行宫腔镜手术发生严重并发症35例临床分析

目的：探讨行宫腔镜检查和宫腔镜电切术发生严重并发症的早期诊断,治疗及预防。方法：对12921例患者行宫腔镜检查,同时行B超扫描;对2221例患行宫腔镜电切术,同时行B超或腹腔镜监护,结果：发生严重并发症35例,其中出血9例,经宫腔球囊置入、电凝、填塞或子宫体切除治愈;子宫穿孔11例,经保守治疗、腹腔镜或子宫切除治愈,空气栓塞1例,经抢救存活,术后感染4例,经抗生素治疗治愈,尿道电切前列腺（TURP）综合征5例,经利尿及静脉输注盐水治愈,子宫内膜去除－输卵管绝育术后综合征（PASS）4例,经扩宫、排出积血,行宫腔粘连或子宫切除治愈,术后8年发生子宫内膜癌1例,再次手术治疗,结论：行宫腔镜检查,以球囊压迫宫腔可有效控制出血,应注意B超腹腔镜监护不能完全防止子宫穿孔,控制灌流液压和手术时间,可减少TURP综合征的发生。行宫腔镜电切术后应加强随访,早期发现PASS和子宫内膜癌,避免空气栓塞的发生。     

宫腔镜手术的并发症：子宫穿孔

子宫穿孔是宫腔镜手术最常见和最严重的并发症,发生率０．２５％～２５％,平均１．３％,２．２５％合并肠管损伤,术者无经验,不正确的使用作用电极,切除较薄峡部、子宫角,行经宫颈宫腔粘连切除术（ＴＣＲＡ）、经宫颈子宫中隔切除术（ＴＣＲＳ）,子宫有手术创伤史等是子宫穿孔的高危因素。Ｂ超见子宫周围有游离液体,宫腔镜见腹膜、肠管或网膜,腹腔镜见腹腔内液体迅速增多,子宫浆膜出血、血肿或创面均提示子宫穿孔。Ｂ超和     

宫腔镜手术的并发症及其防治

在医疗纠纷日益增多的今天 ,如何防治手术并发症是每个外科医生不得不重视的问题。宫腔镜手术如同其他外科手术一样存在并发症 ,有些甚至是致命的。因此 ,了解这些并发症 ,及时地处理和预防十分必要。现将宫腔镜手术常见并发症及其防治概述如下。1　术时并发症1 1　子宫出血子宫出血是宫腔镜最常见的并发症之一 ,发生率在0 2 %～ 1 0 %之间。小量的出血多是在扩张宫颈管或插入宫腔镜时由于宫颈管内膜损伤所致 ,大量的出血往往发生于宫腔镜手术时如经宫颈子宫纵隔切除术 (TCRS)、经宫颈宫腔粘连分离术 (TCRA)、经宫颈子宫肌瘤切除术 (TC…     

宫腔镜电切术中并发症的临床分析

目的 探讨宫腔镜手术中诱发并发症的潜在因素。临床特点及防治措施。方法 对1995年1月-2001年1月,在行各类宫腔镜手术中发生并发症的17例患者进行临床分析。结果 发生子宫穿孔3例和不全子宫穿孔7例,分别发生在较大的子宫肌瘤切除术,宫腔粘连分离术,子宫纵隔切除术和胎骨嵌入切除术中,均在B超或腹腔镜下诊断并经腹腔镜缝合止血,避免了开腹手术;发生术中大出血4例,分别在宽蒂,多发性黏膜下肌瘤切除和子宫腺肌病内膜切除术中,除1例开腹行子宫切除外,3例经宫腔放置球囊导管压迫止血;发生经尿道前列腺切除（TURP）综合征3例,其中载例为宽蒂黏膜下肌瘤和内突壁间肌瘤切除,1例为子宫腺肌病行内膜切除,经补钠,利尿和纠正左心功能衰竭,症状得到控制。结论 复杂的宫腔内操作是宫腔镜单极电切手术中并发症发生的潜在危险,进行术前预处理,术中监护等,是预防及检查手术并发症的基本措施。     

