先天性子宫异常矫正手术对女性生育结局的影响

doi:10.12280/gjfckx.20201100

摘要/Abstract

摘要：

先天性子宫异常在女性生殖系统发育异常中最为常见,易导致不良妊娠及产科结局,对女性生理心理上造成了严重的影响。近年来,宫腔镜、腹腔镜等微创手术在纵隔子宫、双角子宫、单角子宫及残角子宫、T型子宫、苗勒管发育不良等先天性子宫异常患者矫正中的应用越来越广泛,逐渐取代了以往的传统手术,成为先天性子宫发育异常治疗的主要方法。宫腔镜下子宫纵隔切除术、双角子宫成形术、腹腔镜下残角子宫切除术、宫腔镜下T形子宫成形术甚至子宫移植手术的开展,对于不良生育史的先天性子宫异常患者可以保护其生育功能、提高妊娠率,改善不良妊娠结局。综述国内外先天性子宫异常微创矫正手术对女性患者生育结局影响的最新研究进展,并针对子宫异常矫正手术对子宫异常患者的生育能力及妊娠结局是否有改善进行讨论。

关键词: 子宫, 宫腔镜, 先天畸形, 腹腔镜, 妊娠结局

Abstract:

Congenital uterine abnormality is the most common abnormality in the female reproductive system, which easily leads to adverse pregnancy and obstetric outcomes, and has a serious impact on women′s physiology and psychology. In recent years, the application of minimally invasive surgery such as hysteroscopy and laparoscopy in the correction of uterine anomalies such as septate uterus, bicornuate uterus, unicornuate uterus and rudimentary horn uterus, T-shaped uterus, and Müllerian duct dysplasia is more and more widely, gradually replacing the traditional surgery, and become the main method for the treatment of uterine anomalies. Hysteroscopic septum resection, bicorporeal uterus hysteroplasty, laparoscopic rudimentary horn excision, hysteroscopic T-shaped hysteroplasty and even uterine transplantation are carried out to protect the reproductive function, improve the pregnancy rate and the adverse pregnancy outcome of patients with congenital uterine abnormalities. This paper reviews the latest research progress on the impact of minimally invasive corrective surgery for congenital uterine anomalies on the reproductive outcomes of female patients, and discusses whether corrective surgery for uterine anomalies can improve the fertility and pregnancy outcomes of patients with uterine abnormalities.

Key words: Uterus, Hysteroscopes, Congenital abnormalities, Laparoscopes, Pregnancy outcome

王琳, 徐键. 先天性子宫异常矫正手术对女性生育结局的影响[J]. 国际妇产科学杂志, 2021, 48(4): 415-419.

WANG Lin, XU Jian. The Effect of Corrective Surgery for Congenital Uterine Anomalies on Female Reproductive Outcomes[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 415-419.

