宫腔镜手术电热损伤的研究

目的探讨宫腔镜手术中各种电极在不同功率下对子宫组织电热损伤程度.方法设置电极功率为80～120 W,作用时间为3～5 s,作用于宫腔镜手术在体子宫内膜及肌层,在切下内膜组织及电极作用下方分别取材,通过HE染色观察电热损伤.结果不同电极子宫组织电热损伤有显著差异,滚球电极电热损伤最深,气化电极次之,环状电极最薄.结论子宫组织电热损伤程度与电极功率选择关系不大,而与电极形状密切相关.     

子宫腔整复手术后再粘连的防治

宫腔粘连是子宫内膜基底层损伤所引起的疾病，严重影响女性生理健康和生育功能。宫腔镜下宫腔粘连分离术作为子宫腔整复手术的首选治疗方法，以恢复子宫正常解剖结构及功能为目的，但术后复发仍是妇科医生面临的巨大挑战。目前防治术后再粘连的方法主要有屏障治疗、激素治疗和羊膜疗法等，其他的治疗选择，如干细胞疗法、阿司匹林、富血小板血浆、西地那非等治疗尚处于研究当中。目前尚无防治术后再粘连的最佳治疗方案，如何达到最佳治疗效果仍需进一步研究。     

宫腔镜下输卵管插管通液在不孕不育症患者临床治疗中的效果观察

目的:观察宫腔镜下输卵管插管通液在不孕不育症患者临床治疗中的效果。方法:回顾性分析本院2011年4月-2013年2月收治的100例不孕不育症患者的临床资料。结果:术前两组患者的输卵管双侧通畅和一侧不通或通而不畅的发生率明显比术后低,双侧阻塞的发生率明显比术后高,两者比较差异有统计学意义(P0.01);原发不孕组和继发不孕组患者通液后各种情况的输卵管通畅率比较差异均无统计学意义(P0.05);原发不孕组和继发不孕组患者3个月~1.5年后的受孕率比较差异均无统计学意义(P0.05)。结论:宫腔镜下输卵管插管通液在不孕不育症患者临床治疗中的效果良好,能够有效改善各种类型不孕不育症患者输卵管的通畅性,值得在临床广为推广。     

Successful treatment of cardiac arrest following hysteroscopic surgery using extracorporeal membrane oxygenation: A case report

Rationale:Cardiac arrest caused by water intoxication syndrome following hysteroscopic surgery is a rare but life-threatening occurrence. Extracorporeal membrane oxygenation (ECMO) is rarely used to treat water intoxication syndrome in hysteroscopic surgery. Here, we successfully treated a patient with water intoxication syndrome following hysteroscopic surgery with ECMO.Patient concerns:We report a rare case of cardiac arrest during hysteroscopic surgery treated with veno-venous (VV) ECMO.Diagnosis:Water poisoning syndrome was diagnosed by electrolyte examination, the lowest value of serum sodium was 110.7 mmol/L.Interventions:VV-ECMO was prescribed as a measure after traditional cardiopulmonary resuscitation.Results:ECMO was successfully evacuated on day 5 and the patient was discharged on day 45.Conclusion:Mastering the hysteroscopic operative techniques and using a bipolar hysteroscopic generator, isotonic fluid, perfusion pressures less than 100 mm Hg, and local anesthesia may reduce the risk of hysteroscopic water intoxication syndrome. During hysteroscopic surgery, patients may experience cardiac arrest and fatal water intoxication syndrome. Even when traditional cardiopulmonary resuscitation is successful, VV ECMO may contribute to the recovery of brain function if oxygenation is not maintained.     

宫腔镜电切术后左炔诺孕酮宫内缓释系统预防子宫内膜息肉复发的研究

目的探讨左炔诺孕酮宫内缓释系统（LNG-IUS）预防子宫内膜息肉宫腔镜电切术后复发的临床疗效。方法采用前瞻性随机对照研究,将99例宫腔镜子宫内膜息肉切除术（TCRP）患者分为两组,治疗组48例,TCRP后月经来潮第3~5天放置LNG-IUS,其中单发性息肉10例,多发性息肉38例;对照组51例,TCRP术后无任何处理措施,其中单发性息肉11例,多发性息肉40例;门诊随访12个月,观察子宫内膜息肉复发及月经量情况。结果治疗组中无一例复发;对照组中单发性息肉有1例复发,多发性息肉有6例复发,复发率为13.73%（7/51）,两组复发率差异有统计学意义（P〈0.05）。治疗组月经量少于对照组,差异有统计学意义（P〈0.05）。结论 LNG-IUS能有效地预防子宫内膜息肉切除术后的复发并明显减少月经量。     

Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility

OBJECTIVE: To evaluate the reproductive outcome of hysteroscopic metroplasty performed in women with septate uterus and otherwise unexplained primary infertility. DESIGN: Prospective, observational study. SETTING: Tertiary center for reproductive medicine. PATIENT(S): Sixty-one patients with uterine septa and otherwise unexplained primary infertility. INTERVENTION(S): Hysteroscopic division of the uterine septum. MAIN OUTCOME MEASURE(S): Reproductive outcome after hysteroscopic metroplasty. RESULT(S): Of 61 women, 25 (41%) conceived within 8-14 (mean 11.2) months after hysteroscopic metroplasty. Of these, 18 (29.5% of the total group) had live births (13 carried to term and 5 had preterm deliveries), and 7 (11.5% of the total group) had spontaneous abortions. Cervical cerclage was performed in 9 women; only 1 (11.1%) of these patients and 4 (44.4%) of the 9 who did not have a cerclage had preterm deliveries. Twelve of the 18 women (66.6%) who had live births were delivered by cesarean section. CONCLUSION(S): Women with uterine septum and otherwise unexplained infertility might benefit from hysteroscopic metroplasty.     

Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study

BACKGROUND: A prospective, randomized, controlled study was performed to assess the efficacy of auto-crosslinked hyaluronic acid (ACP) gel to prevent the development of de-novo intrauterine adhesions following hysteroscopic surgery. METHODS: One hundred and thirty-two patients with a single surgically remediable intrauterine lesion (myomas, polyps and uterine septa, subgroups I-III) completed the study. Patients were randomized to two different groups: group A underwent hysteroscopic surgery plus intrauterine application of ACP gel (10 ml) while group B underwent hysteroscopic surgery alone (control group). The rate of adhesion formation and the adhesion score was calculated for each group and subgroup 3 months after surgery. RESULTS: Group A showed a significant reduction in the development of de-novo intrauterine adhesions at 3 months follow-up in comparison with the control group. Furthermore, the staging of adhesions showed a significant decrease in adhesion severity in patients treated with ACP gel. CONCLUSIONS: ACP gel significantly reduces the incidence and severity of de-novo formation of intrauterine adhesions after hysteroscopic surgery.