宫腔镜并发症防治的现代观点

宫腔镜临床应用已有20年的历史，一直被认为是安全、有效、简单、微创技术。随着宫腔镜广泛应用，术后随访时间延长，临床资料的积累和科学研究的深入，现在认为其并发症虽少，但有些并发症会危及生命，如空气栓塞、经尿道前列腺电切术（TURP）综合征、出血、感染和未及时发现的子宫穿孔等，但这些并发症严加预防是可以避免的。目前中国宫腔镜应用日趋普及，由诊断发展到手术治疗．强调其安全性，强化安全意识，以便趋利除弊，将有利于宫腔镜临床应用的开展。     

宫腔镜下子宫内膜电切致过度水化综合征一例

患者 5 0岁 ,绝经 1年 ,初潮年龄 15岁 ,平素月经正常 ,末次月经 2 0 0 0年 12月 6日。入院前 2 0d患者无明显诱因出现阴道点滴状出血 ,持续 8d未净而行分段诊断性刮宫 ,刮出少量内膜组织 ,病理检查为“子宫内膜轻度不典型增生” ,患者要求治疗而入院。既往有“肝硬变”病史。入院检查 :脉搏 80次 ,血压 10 0 / 70mmHg(1mmHg =0 133kPa) ,心肺无异常 ,肝脾未扪及。无腹水征象。妇科检查 :外阴及阴道正常 ,宫颈光滑 ,子宫前位 ,大小正常 ,质地中等 ,活动正常 ,双侧附件区正常。常规检查未见异常 ,拟行全子宫切除术。麻醉穿刺中 ,发现皮肤…     

宫腔镜手术出血并发症的防治

宫腔镜手术术中及术后近期出血是宫腔镜手术最常见的第2位并发症，通过增加灌流压力。电凝有搏动的动脉出血点可减少术中出血，应用Foley尿管球囊宫腔堵塞压迫；垂体后叶加压素稀释液宫颈注射产生子宫收缩；采用浸有垂体后叶加压素的棉纱宫内堵塞或米索前列醇塞肛增强子宫收缩等方法可控制术后出血，如所有这些方法无效，还可考虑子宫血管阻断及子宫切除。     

宫腔镜手术出血并发症的防治

宫腔镜手术术中及术后近期出血是宫腔镜手术最常见的第2位并发症。通过增加灌流压力、电凝有搏动的动脉出血点可减少术中出血。应用Foley尿管球囊宫腔填塞压迫；垂体后叶加压素稀释液宫颈注射产生子宫收缩；采用浸有垂体后叶加压素的棉纱宫内填塞或米索前列醇塞肛增强子宫收缩等方法可控制术后出血。如所有这些方法无效，还可考虑子宫血管阻断及子宫切除。     

宫腔镜在子宫不规则出血85例中的诊断价值分析

目的：分析宫腔镜在子宫不规则出血患者诊治中的作用。方法：对2013年1月至2014年2月在我院诊断为子宫不规则出血的85例患者应用宫腔镜检查的同时予以治疗。结果：确诊子宫内膜息肉29例、子宫内膜增生期变化24例、子宫内膜炎9例、流产残留3例、子宫粘膜下肌瘤10例、节育器嵌顿8例（其中有一例早孕合并节育器嵌顿）、子宫内膜不典型增生1例、子宫内膜癌1例。结论：宫腔镜在子宫不规则出血的诊断及治疗中诊断准确、方法简单、疗效好、创伤小、复发率低,是宫内病变诊疗的最佳手段。     

宫腔镜电切术子宫穿孔16例分析

目的 探讨宫腔镜电切术子宫穿孔的发生原因、诊断、处理和预防方法。方法 1990年5月至2002年7月,5家医院共行宫腔镜电切术3541例次,其中宫腔镜子宫内膜切除术(TCRE)1431例,1468例次,宫腔镜子宫肌瘤切除术(TCRM)797例,宫腔镜子宫内膜息肉切除术(TCRP)783例,宫腔镜子宫纵隔切除术(TCRS)189例,宫腔镜子宫粘连切除术(TCRA)112例,宫腔镜宫腔异物取出术(TCRF)192例。术时均行B超和(或)腹腔镜监护,手术日前晚放置宫颈扩张棒或于阴道后穹窿放置米索前列醇200μg,手术步骤按不同的指征及目的进行。结果 发生子宫穿孔16例(0．45％),8例因放置器械所致,其中7例扩宫时穿孔,1例置镜时穿孔,8例为电切电极引起。子宫穿孔发生率,TCRA 4．46％(5／112),TCRF 3．12％(6／192),TCRE 0．27％(4／1468),TCRM 0．13％(1／797);TCRP及TCRS无子宫穿孔发生。16例穿孔均于术中发现,其中B超和(或)腹腔镜监护发现10例(62％),宫腔镜及临床发现6例(38％)。13例为完全子宫穿孔,其中腹腔镜监护发现2例,B超监护发现5例,宫腔镜先于B超发现4例,患者首先出现症状,然后B超证实子宫穿孔2例;子宫不全穿孔3例,2例腹腔镜监护发现,1例B超监护发现。结论 应尽量减少扩宫,置镜在直视下进行;术者的经验及手术类型如TCRA和TCRF与子宫穿孔的发生有关。宫腔镜电切术时B超、腹腔镜监护有助于预防,但不能完全防止子宫穿孔。     

