宫腔镜子宫内膜去除术中电热效应对组织的影响

Study on the Electrothermal Tissue Effects during Transcervical Resection of Endometrium

目的 探讨宫腔镜子宫内膜去除术中电热效应对组织的影响及适宜的电极功率设置。方法 设置电切电极功率为６０ Ｗ、８０ Ｗ、１００ Ｗ，电凝电极功率为３０ Ｗ、６０ Ｗ、８０ Ｗ、１００ Ｗ，作用时间为３ ～５秒和６ ～８ 秒，分别作用于离体子宫和宫腔镜手术中在体子宫，并将作用后的子宫标本通过 Ｈ Ｅ、尼可酰胺腺嘌呤核苷酸黄递酶（ Ｎ Ａ Ｄ Ｈｄ） 染色，观察电热损伤改变。结果 （１） 相同条件下切割电极下方的组织热损伤深度小于凝固电极；（２） 当电切功率８０ Ｗ、１００ Ｗ 和电凝功率３０ Ｗ、６０ Ｗ，电极作用时间大于５ 秒时，组织破坏深度可达内膜下肌层组织２ ．００ ～３ ．００ ｍ ｍ ；（３） 在上述功率和作用时间下的宫腔镜手术中，电热效应对宫壁最大热破坏深度４ ．１６ ｍｍ ，占宫壁厚度的１６ ．２７ ％ 。结论 （１） 宫腔镜手术中切割与凝固电极下方的热损伤深度有明显差异；（２） 适宜的电切功率为８０ ～１００ Ｗ、电凝功率为３０ ～６０ Ｗ。

Objective To investigate the tissue electrothermal effects and to seek the appropriate setting of operative wattage during transcervical resection of endometrium (TCRE). Methods The power setting were 60W, 80W, 100W for cutting and 30W、 60W、 80W、 100W for coagulation when performing endometrial resection in vitro or in vivo with operating time 3～5 seconds or 6～8 seconds respectively. After operation the uterine specimens were stained by hemaloxylin eosin, and respiratory enzyme dehydronicotinamide adenine dinucleotide phosphate diaphorase methods for evaluating the tissue damage. Results (1)The depth of endometrial damage under cutting was considerably less severe than those under coagulation with the same power setting. (2)When the power of cutting and coagulation were 80W, 100W and 30W, 60W respectively and operating time prolonged more than 5 seconds, the thermal damage covered endometrium and 2～3 mm of myometrium in depth. (3)At such wattage and operating time the deepest destruction was only 16.27% of uterine wall. Conclusion (1) There is significant difference in the depth of thermal damage between cutting and coagulation during hysteros copic surgery. (2)The appropriate power setting should be 80～100W for cutting and 30～60W for coagulation.