宫腔镜手术并发症的分析与防治

Causes,Prevention and Treatment of Hysteroscopic Complications

目的探讨宫腔镜手术中并发症发生原因、规律、处理方法及预防措施,提高手术的安全性。方法回顾性分析两所医院2000年1月～2010年12月3258例宫腔镜手术的临床资料及并发症情况。3258例中发生并发症47例,发生率1.44%。其中子宫穿孔17例,大出血11例,灌流液过量吸收综合征13例,感染4例,空气栓塞2例。结果子宫穿孔17例中8例有腹腔镜监测,镜下行穿孔部位缝合;9例无监测者采用加强宫缩等保守治疗。大出血11例中2例发生于经宫颈子宫内膜切除术(TCRE)术中,中转开腹行子宫切除术;9例发生于术后24 h内,加强宫缩及宫腔上球囊导尿管。灌流液过量吸收综合征13例均静脉补钠及利尿治疗。感染4例中2例抗炎治疗2周,2例盆腔脓肿,其中1例开腹行脓肿切开引流,1例经腹腔镜留置腹腔引流,抗炎治疗2周。术中空气栓塞2例均紧急加压给氧,左侧卧位并抬高右肩,心肺复苏。47例并发症均治愈。结论宫腔镜手术中并发症的发生主要与医生的经验及手术难度有关。加强术中术后监测、熟悉内镜解剖及提高手术操作技巧,是减少手术并发症的关键。

Objective To explore the causes,regulation,prevention and treatment of hysteroscopic complications,so that to increase the safety of the surgery. Methods The clinical data from 3258 cases of hysteroscopic surgery that were performed from January 2000 to December 2010 in two hospitals were analyzed retrospectively.Among the cases,47（1.44%） patients developed complications,including 17 cases of uterine perforation,11 cases of hemorrhage,13 cases of transurethral of the prostate（TURP） syndrome,4 cases of pelvic infection,and 2 cases of air embolism. Results In the 17 cases of uterine perforation,8 patients received laparoscopic monitoring and repair,the other 9 patients received conservation treatments,such as strengthening uterine contraction.In the 11 cases who had massive hemorrhage,2 cases were undergoing TCRE,both the cases were converted to open surgery,the other 9 patients developed the hemorrhage in 24 hours after hysteroscopy,and thus received treatments to strengthen contraction,as well as balloon catheterization.Diuretic agent and saline infusion were used in the 13 cases of TRUP.In the 4 cases of pelvic infection,2 patients received anti-inflammatory treatment for 2 weeks,the other 2 showed pelvic abscess and thus received open surgery or laparoscopy for abscess incision and drainage,plus 2-week anti-inflammatory treatment.The 2 cases of air embolism were cured by supply oxygen,cardio-pulmonary resuscitation with the patients lying on the left side with the right shoulder lifting up.All the 47 patients were cured. Conclusions The complications of hysteroscopic surgery are mainly associated with the experience of doctors and difficulty of the operation.The keys to reduce complications are intra-and postoperation monitoring,deep understanding endoscopic anatomy and surgical skills.