An overview of hysteroscopy and hysteroscopic surgery

Hysteroscopy allows direct visualization of the uterine and endocervical cavities. Recent innovations in endoscopic techniques have increased the accessibility of diagnostic and therapeutic procedures. However, hysteroscopic surgery should be performed by an appropriately trained gynaecologist to ensure safe practice and good patient outcomes. This review discusses the basic principles required to undertake diagnostic and operative hysteroscopic surgery, discuss the newer procedures available and highlight the current evidence behind the use of hysteroscopic surgery in the clinical setting.     

Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection

OBJECTIVE: To determine the accuracy of differential diagnosis by team consultation of abortion in progression, low-lying implantation/cervicoisthmic pregnancy, and cervical pregnancy (CP) in patients referred for suspicion of abnormal implantation on the lower segment and cervix of the uterus and to determine the efficacy of endoscopic surgery with uterine artery blockade followed by cervical evacuation in the treatment of confirmed CP. DESIGN: Prospective observational study under multiple-clinic and multiple-hospital cooperation. SETTING: Tertiary clinical and academic medical center. PATIENT(S): Twenty-seven women with a tentative diagnosis of CP made at their primary gynecologists' offices from July 1999 to June 2003. INTERVENTION(S): Second-opinion ultrasound scanning with transabdominal and transvaginal approach and optional color Doppler use. For patients with confirmed CP, a new treatment modality with laparoscopy-assisted uterine artery ligation followed by hysteroscopic local endocervical resection to remove the ectopic pregnancy was employed. For patients with abortion in progression or low-lying implantation/cervicoisthmic pregnancy (non-CP) requiring termination, dilatation and curettage (D&C) was performed under transabdominal ultrasound guidance. MAIN OUTCOME MEASURE(S): Fulfillment of ultrasound-based diagnostic criteria and operative course, convalescence, and commencement of menstruation in those patients with confirmed CP. RESULT(S): Cervical pregnancy was diagnosed in six (22.2%) patients at 相似文献   

Long-term results of hysteroscopic myomectomy in 235 patients

OBJECTIVE: To assess the efficacy of transcervical resection of submucous fibroids according to type and size. MATERIALS AND METHODS: Retrospective follow-up of 235 women with submucous fibroids at outpatient hysteroscopy who underwent a hysteroscopic transcervical resection. The main indications were the abnormal uterine bleeding and fertility problems. Thirty-seven percent of patients had an associated endometrial ablation and 32% had a polyp resection. Fifty-one percent of women were menopausal. In cases of incomplete resection a repeat procedure was offered. RESULTS: Intra-operative complications were rare (2.6%) and there was no major complication. Eighty-four percent of cases were followed-up. The median follow-up was 40 months (range 18-66 months). The procedure was classed as a success in 94.4% of patients. Among the cases that were classed as a failure, four patients had a repeated hysteroscopic procedure, three patients had a subsequent hysterectomy and four patients presented with abnormal uterine bleeding at follow-up. CONCLUSION: The hysteroscopic transcervical resection of submucous fibroids is a safe and highly effective long-term therapy for carefully selected women presenting with abnormal uterine bleeding and fertility problems. It produces satisfactory long-term results with few complications.     

The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding

This study assessed the efficacy of hysteroscopic polyp removal in the management of abnormal uterine bleeding (AUB) of premenopausal patients. The monthly menstrual blood loss, measured semi-objectively by the pictorial blood loss assessment chart (PBAC) and patients satisfaction were recorded prospectively preoperatively and postoperatively. Twenty-one patients were included. Median monthly PBAC-score before treatment was 288 (range 142–670) and 6 months after polyp removal 155 (range 39–560). It was concluded that hysteroscopic polyp removal in premenopausal women with AUB reduces the monthly blood loss significantly and has a high satisfaction rate on the short term.     

