Bacskó G
Department of Obstetrics and Gynecology, University Medical School of Debrecen, Hungary.
Eur J Obstet Gynecol Reprod Biol. 1997 Feb;71(2):219-22. doi: 10.1016/s0301-2115(96)02639-5.
Uterine anomalies are found in 10-15% of women with repeated pregnancy loss. Uterine malformations and benign tumors are common causes of abortions, premature labour and abnormal fetal presentation in some cases. One-third of patients with habitual abortion have a septated or subseptated uterus, and two-thirds of pregnancies in women with duplicated uterus progress to term. Müllerian fusion defects and submucous fibroid may cause poor implantation or ineffective maternal blood supply to the placental site of the developing pregnancy. When these abnormalities were evaluated in infertile patients or in habitual abortions, traditionally the abdominal correction (Jones, Strassman, Tompkins etc.) were used traditionally. These procedures require incision of abdominal and uterine walls in general anesthesia with relative long hospitalization and recovery. The new endoscopic procedure; hysteroscopy is used not only to evaluate the type and size of Müllerian fusion defects but also to treat this malformation. The uterine septum is transsectable, via this elegant method, without injury of abdominal wall and healthy uterine wall musculature. After a traditional abdominal metroplasty there is no other-choice other than the cesarean section to prevent rupture of the uterus, but after hysteroscopic septotomy the vaginal delivery is possible and the uterine rupture rarity.
在反复流产的女性中，10% - 15%存在子宫异常。子宫畸形和良性肿瘤在某些情况下是流产、早产及异常胎位的常见原因。三分之一的习惯性流产患者有纵隔子宫或不完全纵隔子宫，双子宫女性中有三分之二的妊娠可至足月。苗勒管融合缺陷和黏膜下肌瘤可能导致着床不佳或孕期胎盘部位母体血供不足。在评估不孕患者或习惯性流产患者的这些异常情况时，传统上采用腹部矫正手术（如琼斯手术、施特拉斯曼手术、汤普金斯手术等）。这些手术通常需要在全身麻醉下切开腹壁和子宫壁，住院时间和恢复时间相对较长。新的内镜手术——宫腔镜检查不仅用于评估苗勒管融合缺陷的类型和大小，还用于治疗这种畸形。通过这种巧妙的方法可以横断子宫纵隔，而不会损伤腹壁和健康的子宫壁肌肉组织。传统的腹部子宫成形术后，除剖宫产外别无选择以防止子宫破裂，但宫腔镜纵隔切开术后可以经阴道分娩，子宫破裂罕见。
