子宫畸形的诊治
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摘要
先天性子宫畸形可导致不孕和复发性流产,子宫畸形传统的治疗方法为开腹手术。现今宫腔镜子宫成形术(hysteroscopic metroplasty)已经替代了传统的开腹手术,成为子宫畸形最有效的治疗方法。子宫畸形成形术后的生殖预后明显改善。术后应关注妊娠子宫破裂及宫颈机能不全等问题。
Congenital uterine malformation can lead to infertility and recurrent miscarriage.The traditional treatment for uterine malformation is laparotomy.Nowadays hysteroscopic metroplasty has replaced the traditional laparotomy to treat uterine anomaly,and become the most effective treatment for uterine malformation.After metroplasty the reproductive outcome is ameliorated obviously.Attention should be paid to uterine rupture and cervical incompetence during pregnancy after metroplasty.
Congenital uterine malformation can lead to infertility and recurrent miscarriage.The traditional treatment for uterine malformation is laparotomy.Nowadays hysteroscopic metroplasty has replaced the traditional laparotomy to treat uterine anomaly,and become the most effective treatment for uterine malformation.After metroplasty the reproductive outcome is ameliorated obviously.Attention should be paid to uterine rupture and cervical incompetence during pregnancy after metroplasty.
引文
[1]Chan YY,Jayaprakasan K,Zamora J,et al.The prevalence of congenital uterine anomalies in unselected and high-risk populations:a systematic review[J].Hum Reprod Update,2011,17(6):761-771.
[2]Chan YY,Jayaprakasan K,Tan A,et al.Reproductive outcomes in women with congenital uterine anomalies:a systematic review[J].Ultrasound Obstet Gynecol,2011,38(4):371-382.
[3]Tofoski G,Antovska V.Influence of hysteroscopic metroplasty on reproductive outcome in patients with infertility and recurrent pregnancy loss[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2014,35(2):95-103.
[4]Fox NS,Roman AS,Stern EM,et al.Type of congenital uterine anomaly and adverse pregnancy outcomes[J].J Matern Fetal Neonatal Med,2014,27(9):949-953.
[5]Abuzeid M,Ghourab G,Abuzeid O,et al.Reproductive outcome after IVF following hysteroscopic division of incomplete uterine septum/arcuate uterine anomaly in women with primary infertility[J].Facts Views Vis Obgyn,2014,6(4):194-202.
[6]顾小宁,杨敏,刘芳,等.腔内三维超声自由解剖成像模式在子宫畸形诊断中的临床意义[J].中国超声医学杂志,2016,32(2):157-159.
[7]Kenda?uster N,Gergolet M.Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?[J].Gynecol Surg,2016,13:37-41.
[8]Vaz SA,Dotters-Katz SK,Kuller JA.Diagnosis and management of congenital uterine anomalies in pregnancy[J].Obstet Gynecol Surv,2017,72(3):194-201.
[9]夏恩兰,于丹,黄晓武,等.宫腹腔镜联合完全双角子宫成形术后成功分娩四例报告及文献复习[J].中华妇产科杂志,2015,50(10):777-779.
[10]Sugiura-Ogasawara M,Lin BL,Aoki K,等.手术是否可以改善因子宫畸形导致复发性流产的活产率?[J].国际生殖健康/计划生育杂志,2017,36(3):242-245.
[11]夏恩兰,彭雪冰,马宁,等.宫腔镜手术治疗单角子宫成功妊娠三例报告及文献复习[J].中华妇产科杂志,2013,48(9):689-691.
[12]Xia EL,Li TC,Choi SS,et al.Reproductive outcome of transcervical uterine incision in unicornuate uterus[J].Chin Med J,2017,130(3):256-261.
[13]夏恩兰,刘玉环,马宁,等.宫腔镜手术治疗T型子宫成功分娩三例报告及文献复习[J].中华妇产科杂志,2013,48(6):457-459.
[14]Giacomucci E,Bellavia E,Sandri F,et al.Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped,arcuate and septate uterus[J].Gynecol Obstet Invest,2011,71(3):183-188.
[15]Rafea BFA,Vilos GA,Oraif AM,et al.Fertility and pregnancy outcomes following resectoscopic septum division with and without intrauterine balloon stenting:a randomized pilot study[J].Ann Saudi Med,2013,33(1):34-39.
[16]Fedele L,Bianchi S,Marchini M,et al.Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome[J].Hum Reprod,1996,11(4):727-729.
[17]陈汉青,王子莲.子宫破裂的诊断及处理[J].中国实用妇科与产科杂志,2016,32(12):1178-1182.
