| Background and ObjectiveUterine septum belongs to the reproductive tract malformation in women, withrate of80%～90%in congenital uterine malformation. Uterine septum can changesymmetrical form of the uterine cavity, interfere with the patient’s normalreproductive function, and lead to adverse pregnancy outcome as infertility andhabitual abortion. Patients in the choice of treatment orientation, surgery orpregnancy test is it? In clinical practice, physicians treating patients with mediastinaluterus choice is different. For some pregnant minor does not affect uterine septum,without surgery, pregnancy and childbirth can be successful, even if the uterus is notexactly the mediastinum, there are some patients choose existing pregnancy test time.Once patients pregnancy test fails, abortion and intrauterine operation, there may beintrauterine adhesions, pelvic adhesions, and tubal inflammation and othercomplications may occur in patients with secondary infertility. Therefore, earlydiagnosis in patients with mediastinal uterus and timely treatment is veryimportant.Clinical thought to use surgical treatment for patients with adversepregnancy outcome. The transabdominal or transvaginal uterine septum resection weretraditional treatment methods. But they have shortcomings as operation trauma, uterine scar, slow recovery and long time interval of pregnancy. In recent years, withthe development of technology, hysteroscopy in the diagnosis and treatment ofgynecological diseases more widely.The transcervical hysteroscopic resection ofseptum (TCRS) belongs to reduction of minimally invasive operation, and has takenthe place of other traditional operations by the strong points as less trauma, lessbleeding, rapid recovery, preservation of the uterus wall integrity, less complications,short time interval of pregnancy and high pregnancy success rate. Foley postoperativeintrauterine balloon placed five days after hysteroscopic uterine perfusion secondaryexploration Chitosan, parallel artificial cycle of estrogen and progesterone therapycan promote endometrial growth, repair, prevention of intrauterine adhesions.Thisstudy explores the clinical effect of TCRS by ultrasound diagnosis and laparoscopicmonitoring, and follows up the outcome of pregnancy in order to determine the effectof uterine mediastinum, TCRS and pregnancy.Objects and Methods1MaterialsThe clinical data of112patients with the transcervical hysteroscopic resection ofseptum (TCRS) during Jan.2007to Dec.2012were analyzed retrospectively. All thewomen were aged from20to41years and the average age was (29.24±3.61) years.The marriage duration ranged from3to12years and the average time was (5.53±1.21)a. There were86cases with incomplete mediastinal uterus,26cases with completeseptate uterus, and66cases in abortion group,46cases in infertility group.2MethodsAll patients were treated by preoperative diagnosis (Ultrasound, HSG,hysteroscope). First, did preoperative preparation including health education, mentalintervention, routine examination, and cervical, gastrointestinal, instruments,equipment preparation, then carried out TCRS in the general anesthesia,intraoperative exploration uterine picture, clear mediastinal type, the base width ofthe tip of the termination of the diaphragm and other parts. Then cut transversely tothe needle electrode mediastinal tissue, until the base of the mediastinum, and thenup to the annular electrode formation of endometrial tissue repair rough surfacemorphology of normal uterine cavity. Foley was placed after intrauterine balloon for five days, after hysteroscopic uterine perfusion secondary exploration Chitosan,parallel artificial cycle therapy to speed up the repair of the endometrium, preventionof intrauterine adhesions. Whether through telephone follow-up after miscarriage andinfertility group after group of successful natural pregnancy; pregnancy and aftersurgery interval; postoperative outcome of pregnancy and sequential therapy ofestrogen and progesterone effects. and follow-up after miscarriage and infertilitygroup after group of successful natural pregnancy; pregnancy and after surgeryinterval; postoperative outcome of pregnancy and sequential therapy of estrogen andprogesterone effects by telephone.3Statistics AnalysisThe date was analyzed using SPSS17.0software and represented in the form ofx±s. The differences among groups were analyzed using Chisquare Test (Fisher exactprobability method). According to the level of α=0.05in the test, P<0.05was thoughtto be statistically significant.Results1The accuracy rate of Bultrasound was86.61%(97/112), HSG was48.57%（17/35）, and B ultrasound combined with hysteroscopy was100.00%（112/112）.There were statistically significant differences between groups (P<0.05).294patients were followed up from3months to2years. The follow-up ratewas83.93%(94/112) by62cases of successful pregnancy (65.96%),50cases of livebirths (80.65%),48cases of full-term (96.00%),2cases of premature delivery(4.00%),18cases of cesarean section (36.00%). There were no placental implantation,adhesion or postpartum bleeding and other complications. Because of infertility, thesuccess rate of pregnancy was51.16%, the live birth rate was77.27%, and there wasstatistically significant differencees between different types on the success rate ofpregnancy (P<0.05). Because of abortion, the postoperative success rate of pregnancy(78.43%) and live birth rate (82.50%) were significantly higher than the preoperative’s26.29%and9.71%. There were statistically significant differences between them(P<0.05). And the success rate of pregnancy in the abortion was significantly higherthan the infertility’ s. There was statistically significant difference between them(P<0.05). Conclusion1The gold standard treatment for mediastinal uterus is the hysteroscopic resectionof uterine septum (TCRS) by laparoscopic monitoring. It can ensure the operation moreminimally invasive, quick, effective, safe, and diagnose and treat pelvic diseases.2TCRS can significantly reduce the rate of spontaneous abortion, improve therate of live birth, and significantly improve the pregnancy outcome on patients withuterine septum. |
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