불임 또는 습관성 유산 환자에서 중격자궁의 치료가 임신에 미치는 영향 = Effects of Hysteroscopic Septotomy on Pregnancy in Patients with History of Infertility or Recurrent Spontaneous Abortion

국문 초록 (Abstract)

목적: 중격자궁은 흔하게 보고되는 선천성 자궁기형 중 하나이며 여성의 생식능력에 미치는 영향에 대해 아직 이견이 많고, 따라서 치료의 필요성에 대해서도 아직 정립되지 않았다. 본 연구에서는 중격자궁의 존재 및 치료 여부가 생식수행에 미치는 영향에 대해 알아보고자 하였다. 연구방법: 2008년 1월부터 2009년 12월까지 불임 또는 습관성 유산을 주소로 제일병원 산부인과를 방문하여 자궁난관 조영술을 시행한 총 2,838명의 환자들 중 중격자궁이 진단된 44명의 환자들을 대상으로 하였으며, 이 중 27명은 자궁경 하 자궁중격 절제술을 시행 받았으며, 17명은 진단 후 추가적인 치료를 받지 않았다. 대조군은 동일 기간 내에 자궁기형이 진단되지 않은 환자 42명을 나이를 고려 후 무작위 선정하였다. 연구 대상군의 임신율, 자연유산율, 그리고 생존분만율 등에 대한 의무기록을 후향적으로 분석하였으며, 대상군들의 평균 추적 관찰 기간은 진단 후 21.8개월 이었다. 결과: 추적 관찰 기간 중 자궁경 하 질식 자궁중격 절제술을 시행 받은 환자 (n=27)의 55.6% (15/27)가 임신에 성공한 반면 치료를 받지 않은 환자 (n=17)의 약 23.5% (4/17)만이 임신에 성공하여 치료받은 군에서 통계적으로 의미있는 높은 수치를 보였다 (p<0.05). 한편 생존분만율은 치료를 받은 환자군 및 자궁기형이 진단되지 않은 불임 또는 습관성 유산 환자 (대조군, n=42)에서 각각 75%와 84.6%를 보인 반면 치료 받지 않은 군에서는 50% (2/4)를 보여 치료 받지 않은 중격자궁 환자에서 낮은 경향을 보이지만 통계학적 의미는 없었다. 결론: 중격자궁이 생식수행에 미치는 영향은 자연유산 등 산과적 합병증 뿐 아니라 오히려 임신력의 저하에 더 큰 악영항을 미칠 수 있으며 불임 환자에서 중격자궁의 존재 시 적극적인 치료가 임신성공률의 향상에 도움이 될 것으로 생각 되지만 보다 명확한 결론을 위해 규모가 크고 관찰 기간이 긴 대단위 연구가 필요 할 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Objective: The aim of this study was to evaluate the influences of uterine septum and their elimination on the reproductive outcomes in women who have history of recurrent spontaneous abortion (RSA) and/or infertility. Methods: The medical records of reproductive outcomes in patients who have had history of RSA and infertility who were diagnosed with uterine septum only by hysterosalpingogram (HSG) between January 2008 and December 2009 were retrospectively analyzed. The subjects who have had severe male factor, tubal factors, other uterine factors, endocrine abnormalities, peritoneal factors, and abnormal karyotyping among both partners were excluded. In 27 patients, confirmation of diagnosis by laparoscopy and elimination of uterine septum by trans-vaginal hysteroscopy was done. Seventeen patients were strongly suspected to uterine septum on HSG but tried to get pregnancy without any other procedure for evaluation and management of uterine anomaly. Age matched 42 patients who have history of RSA and/or infertility and diagnosed to normal HSG finding at same period were randomly selected as control. The medical records of reproductive outcomes were analyzed and compared between groups. Results: The mean time of observation after diagnosis was 21.8 months (10 to 32). 55.6% (15/27) of patients in patients who received trans-vaginal hysteroscopic uterine septotomy were success to get pregnancies and was significantly higher than that of 17 patients who did not receive proper management (23.5%, 4/17, p<0.05). In control population, 40.5% (17/42) were success to pregnancies and the differences were not statistically significant compared to both two study groups. The live birth rate which was excluded pregnancy loss by abnormal fetal karyotyping and congenital anomaly were 75% (9/12) in treated septated uterus group and 84.6% (11/13) in control group each which have no statistically significant different. In patients with septated uterus who did not receive proper management showed lower delivery rate (50%, 2/4) than that of other groups but was not statistically significant. Conclusion: According to present data, women with a uterine septum have an increased chance of successful pregnancy with improved obstetric outcome after proper management of the uterine cavity. And these results were showed in patients with no regard to their reproductive history. But, in case of failed to receive proper management, uterine septum can affect not only pregnancy ongoing but successful pregnancy too.

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