[18]Golan A,Langer R,Wexler S,et al.Cervical cerclage--its role in the pregnant anomalous uterus[J].Int J Fertil,1990,35(3):164-170.
[19]Grimbizis G,Camis M,Clasen K,et al.Hysteroscopic resection in patients with recurrent abortions or infertility[J].Hum Reprod,1998,13:1188-1193.
[20]Shahrokh TE,Ghaffari F,Jahangiri N,et al.Reproductive outcome following hysteroscopic monopolar metroplasty:an analysis of 203 cases[J].Int J Fertil Steril,2013,7(3):175-180.
[21]Pace S,Cerekja A,Dillon KC,et al.Improvement in uterine artery doppler indices via hysteroscopic metroplasty[J].J Prenat Med,2013,7(2):25-28.2017-12-01
[2]Chan YY,Jayaprakasan K,Tan A,et al.Reproductive outcomes in women with congenital uterine anomalies:a systematic review[J].Ultrasound Obstet Gynecol,2011,38(4):371-382.
[3]Tofoski G,Antovska V.Influence of hysteroscopic metroplasty on reproductive outcome in patients with infertility and recurrent pregnancy loss[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2014,35(2):95-103.
[4]Fox NS,Roman AS,Stern EM,et al.Type of congenital uterine anomaly and adverse pregnancy outcomes[J].J Matern Fetal Neonatal Med,2014,27(9):949-953.
[5]Abuzeid M,Ghourab G,Abuzeid O,et al.Reproductive outcome after IVF following hysteroscopic division of incomplete uterine septum/arcuate uterine anomaly in women with primary infertility[J].Facts Views Vis Obgyn,2014,6(4):194-202.
[6]顾小宁,杨敏,刘芳,等.腔内三维超声自由解剖成像模式在子宫畸形诊断中的临床意义[J].中国超声医学杂志,2016,32(2):157-159.
[7]Kenda?uster N,Gergolet M.Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?[J].Gynecol Surg,2016,13:37-41.
[8]Vaz SA,Dotters-Katz SK,Kuller JA.Diagnosis and management of congenital uterine anomalies in pregnancy[J].Obstet Gynecol Surv,2017,72(3):194-201.
[9]夏恩兰,于丹,黄晓武,等.宫腹腔镜联合完全双角子宫成形术后成功分娩四例报告及文献复习[J].中华妇产科杂志,2015,50(10):777-779.
[10]Sugiura-Ogasawara M,Lin BL,Aoki K,等.手术是否可以改善因子宫畸形导致复发性流产的活产率?[J].国际生殖健康/计划生育杂志,2017,36(3):242-245.
[11]夏恩兰,彭雪冰,马宁,等.宫腔镜手术治疗单角子宫成功妊娠三例报告及文献复习[J].中华妇产科杂志,2013,48(9):689-691.
[12]Xia EL,Li TC,Choi SS,et al.Reproductive outcome of transcervical uterine incision in unicornuate uterus[J].Chin Med J,2017,130(3):256-261.
[13]夏恩兰,刘玉环,马宁,等.宫腔镜手术治疗T型子宫成功分娩三例报告及文献复习[J].中华妇产科杂志,2013,48(6):457-459.
[14]Giacomucci E,Bellavia E,Sandri F,et al.Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped,arcuate and septate uterus[J].Gynecol Obstet Invest,2011,71(3):183-188.
[15]Rafea BFA,Vilos GA,Oraif AM,et al.Fertility and pregnancy outcomes following resectoscopic septum division with and without intrauterine balloon stenting:a randomized pilot study[J].Ann Saudi Med,2013,33(1):34-39.
[16]Fedele L,Bianchi S,Marchini M,et al.Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome[J].Hum Reprod,1996,11(4):727-729.
[17]陈汉青,王子莲.子宫破裂的诊断及处理[J].中国实用妇科与产科杂志,2016,32(12):1178-1182.
[18]Golan A,Langer R,Wexler S,et al.Cervical cerclage--its role in the pregnant anomalous uterus[J].Int J Fertil,1990,35(3):164-170.
[19]Grimbizis G,Camis M,Clasen K,et al.Hysteroscopic resection in patients with recurrent abortions or infertility[J].Hum Reprod,1998,13:1188-1193.
[20]Shahrokh TE,Ghaffari F,Jahangiri N,et al.Reproductive outcome following hysteroscopic monopolar metroplasty:an analysis of 203 cases[J].Int J Fertil Steril,2013,7(3):175-180.
[21]Pace S,Cerekja A,Dillon KC,et al.Improvement in uterine artery doppler indices via hysteroscopic metroplasty[J].J Prenat Med,2013,7(2):25-28.2017-12-01