参考文献 30

[1]	Theodoridis TD, Pappas PD, Grimbizis GF. Surgical management of congenital uterine anomalies (including indications and surgical techniques)[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 59:66-76. doi: 10.1016/j.bpobgyn.2019.02.006. doi: S1521-6934(19)30001-X pmid: 30910446
[2]	Prior M, Richardson A, Asif S, et al. Outcome of assisted reproduction in women with congenital uterine anomalies: a prospective observational study[J]. Ultrasound Obstet Gynecol, 2018, 51(1):110-117. doi: 10.1002/uog.18935. doi: 10.1002/uog.18935 pmid: 29055072
[3]	Akhtar MA, Saravelos SH, Li TC, et al. Reproductive Implications and Management of Congenital Uterine Anomalies: Scientific Impact Paper No. 62 November 2019[J]. BJOG, 2020, 127(5):e1-e13. doi: 10.1111/1471-0528.15968. doi: 10.1111/1471-0528.15968
[4]	Rikken J, Verhorstert K, Emanuel MH, et al. Septum resection in women with a septate uterus: a cohort study[J]. Hum Reprod, 2020, 35(7):1578-1588. doi: 10.1093/humrep/dez284. doi: 10.1093/humrep/dez284
[5]	Rikken JF, Kowalik CR, Emanuel MH, et al. Septum resection for women of reproductive age with a septate uterus[J]. Cochrane Database Syst Rev, 2017, 1(1):CD008576. doi: 10.1002/14651858.CD008576.pub4. doi: 10.1002/14651858.CD008576.pub4
[6]	Vigoureux S, Fernandez H, Capmas P, et al. Assessment of Abdominal Ultrasound Guidance in Hysteroscopic Metroplasty[J]. J Minim Invasive Gynecol, 2016, 23(1):78-83. doi: 10.1016/j.jmig.2015.08.882. doi: 10.1016/j.jmig.2015.08.882
[7]	Fascilla FD, Resta L, Cannone R, et al. Resectoscopic Metroplasty with Uterine Septum Excision: A Histologic Analysis of the Uterine Septum[J]. J Minim Invasive Gynecol, 2020, 27(6):1287-1294. doi: 10.1016/j.jmig.2019.11.019. doi: 10.1016/j.jmig.2019.11.019
[8]	Nouri K, Ott J, Huber JC, et al. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus--a retrospective cohort study and systematic review of the literature[J]. Reprod Biol Endocrinol, 2010, 8:52. doi: 10.1186/1477-7827-8-52. doi: 10.1186/1477-7827-8-52
[9]	Valle RF, Ekpo GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis[J]. J Minim Invasive Gynecol, 2013, 20(1):22-42. doi: 10.1016/j.jmig.2012.09.010. doi: 10.1016/j.jmig.2012.09.010
[10]	Corroenne R, Legendre G, May-Panloup P, et al. Surgical treatment of septate uterus in cases of primary infertility and before assisted reproductive technologies[J]. J Gynecol Obstet Hum Reprod, 2018, 47(9):413-418. doi: 10.1016/j.jogoh.2018.08.005. doi: 10.1016/j.jogoh.2018.08.005
[11]	Pabuccu R, Pabuccu EG, Gomel V. Reproductive outcomes of patients with T-Shaped and septate uterus following metroplasty: an observational study[J]. Facts Views Vis Obgyn, 2020, 11(4):317-321. pmid: 32322827
[12]	Whelan A, Burks C, Stephenson MD. Pregnancy Outcomes in Women With a History of Recurrent Early Pregnancy Loss and a Septate Uterus, With and Without Hysteroscopic Metroplasty[J]. Obstet Gynecol, 2020, 136(2):417-419. doi: 10.1097/AOG.0000000000003953 doi: 10.1097/AOG.0000000000003953 pmid: 32649503
[13]	Rikken J, Kowalik CR, Emanuel MH, et al. The randomised uterine septum transsection trial (TRUST): design and protocol[J]. BMC Womens Health, 2018, 18(1):163. doi: 10.1186/s12905-018-0637-6. doi: 10.1186/s12905-018-0637-6 pmid: 30290803
[14]	Ludwin A, Pfeifer SM. Reproductive surgery for müllerian anomalies: a review of progress in the last decade[J]. Fertil Steril, 2019, 112(3):408-416. doi: 10.1016/j.fertnstert.2019.07.005. doi: S0015-0282(19)30577-1 pmid: 31446900
[15]	Liu Y, Yang Y, Duan J, et al. Favorable pregnancy outcome for a patient with Robert's uterus, bicornuate uterus, and ipsilateral renal agenesis[J]. Int J Gynaecol Obstet, 2020, 151(2):302-303. doi: 10.1002/ijgo.13274. doi: 10.1002/ijgo.13274
