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探讨妊娠期手术和分娩方式对子宫复旧的影响所致的获得性子宫畸形及其特征、分型、诊断标准。收集1990年1月1日～1999年4月30日在我院行宫腔手术28377例,观察所有病例的子宫位置、大小和形态,既往妊娠、分娩和手术史,本次宫腔手术。其中329例同时测定子宫颈长度和子宫深度。获得性子宫畸形分为四型:宫颈宫腔粘连(Ⅰ型),子宫Ⅲ度后倾后屈(Ⅱ型),子宫前腹壁固定(Ⅲ型),颈管宫腔形态失常(Ⅳ型)。结果:筛查出获得性子宫畸形122例,其中发生于剖宫产后49例(1.28％),阴道分娩后31例(0.25％),流产后(未产妇)42例(0.35％)。Ⅰ型主要发生于流产后,Ⅱ型见于各种分娩、流产后,Ⅲ型和Ⅳ型多发生于剖宫产后。剖宫产后子宫颈长度和子宫深度明显大于阴道分娩和流产后(未产妇)(P<0.05)。通过122例畸形的归纳总结,提出了获得性子宫畸形的命名、分型和诊断标准,并剖析了形成的原因,对规范产科临床操作和妊娠期手术具有十分重要的价值。
To investigate the effects of pregnancy surgery and delivery mode on uterine involution caused by acquired uterine malformations and their characteristics, classification, diagnostic criteria. We collected 28,377 cases of uterine surgery in our hospital from January 1, 1990 to April 30, 1999. We observed the uterine position, size and shape, previous pregnancy, childbirth and operation history in all cases and this uterine cavity operation. 329 cases of which both cervical length and uterine depth. Acquired uterine anomalies are divided into four types: cervical intrauterine adhesions (type Ⅰ), uterine Ⅲ degree retroversion retroflexion (type Ⅱ), anterior uterine abdominal wall (type Ⅲ), cervical uterine cavity dysplasia (type Ⅳ). Results: 122 cases of acquired uterine malformations were found, of which 49 cases (1.28%) occurred after cesarean section, 31 cases (0.25%) after vaginal delivery and 42 cases (0.35%) after abortion. Type Ⅰ occurs mainly after abortion, type Ⅱ found in a variety of births, abortion, type Ⅲ and type Ⅳ occurred in the post-cesarean section. Cervical length and uterine depth after cesarean section were significantly greater than those after vaginal delivery and abortion (non-mothers) (P <0.05). Based on the summary of 122 cases of deformity, the naming, typing and diagnosis criteria of acquired uterine malformation were put forward, and the reasons for the formation were analyzed. It is of great value to standardize the clinical operation and the operation of pregnancy.