部分中隔子宮に対する子宮鏡下子宮形成術：不妊症だけの問題か？

The primary objective of this study is to assess the impact of hysteroscopic metroplasty on symptom relief, including dysmenorrhea, dyspareunia, and menstrual blood flow in women with partial uterine septa (U2a class). Additionally, the study aims to investigate potential correlations between clinical and ultrasonographic characteristics and changes in these symptoms.

This was a prospective cohort study conducted at a single center, enrolling women who underwent hysteroscopic metroplasty between March 2022 and September 2023. Participants presented with dysmenorrhea, dyspareunia, and abnormal menstrual blood flow and had expressed a desire for pregnancy. Preoperative symptom severity was measured using a visual analog scale, ranging from 0 to 100. Preoperative three-dimensional transvaginal ultrasonography was performed to assess septal characteristics. A 12-month follow-up was conducted to evaluate changes in symptoms postoperatively. Exclusion criteria included alternative causes of pelvic pain, incomplete septum correction necessitating further surgery, and pregnancy or hormonal therapy within 12 months prior to or following the surgery.

A total of 52 symptomatic patients with U2a uterine septa underwent hysteroscopic metroplasty, and data from 44 patients were analyzed according to the inclusion and exclusion criteria. Postoperative assessments revealed a significant reduction in dysmenorrhea (mean ± standard deviation: 50.2 ± 20.5 vs. 33.1 ± 20.4, P < 0.001) and dyspareunia (mean ± standard deviation: 41.4 ± 9.5 vs. 28.6 ± 24.5, P < 0.028). However, no significant changes were observed in menstrual blood flow.

Hysteroscopic metroplasty in patients with partial uterine septa results in significant symptom relief, particularly for dysmenorrhea and dyspareunia. These findings underscore the potential benefits of metroplasty beyond reproductive outcomes. Further large-scale studies are necessary to confirm these results.