宫腔镜电切术致TURP综合征13例分析  

Analysis of 13 cases of TURP syndrome during hysteroscopic electrosurgery

作　　者：赵辉[1] 杨保军[1] 冯力民[1] 

机构地区：[1]首都医科大学附属北京天坛医院妇产科,100050

出　　处：《中国妇产科临床杂志》2016年第5期413-415,共3页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨宫腔镜电切术TURP综合征的发生原因、术中监测和预防措施。方法对2011年1月至2015年2月在首都医科大学附属北京天坛医院妇科采用宫腔镜电切术至TURP综合征13例进行回顾性分析;同期收集相同指征接受宫腔镜手术而未发生TURP综合征的患者50例,作为对照组,其中TCRM患者27例,TCRA患者23例。结果 (1)13例TURP综合征患者,TCRM 7例,均为Ⅱ型黏膜下肌瘤,TCRA 6例,均为中重度宫腔粘连;经积极抢救和治疗,所有患者痊愈出院;(2)TCRM患者,TURP组与对照组比较,手术时间、灌流量差异无统计学意义(P>0.05),血钠下降值差异有统计学意义(P<0.05),出血量、血糖升高值差异有高度统计学意义(P<0.01);(3)TCRA患者,TURP组与对照组比较,手术时间差异无统计学意义(P>0.05),灌流量差异有统计学意义(P<0.05),出血量、血糖升高值、血钠下降值差异有高度统计学意义(P<0.01)。结论相对的高压灌流和切割创面大面积血窦开放是TURP综合征发生的主要因素。为预防TURP综合征的发生,除需要重视上述两点外,还需加强术中、术后监护,监测末梢血糖的变化是简单快捷的方法之一。0bjective To summarize the causes,intraoperative monitoring and preventive measures of TURP syndrome resulting from hysteroscopic electrosurgery. Methods The retrospective analysis was performed on 13 cases of TURP syndrome patients undergoing hysteroscopic electrosurgery in Beijing Tiantan hospital from January 2011 to February 2015. Meanwhile,according to the same indication,50 cases who underwent transcervical resection of myoma（TCRM, 27 cases） or transcervical resection of uterine adhesion（TCRA,23 cases）without TURP syndrome occurred were collected to be control group. Results① Among 13 cases of TURP syndrome,there were 7 cases of transcervical resection of myoma（TCRM） which were all type Ⅱ submucous myoma. The other 6 cases were underwent transcervical resection of uterine adhesion（TCRA）,which were all severe adhesions. The 13 patients were cured;② Among patients with TCRM, comparing the TURP group to control group,the operating time and perfusion flow had no significantly different（P〈0.05）.The drop of the serum sodium level was significantly different（P〈0.05）. The loss of blood and the rise of glucose level were significantly different（P〈0.01）;③ Among patients with TCRA, the operation time of the TURP group and control group had no significantly difference（P〈0.05） while the perfusion flow was significantly different（P〈0.05）. The blood volume, glucose rise level and the serum sodium drop level were most significantly different（P〈0.01）. Conclusions The relative major factors of TURP syndrome include high pressure perfusion and venous sinuses open during the surgery. We should think highly of the two points and strengthen the monitoring during and post of surgery in order to prevent TURP syndrome. Finger blood glucose monitoring is one of the fast and simple methods.

关 键 词：宫腔镜 低钠血症 TURP综合征 

分 类 号：R713[医药卫生—妇产科学]