| Objective This study aim to evaluate the value of the 2D ultrasonography,HSG,MRI and hysteroscopy combined with laparoscopy in diagnosing the congenital uterine malformation and compare their advantages and disadvantages.This study also explores the reproductive outcome after the treatment by hysteroscopic combined with laparoscopy and to disguss the change of the pregnancy rate after treatment.Methods We collected the clinical date of 95 patients with congenital uterine malformations treated by hysteroscopy combined with laparoscopy at the first affiurted hospital of Soochow university from January 2008 to August 2015 and followed up their reproductive before and after operation. The incidence,clinical characteristics and imaging diagnosis is summarized, for different types of congenital uterine malformation including Septate uterus, Bicornuate uterus, Didelphys uterus, Unicornuate uterus, Arcuate uterus. The advantages and limitations of diagnostic methods including ultrasound,hysterosalpingogram, magnetic resonance imaging and hysteroscopy combined with laparoscopy are discussed. Symptoms were divided into groups according to infertility and recurrent abortion group. And a comparison between different patients was conducted. Evaluation and plotting were conducted by SPSS 19.0.The differences among groups were analyzed using Chisquare Test and P<0.05 was considered to be statistically significant.Results Between January 2008 to August 2015,there were 95 cases of congenital uterine malformations, including 70 cases(74.68%)of partial septate uterus,11 cases(11.58%)of complete septate uterus,6 cases(6.32%) of unicornuate uterus,3 cases(3.15%) of didelphys uterus, 2 cases(2.11%) of uterine dysplasia,1 case(1.05%) arcuate uterus,1 case of(1.05%) bicornuate uterus and 1 case(1.05%) of complex female genital malformations.3 cases of complete septate uterus, 1 case of unicornuate uterus, 1 case of partial septate uterus and 1 case of didelphys uterus were merger vaginal diaphragm.2 cases of didelphys uterus were merger double vaginal.(2)The accuracy rate of ultrasound was 74.74%(71/95),HSG was 19.05%(4/21), MRI was 56.76%(21/37) and hysteroscopy combined with laparoscopy was 100%( 95/95).There were statistically significant differences between groups(P<0.05). The diagnostic accuracy rate of congenital uterine malformations from high to low are combined laparoscopy and hysteroscopy, ultrasonography, magnetic resonance imaging, hysterosalpingography.(3)The completely corrective success rate of Hysteroscopy combined with laparoscopy in treating the congenital uterine malformations is 80%,the partial corrective success rate is 17.89% and the failure rate is 2.11%.(4)95 patients were followed up from 3 months to 7 years. There were 122 gestation among 95 patients with congenital uterine malformations. Spontaneous abortion rate was 73.77%,the life birth rate(LBR) was 6.56%.After the treatment of surgery, there were 75 gestation. Spontaneous abortion rate was 24%(18/75),the life birth rate(LBR) was 76%(57/75). There were statistically significant differences of the Spontaneous abortion rate and the life birth rate between them(P<0.05).The spontaneous abortion rate were significantly lower and the life birth rate were significantly higher after sugery. The success rate of pregnancy was 60.34% and the live birth rate was 82.86% in patients of infertility. The success rate of pregnancy was 83.78% and the live birth rate was 87.10% in patients of infertility. And there was statistically significant differences between different types on the success rate of pregnancy(P<0.05) and the success rate in patients of abortion was obviously higher than the patients of infertility.there was also statistically significant difference between them(P<0.05).(5)The mean time interval between surgery and first pregnancy was 8.67±5.69 months. This study demonstrated a consistent increase of pregnancy during the observation. And in the first nine months grow the fastest. It still in growth after nine months but the trend gradually slowdown.Conclusion(1)In 95 cases with congenital uterine malformations partial septate uterus is the most common, followed by complete septate uterus, unicornuate uterus, didelphys uterus, uterine dysplasia, other types are rare.(2)The gold standard diagnostic methods for congenital uterine malformations is the hysteroscopy combined with laparoscopy.(3)In women with congenital uterine malformations, The minimally surgery correction has a high success rate and is a safe and effective procedure with a decreasing spontaneous and an miscarriage rate and increasing live birth rate and significantly improved their pregnancy outcomes. |
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