门诊无麻醉阴道内镜技术对绝经后女性宫腔病变的应用价值

The value of outpatient non-anesthesia vaginal endoscopic technique for uterine lesions in postmenopausal women

目的探讨门诊无麻醉阴道内镜技术对绝经后女性宫腔病变的应用价值。方法回顾性分析2016年1月至2021年1月复旦大学附属妇产科医院行门诊无麻醉宫腔镜检查的绝经后女性患者96例,包括阴道内镜组(n=47)和传统宫腔镜组(n=49),比较2组的手术时长、术中出血量、膨宫液用量、术中出现假道、手术失败情况、患者疼痛程度(VAS评分)、并发症发生率、术后恢复等。结果阴道内镜组中手术时长短于10 min(86%vs 61%)、术中出血量小于3 mL(93%vs 73%)、轻度疼痛(VAS评分≤3分,83%vs 63%)、术后腹痛时长<2 h(93%vs 71%)、术后出血时长<7 d(98%vs 82%)、手术失败情况(11%vs 0)比例均高于传统宫腔镜组,差异均有统计学意义(P<0.05)。并发症方面,阴道内镜组中恶心/呕吐患者(9%vs 29%)、心率/血压异常患者(12%vs 31%)的比例均低于传统宫腔镜组,差异均有统计学意义(P<0.05)。膨宫液用量和术中出现假道情况,2组差异均无统计学意义。结论阴道内镜技术较传统宫腔镜更微创、更安全,但有一定失败率。门诊无麻醉阴道内镜可作为绝经后女性宫腔病变的前驱检查手段。

Objective To explore the value of outpatient non-anesthesia vaginal endoscopic technique for uterine lesions in postmenopausal women.Methods 96 postmenopausal patients treated by outpatient hysteroscopy from January 2016 to January 2021 in Obstetrics and Gynecology Hospital of Fudan University were retrospectively analyzed,including 47 cases of vaginal endoscopy and 49 cases of traditional hysteroscopy.The two groups were compared with the operation time、the amount of bleeding,the amount of the distension fluid,creation of a false passage,the incidence of failure,patient pain score,incidence of complications and patients’post-surgery recovery.Results For cases with surgery time less than 10 minutes(86%vs 61%)、intraoperative bleeding less than 3 mL(93%vs 73%),mild pain(VAS score≤3,83%vs 63%),the duration of postoperative pain less than 2 hours(93%vs 71%),postoperative bleeding duration less than 7 days(98%vs 82%),surgical failure(11%vs 0),the ratio of which were higher in the vaginal endoscopy group than in the traditional hysteroscopy group,statistically significant(P<0.05).For cases of nausea/vomiting(9%vs 29%),abnormal heart rate/blood pressure(12%vs 31%),the ratio of which were lower in the vaginal endoscopy group than in the traditional hysteroscopy,statistically significant(P<0.05).There was no significant difference in the amount of the distension fluid and creation of a false passage between the two groups.Conclusions Vaginal endoscopy technology is more minimally invasive and safer than traditional hysteroscopy with a certain failure rate.For postmenopausal female with intrauterine lesions,outpatient non-anesthesia vaginal endoscopy can be recommended as an examination method prior to the traditional hysteroscopy.