门诊宫腔镜子宫纵隔切开术可行性分析(附168例报道)  

Analysis of feasibility of hysteroscopical transcervical septal section in outpatient department(report of 168 cases)

作　　者：隋龙[1] 汪清[1] 郑瑞莲[1] 陈敏[1] 胡志琴[1] 杨惠琴[1] 许兴娣[1] 陈玉芳[1] 卫明花[1] 

机构地区：[1]复旦大学附属妇产科医院宫颈疾病诊治中心,上海200011

出　　处：《上海医学》2005年第3期187-190,共4页Shanghai Medical Journal

摘　　要：目的　探讨在门诊实施宫腔镜子宫纵隔切开术(TCRS)的安全性和可行性。方法　回顾性分析168例经阴道超声扫描、子宫输卵管碘油造影(HSG)、宫腔镜和腹腔镜检查明确诊断为子宫纵隔患者的临床资料,比较住院与门诊条件下实施宫腔镜TCRS在手术时间、出血量、膨宫液体消耗量、术后住院时间、手术耐受性方面的差异。综合评价门诊宫腔镜TCRS在时效比方面是否具有优越性。结果　48例住院患者中,行全身麻醉或区域麻醉16例,局部浸润麻醉8例,无麻醉24例;120例门诊患者中,行宫颈浸润麻醉38例,无麻醉82例。术中腹腔镜监护7例,均为同时行输卵管整形或卵巢囊肿剥出术者;B超监护22例;未监护139例(82.7%,139/168例)。应用宫腔镜微型剪刀完成TCRS 17 例(10. 1%, 17/168 例),双极汽化电极切开术120 例(71.4%,120/168例),宫腔镜微型剪刀结合汽化电极切开术31例(18.5%,31/168例)。168例宫腔镜TCRS均一次完成,未发生电损伤、子宫穿孔、水中毒、大出血等严重并发症。住院患者的手术时间、出血量、膨宫液用量与门诊手术患者的差异无显著性;但术后住院时间[(51.78±39.65) h]较门诊手术患者[(1.35±0.76) h]明显延长(P<0.001)。结论　在门诊实施宫腔镜TCRS安全、有效、可行,能节省时间和费用,对患者的生活、工作影响较小。Objective To appraise the security and feasibility of hysteroscopical transcervical resection of septa(TCRS) in our outpatient department (OPD). Methods One hundred sixty-eight cases with ulterine septa were diagnosed by transvaginal sonography, hysterosalpingography(HSG),hysteroscopy or laparoscopy and were divided into in-patient(48 cases) and outpatient(120 cases) groups. The duration of operation, blood loss, consumption of irrigating fluid, period of hospital stay and adaptability were compared statistically between the two groups to appraise the security and feasibility of TCRS practised in clinic. The advantage in timesaving and economy of TCRS in clinic was evaluated generally.Results TCRS was carried out in forty-eight in-patients with ult-erine septa. Among them, 16 cases underwent surgery with general anesthesia or regional anesthesia, 8 with local anesthesia and 24 with demerol injected 30 minutes before surgery. The outpatient group received TCRS, 38 with local anesthesia and 82 with demerol injection 30 mins before surgery only. Hysteroscopic microscissor was used to dissect the septa in 17 cases (10.1%), bipolar vaporizing electrode was used in 120 cases (71.4%),and with both microscissor and bipolar vaporizing electrode in 31 cases (18.5%). All 168 cases were treated successfully without any severe complications. There were no significant differences in operation duration, blood loss and consumption of irrigating fluid between the two groups, but the period of hospital stay in outpatient group averaging (1.35±0.76)h was markedly less than that in the in-patients group averaging (51.78±39.65) h(P< 0.001).Conclusion It is safe, efficacious and feasible for TCRS to be practiced in OPD. Hysteroscopic TCRS in OPD has the advantage of timesaving and more economical, with less effect on patients’ living and work.

关 键 词：纵隔切开术 宫腔镜 子宫输卵管碘油造影 术后住院时间 门诊手术患者 经阴道超声扫描 局部浸润麻醉 宫颈浸润麻醉 手术时间 住院患者 汽化电极 官腔镜 回顾性分析 腹腔镜检查 手术耐受性 囊肿剥出术 严重并发症 临床资料 

分 类 号：R713.4[医药卫生—妇产科学]