Jourdain O, Dabysing F, Harle T, Lajus C, Roux D, Dallay D
Service de Gynécologie, Hôpital Saint-André, Bordeaux, France.
Int J Gynaecol Obstet. 1998 Nov;63(2):159-62. doi: 10.1016/s0020-7292(98)00154-4.
To evaluate the efficiency of flexible Nd-YAG laser hysteroscopic metroplasty.
We present a retrospective study of 17 patients treated for septate uteri between 1990 and 1995. The indication of hysteroscopy was recurrent abortion in nine cases and eight with primary infertility with indication of IVF in another five cases. We did not prescribe any pretreatment. A flexible hysteroscope with a 100-W Nd:YAG laser was used with glycine-controlled flow. The septum was divided by the laser after exploration of the cavity. We proposed a control office hysteroscopy 2 months after surgery to prevent uterine adhesions.
There was no complication. Twelve patients conceived with 10 live births at term and two spontaneous abortions. Four are still infertile, two were lost from the study and two no longer desired pregnancy. Resectoscopic studies showed the same results.
The advantages of this method are the excellent ergonomic properties of the fibroscope and the safety of the laser. We suggest that metroplasty does not improve the pregnancy rate but only the pregnancy outcome of these patients. However, for those with the indication of IVF the procedure seems useful in avoiding abortion.
评估软性钕钇铝石榴石激光宫腔镜子宫成形术的疗效。
我们对1990年至1995年间接受治疗的17例纵隔子宫患者进行了一项回顾性研究。宫腔镜检查的指征为9例复发性流产，8例原发性不孕，另有5例有体外受精指征。我们未进行任何预处理。使用配备100瓦钕钇铝石榴石激光的软性宫腔镜，并采用甘氨酸控制流量。在探查宫腔后用激光切开纵隔。我们建议术后2个月进行门诊宫腔镜检查以预防子宫粘连。
无并发症发生。12例患者受孕，足月分娩10例活产儿，2例自然流产。4例仍未受孕，2例失访，2例不再希望怀孕。宫腔镜电切术的结果相同。
该方法的优点是纤维镜具有出色的人体工程学特性以及激光的安全性。我们认为子宫成形术并不能提高这些患者的妊娠率，而仅能改善其妊娠结局。然而，对于有体外受精指征的患者，该手术似乎有助于避免流产。
