先天性子宫发育异常391例临床分析

摘要

目的 分析先天性子宫发育异常的临床特点及手术矫治对改善生殖预后的临床意义.方法 收集2002年11月至2009年3月首都医科大学附属北京妇产医院391例先天性子宫发育异常患者的临床资料,分析其构成比、临床特点；随访其中185例术后妊娠及分娩结局.结果 (1)391例子宫发育异常包括9种类型,其中以中隔子宫最多见,为246例(62.9％).(2)临床表现主要为自然流产(21.2％)、不孕(13.0％)、原发闭经(12.8％)、无明显症状仅在体检中发现(14.6％).(3)随访行宫腔镜子宫中隔切除术的患者162例,术前自然流产率及不孕率分别为83.0％、17.3％,术后分别下降至15.4％、5.6％(P均＜0.01).术前足月分娩率、新生儿存活率分别为5.3％、10.6％,术后分别上升至76.5％、83.1％(P均＜0.01).结论 先天性子宫发育异常中,以中隔子宫最多见；行宫腔镜手术矫治可显著改善生殖预后.%Objective To investigate the clinical characteristics of uterine malformation and benefit to improve the prognosis of pregnancy post-surgery. Methods Subjects of 391 women with uterine malformation were collected, the pregnancy outcome of 185 subjects were followed-up after surgery. Results ( 1) Among the 391 subjects 9 types were included,246 (62. 9% ) were septum uterine. (2) Clinical manifestation include spontaneous abortion(21. 2% ) , infertility( 13. 0% ) , primary amenorrhea (12.8%) .physical examination without symptoms( 14. 6% ). (3) Subjects of 162 septum uterine were followed up after surgery with laparoscope or hysleroscope under ultrasound, the incidence of spontaneous abortion and embryo without growth before surgery is 82. 0% ,which decrease to 15. 4% with surgery,P <0. 01; the incidence of pregnancy at term is 5. 2% before surgery, which increase 76. 5% with surgery,P <0. 01; the incidence of live birth is 5. 2% before surgery, which increase to 80. 2% ,P < 0. 01. Conclusions Most of uterine malformation is septum uterine , which effects the infertility of women deeply, according the type of uterine malformation and individualization surgery accepted or not and the type of surgery was determined. The infertility prognosis of subjects with septum uterine after surgery was remarkably improved.