Popescu Cristina Diana, Sima Romina-Marina, Amza Mihaela, Bobei Tina Ioana, Cirstoiu Silvia, Ples Liana
IOSUD/PhD Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Department of Obstetrics and Gynaecology, "St John" Hospital, "Bucur" Maternity, Bucharest, Romania.
Maedica (Bucur). 2023 Dec;18(4):631-638. doi: 10.26574/maedica.2023.18.4.631.
Infertility is a complex condition that depends on numerous mechanisms regarding its occurrence and evolution. It does not appear as a single pathology, and therefore the diagnosis and management involve both the identification of etiological causes and other possible systemic interactions. Infertility is defined as a succession of unsuccessful attempts of unprotected intercourse within a couple for 12 months, during the reproductive life. Among the many causes related to infertility, uterine pathology has an important place and hysteroscopy is outstanding in diagnosing and treating various pathologies in this category. This descriptive study was conducted on a retrospective analysis of a group of patients from Bucur Clinical Hospital, Bucharest, Romania. The main data were obtained from medical electronic records and included the type of infertility, associated diagnoses and symptoms, previous investigations, hysteroscopic procedure and follow-up. In order to obtain the database, the above parameters were evaluated and processed in the IBM SPSS Statistics version 28, including other few graphs processed in Microsoft Office Excel 2007. The present study included 51 patients aged between 20 and 40 years, with a mean of 32.02 ± 3.7. Out of the total number of patients, 76.47% of participants to the present study were diagnosed with secondary infertility and 58.82% described menometrorrhagias as the most common symptom. Endometrial polyps were more frequently associated with menometrorrhagias (70% of patients), while synechiae and secondary amenorrhea were found together in 75% of cases. Previous ultrasound evaluation identified uterine cavity abnormalities as nonhomogeneous echo-pattern in 58.82% of cases, with some of them being suggestive of endometrial polyps (37.25%), intrauterine synechiae (3.92%) and uterine fibromas (9.8%). We noticed that 12% of cases required laparoscopy and 4% laparotomy. The outcomes of hysteroscopic management resulted in a conception rate of 39%. We found that 20% of pregnancies achieved were complicated with placenta praevia, 5% with gestational hypertension and 15% with imminence of abortion. Secondary infertility was more frequently encountered than primary infertility and the most common associated manifestations included menometrorrhagia, followed by secondary amenorrhea and pelvic-abdominal pain. Transvaginal ultrasound was correlated with hysteroscopic diagnosed pathology; posthysteroscopic results were favourable, regardless of the size and location of changes in the uterine cavity, thus highlighting the importance of hysteroscopic therapeutic techniques in increasing the chances of conception.
不孕症是一种复杂的病症，其发生和发展取决于众多机制。它并非单一的病理学表现，因此诊断和管理既涉及病因的识别，也涉及其他可能的全身相互作用。不孕症被定义为在生殖期内，一对夫妇进行12个月无保护性交均未成功受孕。在与不孕症相关的众多原因中，子宫病变占有重要地位，宫腔镜检查在诊断和治疗此类各种病变方面表现突出。本描述性研究是对罗马尼亚布加勒斯特布库尔临床医院的一组患者进行回顾性分析。主要数据来自医学电子记录，包括不孕症类型、相关诊断和症状、既往检查、宫腔镜检查过程及随访情况。为获取数据库，上述参数在IBM SPSS Statistics 28版本中进行评估和处理，另有一些图表在Microsoft Office Excel 2007中处理。本研究纳入了51名年龄在20至40岁之间的患者，平均年龄为32.02±3.7岁。在所有患者中，本研究76.47%的参与者被诊断为继发性不孕症，58.82% 的患者称月经过多为最常见症状。子宫内膜息肉更常与月经过多相关（70% 的患者），而粘连和继发性闭经在75% 的病例中同时出现。既往超声评估发现58.82% 的病例子宫腔异常表现为不均匀回声模式，其中一些提示子宫内膜息肉（37.25%）、宫腔粘连（3.92%）和子宫肌瘤（9.8%）。我们注意到12% 的病例需要腹腔镜检查，4% 需要剖腹手术。宫腔镜治疗的结果显示受孕率为39%。我们发现，成功受孕的病例中有20% 并发前置胎盘，5% 并发妊娠期高血压，15%濒 临流产。继发性不孕症比原发性不孕症更常见，最常见的相关表现包括月经过多，其次是继发性闭经和盆腔 - 腹部疼痛。经阴道超声与宫腔镜诊断的病理结果相关；宫腔镜检查后的结果良好，无论子宫腔内病变的大小和位置如何，从而突出了宫腔镜治疗技术在增加受孕机会方面的重要性。
