宫腔镜电切手术中米索前列醇和宫颈插管两种扩宫方式的比较

Comparison of misoprostol versus intubation for cervical priming during operative hysteroscopy

目的比较宫腔镜电切手术中米索前列醇和宫颈插管两种扩宫方式的临床应用价值。方法对拟行宫腔镜电切手术的120例患者随机分组,A组采用米索前列醇直肠置药,B组采用宫颈插管,比较分析两组患者的主观疼痛评分、术中宫颈扩张程度及漏液情况、宫腔镜手术的镜下清晰度、手术时间及出血量、术后体温等。结果A组患者主观疼痛平均分值2.65±1.14、B组3.31±1.56,两组相比有极显著差异(P=0.009)。A组宫颈扩张成功率86.67%、B组70%,两组相比有显著差异(P=0.027)。A组术中宫颈漏液7例、B组11例,两组相比无显著差异(P=0.31)。A组镜下清晰率90%、B组63.33%,两组相比有极显著差异(P=0.001)。A组平均手术时间(31.5±8.93)min、B组(28.3±9.73)min,两组相比无显著差异(P=0.059),A组平均手术出血量(15.33±6.16)mL、B组(16.66±7.35)mL,两组相比无显著差异(P=0.284)。A组术后2d内有低热者6例、B组14例,两组相比有显著差异(P=0.015)。结论米索前列醇直肠置药是较好的宫颈扩张方法,可安全有效地用于宫腔镜电切手术。

Objective To compare the clinical value of misoprostol with intubation for cervical priming prior to operative hysteroscopy. Methods 120 women undergoing hysteroscopy were randomly allocated into two groups. The group A received 400 mg of misoprostol rectally while the group B received cervical intubation for cervical priming. The subjective pain scores, intraoperative cervical dilatation and leakage, clarity of the hysteroscopie field, operation duration ,bleeding volume and postoperative body temperature were assessed and compared between the two groups. Results The subjective pain scores were significantly lesser in group A than in group B（ 2.65 ± 1. 14 vs 3.31 ± 1.56 ,P = 0.009 ）. The success rate of cervical dilatation in group A and B were 86.67% and 70% ,respectively,the difference was significant （P =0. 027）. 7 women in the group A and 11 in the group B had cervical leakage, however, the difference was not significant （P = 0.31 ）. Group A showed higher rate of clarity in the hysteroscopic field （90% vs 63.33% , P = 0. 001 ）. No significant difference existed between group A and group B in the operation duration （31.5 ± 8.93 min vs 28.3 ± 9.73 min,P = 0. 059） and operative bleeding volume （ 15.33 ±6.16ml vs 16.66 ±7.35ml,P =0. 284）. There was 6 women in group A and 14 women in group B had a slight fever during 2 days after the operation,the difference was significant（ P = 0.015 ）. Conclusion Administration of rectal misoprostol could facilitate cervical priming satisfactorily, proved to be an effective and safe methods of cervical dilatation prior to operative hysteroscopy.