Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, No. 20 Block 3, Renminnan Road, Chengdu, 610041, Sichuan Province, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Arch Gynecol Obstet. 2023 Feb;307(2):609-617. doi: 10.1007/s00404-022-06794-9. Epub 2022 Oct 11.
Septate uterus is the most common structural uterine anomaly, which is related to the adverse pregnancy outcomes in women of childbearing age. This article provides a retrospective review of hysteroscopic uterine septum resection performed in our hospital during recent years, focusing on the patients with recurrent miscarriage and primary infertility, and also to identify which patients are more likely to benefit from the surgery.
This is a single-center retrospective study. Cases of women who underwent hysteroscopic septum resection at West China Second Hospital of Sichuan University from January 2014 to December 2019, retrieved through the medical record system, were divided into three groups: Group A was the recurrent miscarriage group, Group B had a history of pregnancy with spontaneous abortion once at most, and Group C was the primary infertility group. Each patient was followed up by telephone about further pregnancy, miscarriage and live birth for at least 1 year.
A total of 176 surgical patients were included in this study. Group A, B, and C include 42, 74, and 60 cases, respectively. The postoperative pregnancy rates of the three groups were 71.4, 82.4, and 75.0%; live births rates were 50.0, 74.3, and 71.7%; and spontaneous abortion rates were 21.4, 17.6, and 13.3%. 62 patients had a complete uterine septum and 114 had a partial uterine septum. For patients with complete septate uterus, the preoperative pregnancy rate was 54.84% and the pregnancy rate increased to 85.48% after surgery; and yet the preoperative and postoperative pregnancy rates in patients with partial septate uterus were close (from 71.9 to 72.8%).
After uterine septum resection, the pregnancy rate and spontaneous abortion rate in RSA patients were not significantly different from the other two groups, but the live birth rate was still significantly lower. Patients with complete uterine septum may benefit more from surgery. The surgical indications should be carefully and strictly evaluated.
纵隔子宫是最常见的子宫结构异常，与育龄妇女的不良妊娠结局有关。本文对近年来我院行宫腔镜子宫纵隔切除术的患者进行回顾性分析，重点关注复发性流产和原发性不孕患者，并确定哪些患者更可能从手术中获益。
这是一项单中心回顾性研究。通过病历系统检索 2014 年 1 月至 2019 年 12 月在四川大学华西第二医院行宫腔镜子宫纵隔切除术的患者，分为三组：A 组为复发性流产组，B 组为既往妊娠史中最多 1 次自然流产，C 组为原发性不孕组。对每位患者进行至少 1 年的电话随访，了解进一步妊娠、流产和活产情况。
本研究共纳入 176 例手术患者。A、B、C 组分别为 42、74、60 例。三组术后妊娠率分别为 71.4%、82.4%、75.0%；活产率分别为 50.0%、74.3%、71.7%；流产率分别为 21.4%、17.6%、13.3%。62 例患者为完全纵隔子宫，114 例为不完全纵隔子宫。对于完全纵隔子宫患者，术前妊娠率为 54.84%，术后妊娠率增加至 85.48%；而不完全纵隔子宫患者术前和术后妊娠率相近（71.9%至 72.8%）。
子宫纵隔切除术后，RSA 患者的妊娠率和流产率与其他两组无显著差异，但活产率仍显著较低。完全性子宫纵隔患者可能从手术中获益更多。手术适应证应仔细严格评估。
