宫腔镜手术在老年女性患者中的应用价值  

Study on clinical application value of hysteroscopy in older women

作　　者：翟建军[1] 初幸之[1] 侯丽娟[1] 曹京红[1] 张毅[2] 

机构地区：[1]首都医科大学附属北京同仁医院妇产科,100005 [2]卫生部北京医院妇产科

出　　处：《中华老年医学杂志》2009年第6期475-477,共3页Chinese Journal of Geriatrics

基　　金：人事部归国人员启动基金2006

摘　　要：目的探讨宫腔镜手术对老年女性诊断性刮宫的价值，及并发症的发生率和预防措施。方法2002年1月至2007年12月在我院进行宫腔镜诊治的老年女性113例（老年组）纳入研究，另有同期进行宫腔镜诊治的非老年女性157例作为对照组。比较两组患者进行宫腔镜手术的成功率，并发症发生率及防治效果；手术后结果与单纯分段诊断刮宫的诊断正确性进行比较。结果113例老年组宫腔镜手术成功率为88．5％（100例），非老年组手术成功率为100％（157例），两组比较差异有统计学意义（P〈0．01）；老年组患者并发症发生率高于非老年组，老年女性行官腔镜下诊断刮宫较单纯诊断刮宫术病灶发现率高，准确性高于单纯诊断刮宫。老年组应用雌激素组成功率为95．5％（64／67），未应用雌激素组为69．6％（32／46），提示应用雌激素可提高手术成功率，差异有统计学意义（P〈0．01）；经过雌激素或米索前列醇处理后手术成功率升高，雌激素组较米索前列醇具有更高的安全性。结论老年女性应用宫腔镜手术诊断刮宫安全可行，但较非老年女性手术成功率低并发症发生率高。术前需给予雌激素。Objective To explore the value of hysteroscopy in diagnostic curettage, the incidence of complications and preventive measures in senile women. Methods One hundred and thirteen senile patients who underwent hysteroscopy from January 2002 to December 2007 were recruited in the study, and one hundred and fifty-seven non senile patients were selected as control group. All the patients were operated with diagnostic curettage and hysteroscopy. The success rate of hysteroscopy operation, the incidence of complications and control effect were recorded and compared between two groups. Results The success rate of hysteroscopy operation was 88.5% （100/113） in the senile group and 100% （157/157） in the non senile group, and there was significant difference（P 〈0. 01）. The incidence of complications was higher in the senile women group than that in the non senile women group （P 〈 0.01 ）. In senile group, the accuracy of diagnostic curettage and hysteroscopy was higher than diagnostic curettage alone, and the success rate was 95.5 % （64/67）in estrogen group and 69.6%（32/46） in blank control group （P〈0.01） ,which indicated that estrogen was positively related with the success rate of operation. Compared with misoprostol, estradiolpretreatment operation was safer and had higher success rate. Conclusions It is safe and feasible to perform hysteroscopy and diagnostic curettage for older women, though it has higher incidence of complications and lower success rate compared with non senile women. Hysteroscopy and diagnostic curettage are more accurate than diagnostic curettage alone, and it is a good choice to apply estradiol before operation.

关 键 词：宫腔镜 刮宫术 雌激素类 

分 类 号：R686[医药卫生—骨科学]