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目的:探讨宫腔镜下子宫纵隔切除术(transcervical resection of septum,TCRS)对患者的妊娠及产科结局的影响。方法:2006年3月～2011年5月使用宫腔镜电切术治疗166例子宫纵隔患者。利用病历资料、手术记录及电话随访,分析术前、术后妊娠结局并总结患者产科结局。结果:术中无严重并发症发生,术后首次妊娠距二探取环后最短1个月即妊娠,自然流产率从术前的64.53%降至术后的15.25%(P<0.01),活产率从术前的1.89%上升至术后的72.03%(P<0.01)。术后剖宫产率80%,无指征剖宫产达到总剖宫产数的41.12%,产后出血率23.53%,其中需要输血的占45%,1例先兆性子宫破裂。结论:宫腔镜下子宫纵隔切除术可以明显改善患者的妊娠结局,术后可尽快妊娠,加强孕期监督、分娩方式指导及预防产后出血发生可进一步改善其产科结局。
Objective: To investigate the effect of hysteroscopic transcervical resection of septum (TCRS) on pregnancy and obstetric outcomes in patients. Methods: From March 2006 to May 2011, a total of 166 cases of uterine mediastinum were treated by hysteroscopic electrotomy. Use of medical records, surgical records and telephone follow-up, analysis of preoperative and postoperative pregnancy outcomes and summarize the patient obstetric outcomes. Results: There was no serious complications during operation. The first postoperative pregnancy was the shortest 1 month after the second ring was detected. The rate of spontaneous abortion decreased from 64.53% preoperatively to 15.25% postoperatively (P <0.01) The yield increased from 1.89% preoperatively to 72.03% postoperatively (P <0.01). Postoperative cesarean section rate of 80%, without indications of cesarean section to reach the total cesarean section number of 41.12%, postpartum hemorrhage rate of 23.53%, of which 45% need blood transfusions, 1 case of threatened uterine rupture. Conclusion: Hysteroscopic resection of uterine septum can significantly improve the outcome of patients with pregnancy, as soon as possible after pregnancy, to strengthen supervision during pregnancy, delivery guidance and prevention of postpartum hemorrhage can further improve their obstetric outcomes.