宫腔镜电切手术中生化监测的临床价值

Clinical value of serum biochemical inspection on hysteroscopic electrosurgery

目的探讨宫腔镜电切术中血清生化监测预防经尿道前列腺切除(transurethralresectionoftheprostate,TURP)综合征的临床价值。探讨提高手术安全性的方法。方法2005年5月～9月宫腔镜电切手术65例,以5%葡萄糖溶液连续灌流宫腔,监测手术前后生化变化,进行比较分析,同时严密观察临床症状体征。结果术后血钾、血钠离子浓度下降,血糖升高,与术前相比差异有显著性(P<0.05),其中与TURP综合征关系密切的血钠离子浓度的变化与膨宫介质用量、手术时间、手术类型、子宫肌壁损伤程度有关,各因素回归分析,血钠下降与手术时间、子宫肌壁损失程度有关。8例手术后患者发生轻度TURP综合征,均发生在肌壁损伤较大的困难手术后,经过及时利尿、补钠,无不良后果发生。结论手术时间和子宫肌壁损伤是发生TURP综合征的主要原因,术中生化监测是十分必要的。熟练的宫腔镜操作技术是手术安全的基础,术中严密监测,及时处理是围术期安全的保障。

[Objective] To evaluate the clinical value of serum biochemical inspection on hysteroscopic electrosurgery to avoid the complication of transurethral resection of the prostate （TURP） syndrome, raise the safety of hysteroscopic electrosurgery. [Methods] There were 65 cases of hysteroscopic electrosurgery performed from May to Sept. 2005.5% Dextrose was used for uterine irrigation. Serum biochemical inspection was inspected before and just finished surgery which value was analyzed prospectively. [Results] Serum potassium, serum sodium concentrations decreased and blood sugar elevated after surgery compared with its level before surgery. Its difference was significantly （P 〈0.05）. Changes of serum sodium concentrations, which linked with TURP syndrome consanguineously, correlated with the volume of uterine distension media, operating time, type of surgery and disrupted degree of uterine wall. Regressive analysis of variables shown that postoperative serum sodium concentrations correlated with the volume of uterine distension media negatively, the volume of uterine distension media correlated with operating time positively. Eight cases happened mild TURP syndrome when surgery finished. Among them 3 cases were performed TCRS and 2 cases were performed TCRM. Normal saline infusion and diuretic management resulted in good outcome. [ Conclusion] Prolonged operating time and severe disruption of uterine wall is the main inducement of TURP syndrome. Serum biochemical inspection during surgery can discover and manage TURP syndrome timely to be avoid neurological sequelae from hyponatraemic encephalopathy.