行宫腔镜手术发生严重并发症35例临床分析被引量：89

Severe complications of hysteroscopic surgeries: an analysis of 35 cases

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摘要目的　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 12 92 1例患者行宫腔镜检查 ,同时行B超扫描 ;对 2 2 2 1例患者行宫腔镜电切术 ,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超和腹腔镜监护不能完全防止子宫穿孔 ;控制灌流液压力和手术时间 ,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。 Objective To investigate the methods of earlier diagnosis, treatment and precautions on the severe complications of hysteroscopic procedures Methods There were 12 921 cases of diagnostic hysteroscopy and 2 221 cases of operative hysteroscopy were performed For diagnostic hysteroscopy B ultrasonography were scaned meanwhile and fluid media were used to distend the uterus For operation hysteroscopy B ultrasonography or laparoscopy was used for monitoring Results Thirty five cases of severe complications encountered There were 9 cases of severe intraoperative bleeding. Foley catheter inserting, bleeding spots coagulating, uterine cavity tampon or hysterectomy were used to stop intraoperative and postoperative bleeding successfully Eleven cases of uterine perforation were treated by conservative therapy, laparoscopy or hysterectomy An air embolism happened on hysteroscopic examination was survived with aggressive rescue There were 4 cases of postoperative infection that had history of pelvic inflammatory disease and cured by antibiotics Diuretic agent and saline infusion were used to treat 5 cases of transurethral resection of prostate (TURP) syndrome effectively For 4 cases of post ablation sterilization syndrome (PASS) dilating the cervix canal and expelling the hematometra, transcervical resection of adhesions or hysterectomy were managed effectively One case of endometrial adenocarcinoma stageⅠa was diagnosed 8 years after transcervical resection of endometrium (TCRE) & transcervical resection of polyp (TCRP), and radical hysterectomy plus selective pelvic lymphadenectomy was performed Conclusions Foley catheter insertion is a simple and efficient method to stop uterine bleeding Uterine adhesion is a high risk factor of uterine perforation Monitoring by B ultrasonography or laparoscopy could not prevent uterine perforation Prevention was essential for air embolism Control the pressure of irrigating flow and operating time can reduce the incidence of TURP syndrome To intensify follow up is the best method to detect PASS and uterine adenocarcinoma