门诊宫腔镜对10565例异常子宫出血患者PALM-CORIN病因分类的应用

目的:探讨门诊宫腔镜及PALM-CORIN病因分类方法对异常子宫出血(AUB)患者病因、诊断、临床治疗的价值。方法:回顾分析2008年1月1日至2015年12月31日在湖北省妇幼保健院妇科门诊宫腔镜诊治中心因异常子宫出血就诊的10565例患者的临床资料,分析其就诊原因、阴道出血模式及宫腔镜检结果,并重新进行PALMCORIN分类,梳理其诊治流程。结果:10565例AUB患者的就诊原因和阴道出血模式依次为:月经频发、月经过多、月经期延长、不规律月经、月经异常合并不孕、经期间出血、月经过少、月经稀发,分别具有不同的PALM-CORIN病因分类。按PALM-COEIN病因分类系统,10565例AUB患者中,存在结构异常者4318例,占40.9%;存在非结构异常者6247例,占59.1%;非结构异常者的年龄显著高于结构异常者(P0.05)。结构异常的患者中,病因分类排序依次为AUB-P、AUB-L、AUB-A、AUB-M;非结构异常的患者中,病因分类排序依次为AUB-O、AUB-I、AUB-E、AUB-N、AUB-C。结论:门诊宫腔镜和PALM-COEIN病因分类系统在AUB的诊治、分流中扮演着重要角色,有助于急慢性AUB患者的流行病学、病因学和治疗等多方面的研究。     

Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding

OBJECTIVE: Our purpose was to compare office hysteroscopy with transvaginal ultrasonography for diagnosing intrauterine pathologic disorders in patients with excessive uterine bleeding, with specimens obtained from either hysterectomy or operative hysteroscopy used to represent the true diagnosis. STUDY DESIGN: A total of 149 patients underwent office hysteroscopy between July 1993 and December 1994. They were evaluated for complaints of menorrhagia, metrorrhagia, or postmenopausal bleeding. Data encompassing patient age, gravidity, parity, indication, ultrasonographic and hysteroscopic findings, comfort level, time required, and complications were gathered by resident physicians. Most hysteroscopic examinations were preceded by transvaginal ultrasonography. All patients received premedication with 600 mg of ibuprofen and a paracervical block with 1% lidocaine without epinephrine. Sixty-five patients underwent operative hysteroscopy or hysterectomy later. The pathologic diagnoses of these specimens were compared with hysteroscopic and ultrasonographic findings, and the sensitivity and specificity of each test were calculated. RESULTS: Hysteroscopy was 79% sensitive and 93% specific in diagnosing intracavitary pathologic disorders, whereas transvaginal ultrasonography was only 54% sensitive and 90% specific. One hundred forty-one patients were comfortable during the procedure, and inspection of the uterine cavity was considered adequate in 136. The majority of procedures were completed in <10 minutes. Twenty-six patients underwent operative hysteroscopy and another 39 underwent hysterectomy. No patient who underwent operative hysteroscopy has had a recurrence of abnormal bleeding over a 12- to 30-month follow-up. CONCLUSION: Office hysteroscopy is a rapid, safe, well-tolerated, and highly accurate means of diagnosing the cause of excessive uterine bleeding. It permits patient and physician to discuss more treatment options before surgery, including outpatient operative hysteroscopic procedures. This means savings in time and in drug, procedure, professional, and hospital costs. (Am J Obstet Gynecol 1996;174:1678-82.)     

剖宫产瘢痕憩室的形成机制及诊断

剖宫产瘢痕憩室（CSD）是剖宫产术后的一个远期并发症。随着剖宫产率持续上升,CSD的发生率随之升高。部分患者因此出现异常子宫出血或剖宫产瘢痕妊娠,甚至发生大出血、孕期子宫破裂、凶险性前置胎盘等严重并发症危及母胎安全。CSD发病机制尚不明确,发生率也无确切数据。CSD的诊断目前国际上仍未形成统一定论。主要是根据病史,临床表现及辅助检查进行临床诊断。影像学检查以及宫腔镜检查已经成为临床上主要的诊断方法与确诊手段。