宫腔镜联合专用宫腔操作钳在胚胎残留取 出术中的应用分析

Hysteroscopy combined with special uterine cavity forceps used in residual trophoblastic tissue removal surgery

摘要:

目的 探讨一种专用的宫腔操作钳用于宫腔镜下胚胎残留取出术的临床效果、优越性以及并发症的发生情况。 方法 选择2010年10月～2012年10月到该院妇科就诊的药流或人流术后胚胎残留的患者共计83例，根据患者意愿将83例患者分为宫腔镜操作组及传统手术组。其中宫腔镜操作组32人，传统手术组51人。宫腔镜组32例患者术前3 d口服米非司酮或补佳乐，术前2 h口服（或舌下含服）米索前列醇600μg，使用宫腔镜系统联合一种专用的宫腔操作钳进行胚胎残留取出术；另外51例胚胎残留患者作为传统手术组，传统手术组术前处理同宫腔镜操作组，采用常规金属吸头进行负压吸引清宫手术。观察两组患者宫颈口扩张情况、镇痛效果、麻醉药物用量、手术时间、苏醒时间、术中出血量，比较两组手术并发症发生情况以及手术费用情况。 结果 两组患者宫颈扩张均良好，扩张程度、镇痛效果差异无显著性（P ﹥0.05）；宫腔镜组麻醉药物用量、手术时间、苏醒时间等指标结果与传统手术组差异无显著性（P ﹥0.05）；宫腔镜组术中出血量及术后出血时间明显少于传统手术组（P ﹤0.05）。在手术并发症方面，宫腔镜组宫颈（宫腔）粘连、再次残留、月经失调的发生明显少于传统手术组（P ﹤0.01），两组均无子宫穿孔发生。在手术费用方面，两组之间差异存在显著性，宫腔镜组明显高于传统手术组（P ﹤0.01）。 结论 对于经济条件优越的患者，宫腔镜联合专用宫腔操作钳进行胚胎残留取出术可能是一种更为理想的处理药流或人流术后胚胎残留的手术方法。

Abstract:

【Objective】 To investigate the clinical efficacy, advantages and complications of a special clamp used for residual trophoblastic tissue removal surgery under hysteroscope. 【Methods】 83 patients were involved in this study with residual trpohoblastic tissue after drug or artificial abortion in the Gynecology department of our hospital. According to the patients' willingness, the 83 cases were divided into hysteroscopic operation group and conventional operation group. 32 cases were in the hysteroscopic group, and the other 51 cases in the conventional group. In the hysteroscopic group, the 32 patients took mifepristone or progynova(Estradiol Valerate Tabletes) orally 3 days before the operation. Preoperative misoprostol 600 μg was administrated orally or sublingually 2 hours before the operation. In this group, the residual trophoblastic tissue removal operation was given under the hysteroscope combined with the special uterine cavity operating forceps. The preoperative management in the conventional group was the same as the hysteroscopic group, and the uterine curettage for the conventional group was carried out by the traditional metal suction tube. The cervical dilatation, analgesic effect, anesthesia drug dosage, operation time, recovery waking time, bleeding amount were observed in the 2 groups, and the operation complications together with the cost were compared. 【Results】 Cervical dilatation situation in the 2 groups were satisfactory, the dilatation degree, analgesic effect in the 2 groups had no significant difference(P >0.05); The indicators of anesthesia drug dosage, operation time, recovery waking time in the hsyteroscopic and traditional operation group had no significant difference(P >0.05); The intra-operative bleeding volume and post-operative bleeding duration in hysteroscopic group were obviously less than in traditional group (P <0.05). In terms of surgical complications, the incidence of cervical canal (uterine cavity) adhesion, re-occurent trophoblastic tissue residue, menstrual disorders in hysteroscopy group were significantly less than in traditional group (P <0.01). There was no uterine perforation in the 2 groups. In the operation cost, there was remarkable difference between the two groups, cost in hysteroscopic group was significantly higher than that in traditional operation group (P <0.01). 【Conclusion】 As for the patients with good economic conditions, hysteroscopy combined with special uterine cavity operation forceps used in trophoblastic tissue removal surgery may be a more ideal operation method for residual trpohoblastic tissue problem after drug or artificial abortion.