CAJ | 학술논문

目的：探讨对子宫中隔患者采用宫腔镜下子宫中隔切除术（TCRS）基础上，术后放置宫内节育器（IUD）并配合激素补充治疗（HRT）对患者妊娠结局的影响。方法：45例符合入选条件的子宫中隔患者均行TCRS手术，其中20例患者单纯行TCRS手术（对照组），25例患者TCRS术后配合IUD＋HRT治疗（治疗组）。随访8～25个月（中位时间18个月），观察比较两组患者宫腔粘连、妊娠结局。结果：术前治疗组妊娠率为52.00％，自然流产率为69.70％，足月产、早产及活产率均为6.06％；对照组妊娠率为50.00％，自然流产率为76.00％，足月产为4.00％，早产为8.00％，活产率为8.00％。术后复查宫腔镜提示所有患者子宫中隔无残留，子宫内膜修复良好，治疗组无1例发生宫腔粘连，对照组2例发生轻微粘连，两组比较无显著差异（χ2＝2.616，P＝0.192）。总妊娠例次为65次，治疗组妊娠率为88.00％、自然流产率为5.26％、足月产为65.79％、早产为28.95％、活产率为83.33％、剖宫产率为69.44％；对照组妊娠率为90.00％、自然流产率为25.93％、足月产为44.44％、早产为29.63％、活产率为75.00％、剖宫产率为85.00％。与治疗前比较，两组患者妊娠结局均有显著改善，且术后治疗组自然流产率显著低于对照组（P＜0.05），其他指标组间比较无显著差异（P＞0.05）。结论：TCRS治疗子宫中隔安全有效，可显著改善患者妊娠结局，术后配合IUD＋HRT，可明显降低自然流产率，一定程度减少宫腔粘连，对患者妊娠结局可能具有一定改善作用，仍有待进一步研究证实。
목적：탐토대자궁중격환자채용궁강경하자궁중격절제술（TCRS）기출상，술후방치궁내절육기（IUD）병배합격소보충치료（HRT）대환자임신결국적영향。방법：45례부합입선조건적자궁중격환자균행TCRS수술，기중20례환자단순행TCRS수술（대조조），25례환자TCRS술후배합IUD＋HRT치료（치료조）。수방8～25개월（중위시간18개월），관찰비교량조환자궁강점련、임신결국。결과：술전치료조임신솔위52.00％，자연유산솔위69.70％，족월산、조산급활산솔균위6.06％；대조조임신솔위50.00％，자연유산솔위76.00％，족월산위4.00％，조산위8.00％，활산솔위8.00％。술후복사궁강경제시소유환자자궁중격무잔류，자궁내막수복량호，치료조무1례발생궁강점련，대조조2례발생경미점련，량조비교무현저차이（χ2＝2.616，P＝0.192）。총임신례차위65차，치료조임신솔위88.00％、자연유산솔위5.26％、족월산위65.79％、조산위28.95％、활산솔위83.33％、부궁산솔위69.44％；대조조임신솔위90.00％、자연유산솔위25.93％、족월산위44.44％、조산위29.63％、활산솔위75.00％、부궁산솔위85.00％。여치료전비교，량조환자임신결국균유현저개선，차술후치료조자연유산솔현저저우대조조（P＜0.05），기타지표조간비교무현저차이（P＞0.05）。결론：TCRS치료자궁중격안전유효，가현저개선환자임신결국，술후배합IUD＋HRT，가명현강저자연유산솔，일정정도감소궁강점련，대환자임신결국가능구유일정개선작용，잉유대진일보연구증실。
Objectives:To investigate the effect of IUD insertion joint with hormone replacement therapy (HRT)on the pregnancy outcome of patients with uterine septum on the basis of TCRS.Methods:45 patients with uterine septum underwent TCRS surgery,20 of who received simple lines TCRS surgery (control group),and 25 patients received IUD +HRT (treatment group)after TCRS surgery.All the patients were followed up for 8-25 months (median 18 months).Intrauterine adhesions and pregnancy outcome of the two groups were observed and compared.Results:Before the surgery,the pregnancy rate and spontaneous abortion rate of the treatment group was 52.00% and 69.70% respectively,while the partus maturus,premature birth and live birth rate were all 6.06%. The pregnancy rate and spontaneous abortion rate of the control group was 50.00%and 76.00%respectively,while the partus matures rate,premature birth and live birth rate were 4.00%,8.00% and 8.00% respectively.After surgery,the review of all patients hysteroscopy indicated that there was no uterine septum residue,with good endom-etrial repair results.There was no case of intrauterine adhesions in treatment group and 2 cases of mild intrauterine adhesions in control group,without statistically significant difference (χ2 =2.616,P=0.192).There were a total of 65 person-times of pregnancy.In the treatment group,the pregnancy rate,spontaneous abortion rate,partus maturus rate,premature birth rate,live birth rate and cesarean section rate was 88.00%,5.26%,65.79%, 28.95%,83.33% and 69.44% respectively;in the control group,they were 90.00%,25.93%,44.44%, 29.63%,75 .00%and 85 .00%respectively.Compared with the situation before treatment,pregnancy outcomes of both groups had been significantly improved.After surgery,the spontaneous abortion rate of treatment group was significantly lower than that of control group (P<0.05 ),with no significant difference in other indicators (P>0.05 ).Conclusion:TCRS is safe and effective in treating patients with uterine septum.It can significantly improve the pregnancy outcomes and significantly reduce the rate of spontaneous abortion and intrauterine adhesions to some extent combined with postoperative IUD +HRT.It may make some improvements on the pregnancy outcome of pa-tients,which remains to be further studied.