不同Gutenberg分型胚物残留患者宫腔镜术后的临床结局  

Clinical outcome of different Gutenberg ultrasonographic patterns under hysteroscopy

作　　者：张露平[1] 张生澎[1] 韩丹[1] 李晶华[1] 冯力民[1] Zhang Luping;Zhang Shengpeng;Han Dan;Li Jinghua;Feng Limin(Department of Obstetrics and Gynecology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,P.R.China)

机构地区：[1]首都医科大学附属北京天坛医院妇产科,北京100070

出　　处：《中国计划生育和妇产科》2024年第11期67-71,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的 比较不同Gutenberg分型胚物残留患者的临床特点及宫腔镜术后的临床结局。方法 回顾性分析2019年1月至2022年5月在首都医科大学附属北京天坛医院因胚物残留行宫腔镜手术的98例患者的临床资料,依据术前Gutenberg超声分型特征将胚物残留分为0~3型,分析比较患者的一般资料、临床表现、胚物残留超声特点、术前血hCG水平及宫腔镜手术相关信息。结果 4组患者的年龄、孕产次及术前hCG水平、胚物组织长度和术前间隔时间无统计学差异(P>0.05)。2~3型的手术次数、手术时间、膨宫液量明显大于0~1型(P<0.05),而0型和1型、2型和3型之间比较无统计学差异(P>0.05)。3型出血量明显多于0、1、2型(P<0.05),2型出血量明显多于0型和1型(P<0.05),而0型和1型之间无统计学差异(P>0.05)。共6例存在并发症,2型1例,为术中活动性出血(刨削系统);3型5例,活动性出血1例(单极),子宫穿孔1例,TURP综合征(transurethral resection of prostate syndrome)2例(单极),低钾血症1例(双极)。结论 Gutenberg分型中2~3型胚物残留的宫腔镜手术风险要明显高于0~1型,术前可使用Gutenberg超声分型对患者进行术前评估预测手术风险,以便临床医生做好充分的术前准备和术中应急抢救措施。Objective To compare the clinical characteristics and the clinical outcome of hysteroscopic surgery in patients with retained products of conception(RPOC)of different Gutenberg ultrasonographic patterns.Methods The clinical data of 98 patients who underwent hysteroscopic surgery due to embryo residue in Beijing Tiantan Hospital,Capital Medical University from January 2019 to May 2022 were retrospectively analyzed,and the embryo residue was divided into type 0~3 according to the preoperative Gutenberg ultrasound typing characteristics,and the general data,clinical manifestations,ultrasound characteristics of embryo residue,preoperative blood hCG level and hysteroscopic surgery related information were analyzed and compared.Results There were no significant differences in age,gestational time,preoperative hCG level,RPOC length and preoperative interval between the four groups(P>0.05).The number of operation,operation time and distension medium volume of type 2~3 were significantly greater than those of type 0~1(P<0.05),while there was no significant difference between type 0 and type 1,type 2 and type 3(P>0.05).The blood loss of type 3 was significantly higher than that of type 0,1,2(P<0.05),the blood loss of type 2 was significantly higher than that of type 0 and type 1(P<0.05),while there was no significant difference between type 0 and type 1(P>0.05).There were 6 with complications,and 1 case of type 2 was active bleeding(Intergrated Bigatti Shaver).There were 5 cases of type 3,1 case of active hemorrhage(unipolar),1 case of uterine perforation,2 cases of transurethral resection of prostate syndrome(unipolar),and 1 case of hypokalemia.Conclusion The operative risk of type 2~3 is significantly higher than that of type 0~1.Preoperative ultrasound findings and the use of the Gutenberg classification will help physicians counsel patients more effectively and help surgeons to be more prepared with the necessary equipment available in the operating room.

关 键 词：胚物残留 宫腔镜 Gutenberg超声分型 TURP综合征 

分 类 号：R713.4[医药卫生—妇产科学]