宫腔镜在高危计划生育手术中应用的单中心研究

Application ofhysteroscopy in high-riskfamily planning operations

目的探讨宫腔镜在高危计划生育手术中的应用价值。方法选取2013年1月至2018年10月行宫腔镜高危计划生育手术患者558例,记录患者一般临床资料及手术情况、术后阴道出血及月经恢复时间、住院时间、手术并发症,同时记录术中意外发现的宫腔异常合并症(宫腔粘连、子宫内膜息肉、黏膜下子宫肌瘤、子宫疤痕憩室)。结果子宫瘢痕妊娠(内生型)241例,稽留流产(≥2次)123例,宫角妊娠58例,人工流产或清宫术后妊娠物残留53例,妊娠合并子宫纵隔或双子宫27例,嵌顿环(包含残留环)56例;宫腔镜手术时间(10.3±5.3)min,术中出血量(8.0±7.1)ml,术后阴道出血时间(6.7±2.7)d,住院时间(1.4±0.5)d,术后月经恢复时间(31.8±5.0)d,手术并发症发生率为0.7%(子宫穿孔1例、术中大出血2例、宫腔粘连1例);术中意外发现宫腔异常合并症发生率为39.6%。结论宫腔镜技术用于高危计划生育手术安全有效,手术并发症少,同时能发现宫腔异常合并症,值得在高危计划生育手术中进一步推广。

Objective To evaluate the application of hysteroscopy in high-risk family planning operations. Methods A total of 558 patients undergoing family planning operations with hysteroscopy in our hospital from January 2013 to October 2018 were retrospectively analyzed. General clinical data were recorded, the operation time, intraoperative blood loss, the related complication, the postoperative vaginal bleeding,length of hospital atay and the menstrual recovery time were documented.Moreover, the unexpected findings of uterine cavity(including intrauterine adhesion, endometrial polyp, submucous uterine myomas,cesarean scar diverticulum) was also documented. Results There were 241 cases of cesarean scar pregnancy(endogenous type),123 cases of missed abortion(≥ two times), 58 cases of corneal pregnancy, 53 cases of removal of pregnancy residues after induced abortion or curettage, 27 cases of uterine septum or double uterus, 56 cases of incarcerated ring(containing residues). The operation time was(10.3±5.3)min;the blood loss during operation was(8.0±7.1)ml;the time of postoperative vaginal bleeding was (6.7±2.7) days;the length of hospital stay was(1.4±0.5)days;the recovery time of postoperative menstruation was (31.8±5.0)days;the surgical complication rate was 0.7%(1 case of uterine perforation, 2 cases of intraoperative massive bleeding, 1 case of intrauterine adhesion);the coexisting disease rate of uterine cavity was 39.6%. Conclusion Hysteroscopy is safe and effective in the treatment of high-risk family planning operations. Surgical complication is rare and some abnormal intrauterine diseases can be found during the operation.