缝扎牵拉宫颈在绝经期患者钳夹宫颈困难宫腔镜手术中的应用  

Application of Suture and Traction of Cervix for Cervical Clamping Difficulties in Hysteroscopic Surgery in Menopausal Women

作　　者：王丛 张玉媛 效小莉 史连耀 牛玥 王丹妮 付凤仙 Wang Cong;Zhang Yuyuan;Xiao Xiaoli(Department of Obstetrics and Gynecology,Aerospace Central Hospital(ASCH),Beijing 100049,China)

机构地区：[1]北京大学航天临床医学院航天中心医院妇产科,北京100049

出　　处：《中国微创外科杂志》2023年第11期870-873,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨缝扎牵拉宫颈在绝经期患者钳夹宫颈困难宫腔镜手术中应用的可行性和安全性。方法2020年4月~2022年4月我科对36例绝经期患者在宫腔镜手术中钳夹宫颈困难采用1-0可吸收线缝扎宫颈,助手牵拉可吸收线固定宫颈,协助完成宫腔镜手术。结果36例采用缝扎牵拉固定宫颈成功完成宫腔镜手术,其中31例缝扎牵拉宫颈顺利,3例缝扎宫颈后牵拉时缝线脱落,二次缝扎固定;2例宫颈表面渗血,阴道内填塞纱布压迫,术后6~12 h后取出纱布,观察创面无活动性出血。宫腔镜手术时间10~60 min,(29±16)min;术中出血5~10 ml;术中均无宫腔假道形成、子宫穿孔、经尿道前列腺电切综合征等手术并发症发生。36例随访6~12个月,3例术后1~2个月宫颈缝线留结处缝线脱落吸收;妇科检查:阴道及宫颈未见明显异常;超声示子宫内膜厚度2~4 mm,无异常子宫出血、阴道排液及宫腔积液等。结论缝扎牵拉固定宫颈协助完成钳夹宫颈困难宫腔镜手术操作简便,可以协助完成宫颈局部预处理及宫颈扩张,减少宫腔镜手术并发症,保障手术安全。Objective To evaluate the feasibility and safety of cervical suture and traction for cervical clamping difficulties in hysteroscopic surgery in menopausal women.Methods From April 2020 to April 2022,we used 1-0 absorbable thread for suture and traction of the cervix in 36 menopausal patients who had difficulty clamping the cervix during hysteroscopic surgery.During the operation,the assistant pulled the absorbable suture to fix the cervix for assisting the completion of hysteroscopic surgery.Results The hysteroscopic operation was successfully completed in all the 36 cases with cervical fixation by suture and traction.Among them,the cervical suture and traction was smoothly in 31 cases.The cervical suture fell off during the traction operation in 3 cases and a secondary suture ligation fixation was required.Two cases had bleeding on the surface of the cervix,and the vagina was compressed with gauze.At 6-12 hours postoperatively,the gauze was removed and no active bleeding was observed on the wound surface.The time of hysteroscopic surgery was 10-60 min(mean,29±16 min).The intraoperative bleeding was 5-10 ml.There were no surgical complications such as the formation of uterine cavity false passage,uterine perforation,or transurethral resection of the prostate syndrome during the operation.All the 36 cases were followed up for 6-12 months.Three cases had suture detachment and absorption at the cervical suture knot at 1-2 months after surgery.Gynecological examination showed no obvious abnormalities found in the vagina and cervix.Ultrasonography showed a thickness of 2-4 mm of the endometrium,without abnormal uterine bleeding,vaginal discharge,or uterine cavity effusion.Conclusions Cervical suture and traction for cervical clamping difficulties in hysteroscopic surgery is simple to perform.It helps local cervical pretreatment and dilation,reduces complications of hysteroscopic surgery,and ensures operation safety.

关 键 词：绝经期 缝扎牵拉宫颈 宫腔镜手术 

分 类 号：R713[医药卫生—妇产科学]