宫腔镜气体栓塞的认识

宫腔镜手术是一项微创、安全的术式，已成为妇科的一项诊疗常规。其优点包括手术时间短、术后恢复快、并发症少。然而，宫腔镜手术存在一些潜在、致命的并发症，如TURP综合征、空气或气体栓塞。气体栓塞发病率较低，但危险性极高，整个手术过程均可发病，发病隐匿，临床症状缺乏特异性，容易被手术医师忽略而导致灾难性后果。在宫腔镜手术过程中，大的子宫静脉的暴露会为气体的进入提供入口，临床上已有许多致死病例的报道。近年来手术医师对气体栓塞的意识有所增强，但关于如何减少其发生率仍缺乏相应的指南。另外，不同气体组成不同，其病理生理改变也不同。术中密切监测症状及体征，及时发现、尽早干预能明显提高患者存活率。该文章旨在提高妇科医师对宫腔镜手术气体栓塞的认识，为术者、手术室人员及麻醉医师提供相应指南，减少术中气体栓塞的危险性，尽最大可能阻止灾难性并发症的发生。

The Understanding of Air or Gas Embolism in Hysteroscopy

Because of safety and minimally invasion, hysteroscopic surgery has gotten popularity and has become the routine for diagnostic and therapeutic interventions of intrauterine pathology. Advantages consist of short operating time, rapid postoperative recovery and low morbidity. However, during hysteroscopic surgery there are concerns about potential complications such as venous air and gas embolism. These are rare but hazardous complications, which can occur in all surgical procedures. In hysteroscopic surgery, large uterine veins may be exposed and are, therefore, entries for gas or air. A number of fatal cases have been described as case reports. Although awareness for air and gas embolism is raised this way, proper guidelines how to reduce the risk of venous gas or air embolism are lacking. The pathophysiologic difference between gas and air embolism is described herein because composition of the gases differs with their different physiologic effects. Signs and symptoms of patients are described, as early detection and intervention are crucial for survival. Furthermore, we provide guidelines for operating department personnel, surgeons, and anesthesiologists to reduce the risk of venous gas or air embolism during hysteroscopic procedures. Potential complications of these procedures may be prevented by this way.