Nd∶YAG激光宫腔镜手术21例分析

Analysis of 21 Cases of Hysteroscopic Surgery by Nd:YAG Laser

探讨Ｎｄ∶ＹＡＧ激光在宫腔镜下应用的可行性和临床疗效。方法选择６例功能失调性子宫出血和１５例子宫粘膜下肌瘤共２１例患者，应用Ｎｄ∶ＹＡＧ激光在宫腔镜下行单纯去内膜术（６例）、单纯肌瘤摘除术（７例）和去内膜加肌瘤摘除术（８例）。结果２１例手术全部获得成功，包括１例行２次手术者（第１次手术切除部分瘤体，第２次手术切除剩余瘤体并同时行去内膜术）。术后月经恢复正常１３例，少经７例，１例月经仍多但较术前好转，病人满意率为１００％。术前贫血的１５例患者术后１３例得到纠正，２例改善。无严重手术并发症。１４例术前接受药物准备患者用药前后的宫腔深度分别为８．９ｃｍ±０．８ｃｍ和８．３ｃｍ±０．９ｃｍ，配对ｔ检验差异有显著意义（Ｐ＜０．０５）。用药组和未用药组内膜萎缩程度的Ｍａｎｎ－ＷｈｉｔｎｅｙＵ检验和Ｋｏｌｍｏｇｏｒｏｖ－Ｓｍｉｒｎｏｖ检验提示两组间差异无显著意义（Ｐ＞０．０５），但用药组内膜条件较未用药组略好。术中液体用量与手术时间的Ｐｅａｒｓｏｎ相关系数为０．５５，Ｐ＝０．０２８。结论在术前充分准备和术中尽量缩短手术时间的前提下，Ｎｄ∶ＹＡＧ激光在宫腔镜下应用具有用途广、相对安全、疗效好的优点。手术前药物准备能显著缩小?

Objective To study the feasibility and curative effect of Nd∶YAG laser application in hysteroscopic surgery. Methods A total of 21 cases were recruited, including 6 cases with dysfunctional uterine bleeding and 15 cases with submucosal uterine myoma. Subsequently 6 endometrial laser ablation (ELA) only, 7 submucosal myomectomies and 8 myomectomies combined with ELA were performed. All cases were treated by Nd∶YAG laser under hysteroscopic control. Results All 21 operations succeeded, including 1 case of secondary operation in order to completely remove the myoma and to perform an ELA at the same time after an incomplete myomectomy at the first time. Postoperatively the total patients' satisfaction rate was 100%, including 13 cases with restored normal menstruation, 7 cases of oligomenorrhea, 1 case still had menorrhea but with somewhat improvement compared with her preoperative condition. In 15 cases with anemia, 13 cases were corrected and the other 2 cases improved postoperatively. Noserious operative complication occurred. Of 14 cases who received preoperative pharmacal preparation, uterine cavity depth were 8.9 cm ± 0.8 cm before and 8.3 cm±0.9 cm after preparation. The paired t test indicated significant difference (P<0.05). The Mann Whitney U test and Kolmogorov Smirnov test of endometrial atrophic degree indicated no statistical difference between preparation and non-preparation groups (P>0. 05), but the endometrial condition in the preparation group was slightly better than that in the non preparation group. The Pearson correlation coefficient between fluid deficit during operation and operative time was 0 55 (P=0 028). Conclusions After careful preparation of endometrium and as much as possible to reduce operative time, Nd∶YAG laser may have the advantages of wide application, being relatively safe and showing good curative effect in hysteroscopic surgery. Preoperative pharmacal preparation significantly reduced depth of the uterine cavity, however, with little improvement of endometrial condition.