宫腹腔镜治疗子宫纵膈144例临床分析.docVIP

宫腹腔镜治疗子宫纵膈例临床分析Clinical analysis of 72 cases of laparoscopy in treatment of uterine mediastinum Abstract Objective: To study the clinical effect of treatment of uterine mediastinum in laparoscopy. Method: in our hospital from September 2010 -2012 year in September 72 cases of patients with uterine mediastinum in laparoscopy recovery and postoperative pregnancy. Results: the patients were chosen in this paper to complete the operation, no complication, operation 3 months after the review, ultrasound showed a normal uterine cavity form. 9-42 months of follow-up of these patients, including 58 cases of successful pregnancy, pregnancy rate 80.6% ( 58/72 ), the pregnancy time distance operation time was 5-12 months; pregnancy 6 cases of abortion, abortion rate was 10.3% ( 6/58 ); 40 cases were full-term delivery, including 16 cases of premature rupture of fetal membrane, 10 cases of breech presentation. The successful delivery of maternal health were, no fetal malformations and low birth weight infants. Conclusion: in hysteroscopic resection of uterine mediastinum is a good method in the treatment of uterine mediastinum, can improve the success rate of pregnancy and fetal health rate. Keywords: Uterine mediastinum; Laparoscopy; clinical analysis 子宫纵膈的形成是由于双侧副中肾管融合后，纵膈在吸收过程中受到阻碍形成的程度不等的纵膈，发病率约为0.009%-12%，尤其是子宫发育异常的妇女发病率相对较高，约为75%。纵膈子宫会导致很多产科疾病，例如妊娠流产、不孕、胎膜早破、胎盘早剥、前置胎盘以及臀位产等等[1]。我院选择2010年9月-2012年9月间144例在宫腹腔镜下治疗子宫纵膈患者的恢复情况以及术后患者的妊娠情况。 1资料与方法 1.1基本资料 我院选择2010年9月-2012年9月间144例在宫腹腔镜下治疗子宫纵膈患者的恢复情况以及术后患者的妊娠情况，年龄在23-38岁之间，平均为29.2岁，其中36例患者为原发性不孕，32例患者为继发性不孕，60例患者是由其他原因引起的不孕，16例患者为单纯纵膈子宫不孕，所有患者均未发现泌尿系统及阴道异常；患者的不孕时间在1-7年之间[2]。有72例患者由于流产发现为纵膈子宫，自然流产次数在1-4次之间，4例为妊娠35周时早产。所有患者均行宫腹腔镜下子宫纵膈电切术。 1.2治疗过程 1.2.1术前准备 所有患者均需住院治疗，带患者月经干净3-7天后，对血、尿以及阴道分泌物进行检查，同时对心肺功能及肝肾功能进行检查，确定无手术禁忌症后开始实施手术[1]。进行手术前要在阴道后穹窿处放置400ug米索前列醇，主要作用为i软化扩张宫颈。术后采取膀胱截石位，进行气管插管麻醉。常规进行消毒，在腹腔镜下进行宫腔镜手术[3]。 1.2.2行宫腔镜手术切除子宫纵膈 在腹腔镜下行宫腔镜手术切除子宫纵膈的具体步骤为：首先垂直沿纵膈长轴进行切口，从纵膈低向宫底切口，双侧切口要对称，直到能够看到双侧输卵管位置，宫底表现为圆弧形，将腹腔镜管线调暗，在腹腔镜下观察到宫腔镜光源宫