fny5jt9 发表于 2024-7-8 08:36:10

谈谈双子宫、纵隔子宫对妊娠的影响


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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">优秀</span>医疗为您健康保驾护航</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">”</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近期</span>来锦华妇科医院的复发性流产<span style="color: black;">病人</span>中,门诊三维彩超<span style="color: black;">检测</span>出有几例子宫畸形的,如双子宫双宫颈、纵隔子宫、不全纵隔子宫等等,<span style="color: black;">病人</span>想<span style="color: black;">认识</span>清楚<span style="color: black;">这般</span>的子宫对妊娠有影响吗?<span style="color: black;">首要</span>,我来介绍一下这几类子宫的解剖学形态:</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">”</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">不全纵隔子宫</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">指纵隔终止于宫颈内口以上</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">完全纵隔子宫</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">指纵隔终达宫颈内口,合并或不合并宫颈/阴道的<span style="color: black;">反常</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">不全双角子宫</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">凹陷止于宫颈内口以上。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">完全双角子宫和双子宫</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">凹陷终达宫颈内口,<span style="color: black;">乃至</span>完全未融合形成双子宫。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">单角子宫</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">包</span><span style="color: black;">含所有仅有<span style="color: black;">一边</span>子宫<span style="color: black;">生长</span>的畸形,对侧<span style="color: black;">生长</span>不完全或缺如,将该类单独列出而不归属于子宫<span style="color: black;">生长</span>不良的一类,是<span style="color: black;">由于</span>该类中存在有正常功能的单体子宫。</span><span style="color: black;">如下图所示:</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/0lXDicicZEh5UHogF52mKSN7MEs8S8OelHib8eyS00uKRKbzcFricV3kiaxJHxbib81Hao3vBlz6ibgqzGuInEll5sTRA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>,国内外<span style="color: black;">针对</span>子宫畸形的诊断,尽管有<span style="color: black;">非常多</span><span style="color: black;">没</span>创的<span style="color: black;">办法</span><span style="color: black;">能够</span><span style="color: black;">选取</span>,如:二维、三维的彩超,子宫输卵管的造影或核磁共振,<span style="color: black;">然则</span>诊断的金标准应该是行宫腹腔镜联合探查。文献<span style="color: black;">显示</span>,有5%女性的子宫在解剖结构上并非完全正常,<span style="color: black;">拥有</span>复发性流产病史的女性尤为<span style="color: black;">明显</span>。<span style="color: black;">因此呢</span><span style="color: black;">没</span>创的诊断<span style="color: black;">办法</span>(门诊宫腔镜<span style="color: black;">检测</span>及二维和三维的彩超)以及微创的手术治疗就<span style="color: black;">显出</span>非常<span style="color: black;">要紧</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近期</span>半年在门诊行宫腔镜<span style="color: black;">检测</span>的<span style="color: black;">拥有</span><span style="color: black;">表率</span>性的<span style="color: black;">照片</span>如下:</p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/0lXDicicZEh5UABdZBGlTWSASB1TV0NNfFhnwdFBXtvIVmBY1bUicjyBav6ic94FYqVt9zHmpf8uCCJPCVxnnjJGJA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/0lXDicicZEh5UHogF52mKSN7MEs8S8OelHlTQ6yY9sibTLibCpt2x9H94dfFa3ZIDvoOwyIpNZBMGFWfon3M7lBQHA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/0lXDicicZEh5UABdZBGlTWSASB1TV0NNfFKy2icK43Qe6goR0mhZxaPgSq4GibvXXLh7DpMQCI8ywhHpdxyLs0dicWA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/0lXDicicZEh5UABdZBGlTWSASB1TV0NNfFJliaccCzpgZg2G5q0eczSYicy5YuURxvDO34uyP4hqEKdtbpBC8bvkgQ/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">双子宫与纵隔子宫是最<span style="color: black;">平常</span>的子宫畸形,是复发性流产的病因之一,纵隔子宫妊娠后流产率最高。二维超声可<span style="color: black;">做为</span>一种子宫畸形的初筛<span style="color: black;">办法</span>。彩色多普勒监测纵隔有血流者流产的<span style="color: black;">出现</span>率较高,有助于纵隔子宫流产预测。三维超声是诊断子宫畸形的首选<span style="color: black;">办法</span>。有的<span style="color: black;">病人</span>会问到底用<span style="color: black;">不消</span>做纵隔切除术呢?纵隔切除术<span style="color: black;">能够</span><span style="color: black;">显著</span>改善纵隔子宫的生殖预后,双子宫<span style="color: black;">通常</span>不需矫形手术,其他类型子宫畸形的矫形术<span style="color: black;">针对</span>预防流产<span style="color: black;">出现</span>有<span style="color: black;">必定</span><span style="color: black;">功效</span>。子宫畸形<span style="color: black;">病人</span>易合并宫颈功能不全,有子宫畸形但未经证实合并宫颈功能不全者,预防性宫颈环扎的证据不足。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">纵隔子宫<span style="color: black;">引起</span>流产的机制如下:</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、纵隔部分使宫腔变形,妊娠后腔内压力不<span style="color: black;">平衡</span>,胎囊生长受限。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、纵隔表面内膜<span style="color: black;">生长</span>不良、平滑肌含量<span style="color: black;">增多</span>且肌纤维<span style="color: black;">摆列</span><span style="color: black;">错乱</span><span style="color: black;">导致</span>胎囊供血不足、子宫不协调收缩,胚胎流产。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、应用扫描电镜<span style="color: black;">发掘</span>纵隔内膜<span style="color: black;">表示</span>出<span style="color: black;">生长</span>缺陷,对雌、孕激素的反应效能降低,可能<span style="color: black;">导致</span>不正常的子宫收缩致使胎儿死亡。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4、宫腔纵隔空间的限制及由此<span style="color: black;">诱发</span>的宫腔内压力<span style="color: black;">上升</span>,继而<span style="color: black;">引起</span>的相对宫颈功能不全是晚期流产的<span style="color: black;">原由</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">”</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">综上所述,<span style="color: black;">针对</span><span style="color: black;">无</span>临床症状的子宫畸形<span style="color: black;">病人</span>,<span style="color: black;">通常</span>不<span style="color: black;">必须</span>特殊处理。<span style="color: black;">针对</span>表现为复发性流产的双子宫、双角子宫、弓形子宫及纵隔子宫<span style="color: black;">病人</span>,在除外其他<span style="color: black;">引起</span>复发性流产病因后,可施行矫形术,矫形术<span style="color: black;">能够</span><span style="color: black;">明显</span>改善妊娠<span style="color: black;">结果</span>。总之,需不<span style="color: black;">必须</span>做矫形手术,要因人而异,要听从专家的建议,不要<span style="color: black;">茫然</span>做决定。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">”</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献:</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.冯力民《妇产科在线》(冯力民教授团队翻译自Hysteroscopy News)2018-03-11</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.连岩 &nbsp;王谢桐 &nbsp;《中国实用妇科与产科杂志》2013年第2期</p>
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星☆雨 发表于 2024-8-22 00:26:59

我完全同意你的观点,说得太对了。

nqkk58 发表于 2024-8-24 16:14:42

对于这个问题,我有不同的看法...

b1gc8v 发表于 2024-9-27 10:18:04

同意、说得对、没错、我也是这么想的等。

4zhvml8 发表于 2024-10-30 07:56:38

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