目的：评估侵袭性宫颈扩张术对于在完整纵隔子宫的非交通腔之间形成初始穿孔是否有效，这是宫腔镜保留子宫颈成形术的第一步。
方法：回顾性队列。
方法：三级转诊中心。
方法：对53例完全纵隔子宫患者进行阴道检查，联合二维/三维阴道超声，和办公室宫腔镜检查。
方法：比较了接受宫腔镜保留宫颈成形术的患者，这些患者最初是通过积极的宫颈扩张术或传统的探条引导切口方法形成的穿孔。
结果：在53例完全纵隔子宫患者中，44例患者接受了宫腔镜保留宫颈的子宫成形术，需要形成穿孔。接受积极的宫颈扩张术形成穿孔的患者手术时间没有明显缩短（33.5分钟，95％CI：28.4-38.6vs48.7分钟，95%CI：28.2-71.3，p=0.099），使用了显著较低体积的膨胀介质(3.6升，95％CI：3.1-4.1vs6.8升，95%CI：4.2-9.3，p<.001），成功率较高(84.4%，95%CI：67.2-94.7vs50.0%，95%CI：21.1-78.9，p=0.019）。穿孔部位均发生在宫颈内膜间隔上，通常是纤维状和无血管的。
结论：我们提出了一个新的，在宫腔镜保留子宫颈成形术中创建初始穿孔的有效方法。成功可能是由于重复的子宫颈隔膜存在潜在的弱点，在侵略性机械扩张时自发撕裂。该方法基于潜在的不可靠线索，放弃了与尖锐切口相关的风险，并且可以大大简化程序。
To evaluate whether aggressive cervical dilation is effective for creating the initial perforation between noncommunicating cavities of the complete septate uterus (CSU), which serves as the first step of hysteroscopic cervix-preserving metroplasty (CPM).
A retrospective cohort.
A tertiary referral center.
Fifty-three patients with CSU were diagnosed using vaginal examinations, combined two- and three-dimensional vaginal ultrasounds, and office-based hysteroscopies.
Patients who had received hysteroscopic CPM with the initial perforation created by aggressive cervical dilation or by the traditional method of bougie-guided incisions were compared.
Of the 53 patients with CSU, 44 patients received hysteroscopic CPM that required the creation of a perforation. Patients who received aggressive cervical dilation for creation of the perforation had nonsignificantly shorter surgical times (33.5 minutes, 95% confidence interval [CI], 28.4-38.6 vs 48.7 minutes, 95% CI, 28.2-71.3, p = .099), used significantly lower volumes of distending media (3.6 liters, 95% CI, 3.1-4.1 vs 6.8 liters, 95% CI, 4.2-9.3, p <.001), and had higher success rates (84.4%, 95% CI, 67.2-94.7 vs 50.0%, 95% CI, 21.1-78.9, p = .019). The sites of perforation all occurred on the endocervical septum and were generally fibrous and avascular.
We present a novel, effective method for creating the initial perforation in hysteroscopic CPM. The success may be because of the existence of a potential weakness in the septum of the duplicated cervix, which spontaneously tears upon aggressive mechanical dilation. The method forgoes the risks associated with sharp incisions based on potentially unreliable cues and may greatly simplify the procedure.
