冷膨宫液在宫腔镜手术中的临床应用研究  

Clinical study of a cooled uterine distending medium in hysteroscopic surgery

作　　者：董建春[1] 马迎春[2] 魏增涛[1] 马艳秋[1] 卢爱英[1] 吴希海[1] 周光亮[1] 冯兰青[1] 

机构地区：[1]山东大学临床医学院暨济南市中心医院妇产科,济南250013 [2]山东省聊城市人民医院

出　　处：《现代妇产科进展》2005年第4期297-299,303,F0003,共5页Progress in Obstetrics and Gynecology

基　　金：山东省卫生厅课题(01CA1CAAB7)

摘　　要：目的:评价4℃5%葡萄糖溶液用于宫腔镜手术时对液体吸收量、失血量以及热损伤的影响。方法:(1)随机将异常子宫出血81例经药物治疗无效而行宫腔镜下子宫内膜切除术的患者分为两组,分别采用4℃5%葡萄糖溶液(42例)及常温5%葡萄糖溶液(39例)作膨宫介质,膨宫压力100mmHg,膨宫液流速为200ml/min。记录膨宫液吸收量、失血量,手术前后的血钠浓度;(2)取28例新鲜的离体子宫,以相同条件进行电凝及电切,光学显微镜下观察热坏死带深度。结果:(1)冷膨宫液组液体吸收量、出血量分别为263.69±143.82ml、36.95±22.18ml;常温膨宫液组分别为419.74±271.86ml、51.15±29.23ml,两组差异有显著性(P<0.01,P<0.05)。冷膨宫液组及常温膨宫液组血钠改变值分别为2.98±2.59mmol/L与4.59±3.71mmol/L,两组亦有显著差异(P<0.05)。(2)冷膨宫液组电切、电凝时热损伤深度为0.138±0.040mm和0.254±0.074mm,明显低于常温膨宫液组的0.166±0.052mm和0.313±0.126mm,差异均有显著性(P<0.05)。结论:冷膨宫液可以明显减少液体的吸收,减少术中出血,对血钠影响小,并可减轻热损伤,提高手术的安全性。Objective：To evaluate the effect of 4℃ 5% edxtrose solution as edstention media on absorption of fluids,blood loss and thermal injury during operative hysteroscopy.Methods：（1） In this randomized control study,hysteroscopic endometrial resection was performed in 42patients using 4℃ 5% dextrose solution（study group） and in 39 patients using normal temperature 5% dextrose solution （control group） as distention media.The volume of distention fluid intravasation,blood loss and plasma sodium concentrations were measured.（2）The experiment of endometrial cutting or coagulation（in vitro） was made under the same condition as mentioned,and zones of thermal necrosis were measured using a stage micrometer a gainst a 0.01mm standard.Results：（1）The volume of distention fluid intravasation in the treated group was lower than that of the control group （263.69±143.82ml vs 4719.74±271.86ml,P〈0.01）.Blood loss in the treated group was lower than that of the control group （36.95±22.18ml vs 51.15±29.23ml,P〈0.05）.The decrease of the plasma sodium concentrations in the control group was greater than that of the study group （-4.59±3.71mmol/L vs -2.98±2.59mmol/L;P〈0.05）.（2）Zones of thermal necrosis of cutting and coagulation nuder cooled distention media were all less than those of the control group（0.138±0.040mm vs 0.166±0.052mm,and 0.254±0.074mm vs 0.313±0.126mm,P〈0.05）.Conclusion：The cooled uterine distending medium reduces distention fluid intravasation and blood loss significantly,and the effect on lpasma sodium slightly.The cooled uterine distending medium can also decrease the extent of thermal injury and prevent the related complications.

关 键 词：宫腔镜外科手术 电外科手术 膨宫介质 热损伤 

分 类 号：R713[医药卫生—妇产科学]