[16]	Gulavi E, Kyende Mutiso S, Mariara Muriuki C, et al. Successful Pregnancy Outcome after Open Strassman Metroplasty for Bicornuate Uterus[J]. Case Rep Obstet Gynecol, 2018, 2018:4579736. doi: 10.1155/2018/4579736. doi: 10.1155/2018/4579736
[17]	Karthik S, Kriplani A, Mahey R, et al. Successful Reproductive Outcome After Laparoscopic Strassmann′s Metroplasty[J]. J Hum Reprod Sci, 2017, 10(3):231-234. doi: 10.4103/jhrs.JHRS_11_17. doi: 10.4103/jhrs.JHRS_11_17 pmid: 29142454
[18]	Ouyang Y, Cai P, Gong F, et al. The risk of twin pregnancies should be minimized in patients with a unicornuate uterus undergoing IVF-ET[J]. Sci Rep, 2020, 10(1):5571. doi: 10.1038/s41598-020-62311-5. doi: 10.1038/s41598-020-62311-5 pmid: 32221343
[19]	Zhang Y, Pang Y, Zhang X, et al. Full-term pregnancy in a rudimentary horn with a live fetus: A case report[J]. Medicine(Baltimore), 2020, 99(34):e21604. doi: 10.1097/MD.0000000000021604. doi: 10.1097/MD.0000000000021604
[20]	Zhang Y, Liu S, Zhang X, et al. Laparoscopic metroplasty for unicornuate uterus with a functional noncommunicating rudimentary horn[J]. Int J Gynaecol Obstet, 2020, 149(1):31-36. doi: 10.1002/ijgo.13093. doi: 10.1002/ijgo.13093 pmid: 31883106
[21]	Faller E, Baldauf JJ, Becmeur F, et al. Laparoscopic Management of a Rudimentary Uterine Horn[J]. J Minim Invasive Gynecol, 2018, 25(5):769-770. doi: 10.1016/j.jmig.2017.10.027. doi: 10.1016/j.jmig.2017.10.027
[22]	Sawada M, Kakigano A, Matsuzaki S, et al. Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn[J]. J Obstet Gynaecol Res, 2018, 44(6):1080-1086. doi: 10.1111/jog.13622. doi: 10.1111/jog.13622
[23]	Pados G, Tsolakidis D, Athanatos D, et al. Reproductive and obstetric outcome after laparoscopic excision of functional, non-communicating broadly attached rudimentary horn: a case series[J]. Eur J Obstet Gynecol Reprod Biol, 2014, 182:33-37. doi: 10.1016/j.ejogrb.2014.08.023. doi: 10.1016/j.ejogrb.2014.08.023
[24]	Şükür YE, Yakıştıran B, Özmen B, et al. Hysteroscopic Corrections for Complete Septate and T-Shaped Uteri Have Similar Surgical and Reproductive Outcome[J]. Reprod Sci, 2018, 25(12):1649-1654. doi: 10.1177/1933719118756774. doi: 10.1177/1933719118756774
[25]	Alonso Pacheco L, Laganà AS, Garzon S, et al. Hysteroscopic outpatient metroplasty for T-shaped uterus in women with reproductive failure: Results from a large prospective cohort study[J]. Eur J Obstet Gynecol Reprod Biol, 2019, 243:173-178. doi: 10.1016/j.ejogrb.2019.09.023. doi: S0301-2115(19)30418-X pmid: 31570176
[26]	Garzon S, Laganà AS, Di Spiezio Sardo A, et al. Hysteroscopic Metroplasty for T-Shaped Uterus: A Systematic Review and Meta-analysis of Reproductive Outcomes[J]. Obstet Gynecol Surv, 2020, 75(7):431-444. doi: 10.1097/OGX.0000000000000807. doi: 10.1097/OGX.0000000000000807
[27]	Brännström M. Womb transplants with live births: an update and the future[J]. Expert Opin Biol Ther, 2017, 17(9):1105-1112. doi: 10.1080/14712598.2017.1347633. doi: 10.1080/14712598.2017.1347633 pmid: 28683576
[28]	Fageeh W, Raffa H, Jabbad H, et al. Transplantation of the human uterus[J]. Int J Gynaecol Obstet, 2002, 76(3):245-251. doi: 10.1016/s0020-7292(01)00597-5. doi: 10.1016/s0020-7292(01)00597-5
[29]	Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation[J]. Lancet, 2015, 385(9968):607-616. doi: 10.1016/S0140-6736(14)61728-1. doi: S0140-6736(14)61728-1 pmid: 25301505
[30]	Wei L, Xue T, Tao KS, et al. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months[J]. Fertil Steril, 2017, 108(2):346-356.e1. doi: 10.1016/j.fertnstert.2017.05.039. doi: S0015-0282(17)30422-3 pmid: 28778283