T-shaped uterus who underwent hysteroscopic metroplasty from Jan. 2017 to Sept. 2019 were followed-up by telephone in Apr. 2021. All patients received hysteroscopic metroplasty using microcissors, followed by estrogen-progesterone sequential treatment, with or without intrauterine device (IUD) implantation. According to whether they had had history of intrauterine operation, patients were divided into congenital group and acquired group. The main outcome measure was postoperative live birth rate. χ test and t test were used for comparison between groups. Cochran-Mantel-Haenszel test were used for stratified analysis. P < 0.05 was considered statistically significant.
RESULTS
One hundred and eleven patients were included in total, with 46 in congenital group and 65 in acquired group. After hysteroscopic metroplasty, in the congenital group, the pregnancy rate increased from 28.3% to 87.0% (P < 0.001) and the live birth rate increased from 23.1% to 79.5% (P = 0.001); in the acquired group, the pregnancy rate slightly dropped from 98.5% to 72.3% (P < 0.001) while the live birth rate increased from 20.8% to 74.5% (P < 0.001). No statistically significant difference was observed in postoperative reproductive outcome indicators between the two subgroups except mode of conception.
CONCLUSIONS
For both groups, hysteroscopic metroplasty may improve reproductive outcomes for patients with T-shaped uterus.
背景
T 型子宫是一种表现不明显的苗勒管畸形。宫腔粘连和结核也可能导致 T 型子宫。宫腔镜子宫整形术是 T 型子宫的一种治疗选择，而术后生育结局尚未得到彻底研究。本研究旨在确定接受冷剪刀宫腔镜子宫整形术的 T 型子宫中国女性的生育结局。
方法
这是一项在大学附属医院生殖外科进行的回顾性队列研究。2021 年 4 月通过电话对 2017 年 1 月至 2019 年 9 月期间接受宫腔镜子宫整形术的 111 例 T 型子宫患者进行了随访。所有患者均采用显微剪刀行宫腔镜子宫整形术，随后行雌孕激素序贯治疗，联合或不联合宫内节育器（IUD）植入。根据是否有宫腔操作史，将患者分为先天性组和后天性组。主要观察指标为术后活产率。组间比较采用 χ 检验和 t 检验。Cochran-Mantel-Haenszel 检验用于分层分析。P<0.05 为差异有统计学意义。
结果
共纳入 111 例患者，其中先天性组 46 例，后天性组 65 例。宫腔镜子宫整形术后，先天性组妊娠率由 28.3%上升至 87.0%（P<0.001），活产率由 23.1%上升至 79.5%（P=0.001）；后天性组妊娠率略有下降，由 98.5%降至 72.3%（P<0.001），活产率由 20.8%上升至 74.5%（P<0.001）。除受孕方式外，两组术后生育结局指标差异均无统计学意义。
结论
对于两组患者，宫腔镜子宫整形术均可改善 T 型子宫患者的生育结局。
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