宫腔镜电切术前扩张宫颈用药的探讨

Discussion of drug used to expand cervix before treatment of electrouterogram under hysteroscope

目的探讨卡孕栓、米索前列醇在宫颈镜电切手术前扩张宫颈的作用。方法用双盲法将需行宫腔镜电切手术的120例患者随机分为两组:卡孕栓组和米索前列醇组各60例,患者行宫腔镜手术前阴道分别放置卡孕栓0.5mg和米索前列醇400ug。分别取30min/60min/120min/180min4个时间段来观察宫颈扩张的效果。并从起效时间、药物副反应发生率、宫颈扩张直径、术中痛觉分级、术中出血量、术后人流综合征发生率等方面来综合评价两者的作用效果。结果卡孕栓组30min宫放张直径为7.87±0.70cm,明显高于米索前列醇组30min的宫颈扩张直径(5.30±0.73cm),P<0.05;卡孕栓组30min宫颈扩张直径与米索前列醇组120min宫颈扩张直径(7.53±0.54cm)相比,无显著性差异,P>0.05;卡孕栓组180min宫颈扩张直径(6.30±0.36cm),明显小于米索前列醇组180min的宫颈扩张直径(7.57±0.58cm),有显著性差异,P<0.05;卡孕栓组药物副反应发生例数(5例)及人流综合症发生例数(2例),均明显低于米索前例醇组(13例和9例),P<0.05;两组术中痛觉分级无显著性差异,P>0.05。结论宫腔镜手术前阴道放置米索前例醇和卡孕栓均能有效地扩张宫颈,卡孕栓扩张松弛宫颈的起效时间短,腹痛及人流综合征等副作用发生较少,但米索前列醇的宫颈扩张及收缩子宫的作用更持久。

Objective To explore the reaction of methyl earprest suppository （MCS） and misoprnstol which used to expand cervix before treatment of electrouterogram under hysteroscope. Methods 120 patients were randomly distributed into the two groups in double blind, the MCS group consisted of 60 eases treated with methyl earprest suppository 0.5mg and the misoprnstol group consisted of 60 cases treated with misoprostol 400ng in vagina before the operation of the hysternscope. The expanding effect of cervix were observed after 30min, 60min. 120min and 180min respectively, and the initiatory effect time, side effect, the expanding diameter of cervix, the sense grade of pain in operation, bleeding volume and artificial abortion syndrome rate after operation were recorded. Results The expanding diameter of cervix after 30mtn in the MCS group and the misoprnstol group were （7.87cm±0.70cm）, （5.30cm±O.73cm） respectively. There was statistical difference between two groups （P〈0.05）. Compared 30min expanding cervix effect in the methyl earprost suppository group to 120min in the misoprestol group, There was no obvious difference between two groups （P〉0.05）; The expanding diameter of cervix after 180rain in the MCS group and the misoprostol group were （6.30cm±0.36cm）, （7.57cm± 0.58cm） respectively, There was statistical difference between two groups（P〈0.05）; The eases of side effect in the MCS group and the misoprostol group were 5, 13 respectively, There was statistical difference between two groups （P〈0.（15）; There was no statistical difference in thc sense grade of pain in operation between two groups （P〉0.05）. Conclusion It can expand cervix effectively before methyl earprost suppository of eleetreuterogram un-der hysteroscope unless the vagina was laid both misoprostol and methyl carprost suppository. The methyl carprost suppository expands cervix in short initiatory effect time. The occurrence rate of the bellyache and artificial abortion rate was little, but the misoprostol can last long in expanding cervix and shrinking uterus.