宫腔镜电切术中并发症的临床分析

Clinical study of severe complications during hysteroscopic surgeries

目的 探讨宫腔镜手术中诱发并发症的潜在因素、临床特点及防治措施。方法 对1995年 1月～ 2 0 0 1年 1月 ,在行各类宫腔镜手术中发生并发症的 17例患者进行临床分析。结果 发生子宫穿孔 3例和不全子宫穿孔 7例 ,分别发生在较大的子宫肌瘤切除术、宫腔粘连分离术、子宫纵隔切除术和胎骨嵌入切除术中 ,均在B超或腹腔镜下诊断并经腹腔镜缝合止血 ,避免了开腹手术 ;发生术中大出血 4例 ,分别在宽蒂、多发性黏膜下肌瘤切除和子宫腺肌病内膜切除术中 ,除 1例开腹行子宫切除外 ,3例经宫腔放置球囊导管压迫止血 ;发生经尿道前列腺切除 (TURP)综合征 3例 ,其中 2例为宽蒂黏膜下肌瘤和内突壁间肌瘤切除 ,1例为子宫腺肌病行内膜切除 ,经补钠、利尿和纠正左心功能衰竭 ,症状得到控制。结论 复杂的宫腔内操作是宫腔镜单极电切手术中并发症发生的潜在危险 ,进行术前预处理、术中监护等 。

Objective To investigate the clinical characteristics, treatment and prevention methods of severe complications during hysteroscopic procedures Methods From January 1995 to January 2001, seventeen cases with uterine perforation, heavy bleeding and fluid overload respectively were encountered during hysteroscopic procedures This analysis focuses on their diagnosis and clinical management as well as prevention methods Results Three cases with uterine perforation and seven with uncomplete perforation followed transcerivcal resection of myoma (TCRM), transcerivcal resection of adhension, transcerivcal resection of septum and transcerivcal removal of foreign body respectively, which were diagnosied by both B ultrasonography and laparoscopy and treated laparoscopically Four cases with heavey bleeding were encountered during TCRM Foley catheter was inserted into uterine cavity to stop the bleeding successfully Three cases with fluid overload were cured by diuretic agent and saline infusion There were no serious consequence happened Conclusions It is a potential high risk factor of resulting in complications that performing complicated procedures inside uterine cavity during hysteroscopic operations Pre treatment with gonadotropin releasing a and guiding with B ultrasound/ laparoscopy as well as controlling irrigation pessure are necessary for proventing above complications