不同宫颈扩张方式在无阴道分娩史患者宫腔镜手术中的应用效果比较  

The Effect of Different Cervical Dilatation in Hysteroscopic Surgery of Nullipara

作　　者：陈雁南[1] 王芳[1] 刘琰[1] 张峰[1] 任琛琛[1] 杨立[1] 李飞燕[1] 乔明静 CHEN Yan-nan;WANG Fang;LIU Yan;ZHANG Feng;REN Chen-chen;YANG Li;LI Fei-yan;QIAO Ming-jing(The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院妇科,河南郑州450052

出　　处：《河南医学研究》2020年第33期6171-6174,共4页Henan Medical Research

摘　　要：目的研究米索前列醇、卡孕栓、间苯三酚及一次性宫颈扩张器对无阴道分娩史的宫腔镜手术患者宫颈扩张程度及不良反应的影响。方法选取2018年6月至2019年12月在郑州大学第三附属医院接受相应宫腔镜手术治疗的415例患者,均无阴道分娩或试产史,病种包括不全子宫纵隔、子宫内膜息肉、子宫肌瘤、宫腔粘连。同一病种按不同扩宫方式随机分为4组,比较组间的宫颈扩张效果,按不同扩宫方式分组后比较组间不良反应。结果4种扩宫方式在宫腔镜下子宫纵隔电切术、宫腔镜下子宫内膜息肉电切术、宫腔镜下子宫肌瘤电切术中扩宫效果比较,差异无统计学意义(P>0.05);4种扩宫方式在宫腔镜下宫腔粘连分离术中扩宫效果差异有统计学意义(P<0.05)。4种不同扩宫方式在中度宫腔粘连患者中扩宫效果差异无统计学意义(P>0.05),在重度宫腔粘连患者中差异有统计学意义(P<0.05)。在4种扩宫方式出现的各项不良反应中,米索前列醇组不良反应出现较多(12.75%)(P<0.05)。结论一次性宫颈扩张器在无阴道分娩史的患者中能达到较好的宫颈预处理效果,尤其是在宫腔重度粘连的患者中,术后不良反应较少,值得临床推广使用。Objective To study the effect of cervical pretreatment with misoprostol,carboprost suppository,phloroglucinol and disposable cervical dilator on the degree of cervical dilatation and adverse reactions of hysteroscopic surgery in nullipara.Methods From June 2018 to December 2019,415 patients with no vaginal delivery history who received hysteroscopic surgery in the Third Affiliated Hospital of Zhengzhou University were selected.The diseases included incomplete mediastinum,endometrial polyp,hysteromyoma and intrauterine adhesions.The same disease was randomly divided into 4 groups according to different dilatation methods.The cervical dilatation effect between the groups was compared,and the adverse reactions were compared after grouping according to different uterine dilatation methods.Results There were no significant differences among the four methods in hysteroscopical transcervical resection of septa,hysteroscopical transcervical resection of endometrial polyps and hysteroscopical transcervical resection of myoma(P>0.05).There was difference in the hysteroscopic separation of intrauterine adhesions(P<0.05).There was no difference in the effect of four different dilation methods in patients with moderate intrauterine adhesions(P>0.05).There was difference in patients with severe intrauterine adhesions(P<0.05).Among the four ways of expanding uterus,misoprostol group had more adverse reactions(12.75%)(P<0.05).Conclusion The use of disposable cervical dilator in nullipara with severe intrauterine adhesions can achieve a better effect of cervical pre-treatment,with fewer postoperative adverse reactions,which is worthy of clinical application.

关 键 词：宫颈预处理 宫腔镜 未产妇 

分 类 号：R713.4[医药卫生—妇产科学]