宫腔镜检查和治疗宫腔内病变的临床应用

Clinical application of hysteroscope in examination and treatment of intrauterine lesions

目的探讨宫腔镜在诊断和治疗宫腔内病变方面的应用价值。方法收集2002年6月至2013年3月在乐山市人民医院行宫腔镜检查和治疗的562例病例资料进行临床回顾性分析。结果在562例患者中,宫腔镜检查275例,占48.9%;疾病谱为功血、子宫黏膜下肌瘤、子宫内膜息肉、子宫内膜炎症、子宫内膜增生性病变、子宫内膜癌或子宫肉瘤等。宫腔镜下宫腔内异物取出术118例,成功110例,成功率达93.2%。宫腔镜下子宫内膜、子宫内膜息肉、子宫黏膜下肌瘤、宫腔粘连、子宫纵隔切除术共169例,手术成功160例,成功率达94.7%。术中和术后并发症发生子宫穿孔6例(1.1%),盆腔感染5例(0.9%),水中毒3例(0.5%)。结论宫腔镜检查提高了对子宫疾病的检出率,并可对某些常规检查不能确诊的疾病进行定位取病检,做到早期诊治、创伤小、疗效好、术后恢复快,更利于生殖预后等优点,收到良好效果。

Objective To investigate the application value of hysteroscope in diagnosis and treatment of intrauterine lesions.Methods The clinical data of 562 cases which accepted examination and treatment by hysteroscopy during June 2002 to March 2013 were retrospectively analyzed.Results Among 562 cases 275 cases accepted hysteroscopy, occupying 48.9%.The disease spectrum was dysfunctional uterine bleeding （ DUB） , submucosal uterine fibroids, endometrial polyps, endometrial inflammation, endometrial hyperplasia, endometrial cancer and uterine sarcoma.There were 118 cases accepting intrauterine foreign body removal surgery with hysteroscope, and 110 cases were successful with the successful rate of 93.2%.There were 169 cases undergoing TCRE, TCRP, TCRM, TCRA or TCRS, and 160 cases were successful with the successful rate of 94.7%.There were 6 cases （1.1%） of uterine perforation, 5 cases （0.9%） of pelvic infection and 3 cases （0.5%） of water intoxication occurring during or after surgery.Conclusion Hysteroscopy increases the detection rate of uterine diseases, and it can locate lesions for some diseases which cannot be diagnosed by routine examination.Hysteroscopy provides early diagnosis and treatment, mild invasion, good efficacy and rapid recovery, which is beneficial for reproductive prognosis.