增强生育力的宫腔镜手术；生殖结局的多中心回顾性队列研究。
Fertility-enhancing hysteroscopic surgery; multi-center retrospective cohort study of reproductive outcome.
机构信息
School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan.
Jordan University hospital, Amman, Jordan.
出版信息
BMC Womens Health. 2023 Aug 29;23(1):459. doi: 10.1186/s12905-023-02562-2.
INTRODUCTION
Hysteroscopic surgery and assisted reproduction technology are feasible ways to improve the reproductive outcome. Our aim was to study hysteroscopic septoplasty and myomectomy's effect on infertility and reproductive performance.
METHODS
Retrospective cohort of patients who had unexplained infertility and/or recurrent miscarriages and had myomectomy or septoplasty in the period September 2016-october 2021 with a total of 18 months' follow up. The main outcome measures were spontaneous pregnancy, term pregnancy and miscarriage. For analysis, we used Statistical Package for Social Sciences (SPSS) version 20.
RESULTS
One hundred and sixty-five patients were included. The mean age of patients was 39 years. 40 patients had septum resection and 125 patients had hysteroscopic myomectomy. A spontaneous pregnancy rate after surgery was achieved in 46 patients (27.9%). Out of the 64 patients who had failed IVF preoperatively, 32 patients (50%) had a successful IVF post-hysteroscopic surgery and there were more successful cases in the patients who had fibroid resection but this difference did not reach a statistical significance (P value 0.055). In the 79 pregnancies after surgery, preterm birth and miscarriage were seen in 10 patients (12.7%), similarly, respectively after septal or fibroid resection. Miscarriages were less post-operatively. Hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy rate (63.0% Vs 37.0%, P value 0.018), more term pregnancies (87.5% vs. 12.5%, P value 0.001) and less miscarriage rate (40%vs 60%, P value 0.003). Pregnancy post-operatively in patients with primary infertility was more statistically significantly associated with hysteroscopic myomectomy than with hysteroscopic septoplasty (95.8% vs. 4.2%, p value 0.030). In patients who got pregnant postoperatively there was no statistically significant difference in the mode of delivery.
CONCLUSION
In carefully selected patients with unexplained infertility and recurrent miscarriage, hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy, more term pregnancies and less miscarriage rates. More than metroplasty, hysteroscopic myomectomy led to higher spontaneous pregnancies in patients with primary infertility.
TRIAL REGISTRATION
NCT05560295.
介绍
宫腔镜手术和辅助生殖技术是改善生殖结局的可行方法。我们的目的是研究宫腔镜下隔切开术和子宫肌瘤切除术对不孕和生殖性能的影响。
方法
回顾性队列研究了 2016 年 9 月至 2021 年 10 月期间因不明原因不孕和/或复发性流产而行子宫肌瘤切除术或隔切开术的患者，共随访 18 个月。主要观察指标为自然妊娠、足月妊娠和流产。分析采用社会科学统计软件包（SPSS）第 20 版。
结果
共纳入 165 例患者。患者平均年龄为 39 岁。40 例患者行隔切开术，125 例患者行宫腔镜子宫肌瘤切除术。术后自然妊娠率为 46 例（27.9%）。在术前接受过 64 例 IVF 治疗失败的患者中，32 例（50%）在宫腔镜手术后 IVF 成功，且在接受肌瘤切除术的患者中，成功病例更多，但差异无统计学意义（P 值 0.055）。在术后 79 例妊娠中，早产和流产分别为 10 例（12.7%），分别在隔切开术或肌瘤切除术组。术后流产减少。与宫腔镜子宫成形术相比，宫腔镜子宫肌瘤切除术与较高的自然妊娠率显著相关（63.0%比 37.0%，P 值 0.018）、较多的足月妊娠（87.5%比 12.5%，P 值 0.001）和较低的流产率（40%比 60%，P 值 0.003）。术后原发性不孕患者妊娠与宫腔镜子宫肌瘤切除术的相关性明显高于宫腔镜子宫成形术（95.8%比 4.2%，P 值 0.030）。在术后妊娠的患者中，分娩方式无统计学差异。
结论
在经过精心挑选的不明原因不孕和复发性流产患者中，与宫腔镜子宫成形术相比，宫腔镜子宫肌瘤切除术与更高的自然妊娠率、更多的足月妊娠和更低的流产率显著相关。与宫腔镜子宫成形术相比，宫腔镜子宫肌瘤切除术在原发性不孕患者中导致更高的自然妊娠率。
试验注册
NCT05560295。
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