宫腔镜刨削系统治疗子宫黏膜下肌瘤

Hysteroscopic Shaving System for the Treatment of Uterine Submucous Leiomyoma

目的探讨宫腔镜刨削系统治疗黏膜下肌瘤的安全性。方法 2017年2~7月我院应用宫腔镜刨削系统完成8例子宫黏膜下肌瘤切除术,术前充分宫颈准备,腰硬联合麻醉下扩张宫颈至10号,置入宫腔镜刨削系统操作手件,明确宫腔内肌瘤的部位、大小、类型。将刨削刀头直接紧贴肌瘤表面开始刨削旋切,缩减瘤体直至被切净。结果 8例0型和Ⅰ型子宫黏膜下肌瘤切除术均顺利完成。净旋切手术时间15~40 min,(28.5±8.6)min。术后7例血红蛋白下降1~23 g/L,中位数2 g/L;1例血红蛋白由76 g/L上升至77 g/L。6例血钾下降0.14~0.64 mmol/L,中位数0.29 mmol/L;2例出现低钾血症,分别为3.4、3.2 mmol/L,无特殊不适,补钾治疗后血钾恢复正常。6例血钠水平下降0.5~5.5 mmol/L,但均在正常值范围,2例血钠水平上升,分别为1.3、0.8 mmol/L。无宫颈裂伤、子宫穿孔、术后呼吸窘迫、感染等并发症发生。8例均术后第2天出院。术后2周门诊随访彩超均未见宫内残留。结论宫腔镜刨削系统治疗子宫黏膜下肌瘤简便、安全。

Objective To explore the safety of hysteroscopic shaving system in the treatment of uterine submucous leiomyoma. Methods Eight patients with uterine submucous leiomyoma were treated with hysteroscopic shaving system between February 2017 and July 2017.After full cervical preparation before operation,a combined spinal-epidural anesthesia was given.The cervical dilation was conducted to introduce the hysteroscopic shaving system.The location,size and type of uterine submucous leiomyoma were determined.The head of shaving system was closed to the surface of submucous leiomyoma for rotary-cut out the myoma tissue. Results Type 0 or 1 uterine submucous leiomyoma of 8 patients were successfully resected.The operation time was 15-40 min(mean,28.5±8.6 min).Postoperatively,the hemoglobin decreased by 1-23 g/L(median,2 g/L)in 7 patients and increased from 76 g/L to 77 g/L in 1 patient.The blood potassium level decreased by 0.14-0.64 mmol/L(median,0.29 mmol/L)in 6 patients.Hypokalemia occured in 2 patients(3.4 mmol/L and 3.2 mmol/L,respectively),which recovered to normal after potassium supplementation.The serum sodium level decreased by 0.5-5.5 mmol/L in 6 patients with normal range,and increased by 1.3 and 0.8 mmol/L in 2 Patients.There were no complications such as laceration of cervix,perforation of uterus,postoperative respiratory distress or infection.All the 8 patients were discharged on the second day after surgery.At 2 weeks after the operation,no abnormal intrauterine tissue was detected by color doppler ultrasonography. Conclusion Hysteroscopic shaving system is simple,effective and safe for the treatment of type 0 or 1 uterine submucous leiomyoma.