多部位局麻用于MyoSure宫腔镜子宫内膜息肉机械旋切术效果

Clinical effect of the MyoSure hysteroscopic mechanical circumcision for treating endometrial polyps of patients under multi-site local anesthesia

目的:探讨多部位局部麻醉用于宫腔镜机械旋切术治疗子宫内膜息肉(EP)的效果及安全性。方法:选择2019年5月-2022年5月于本院就治的EP患者182例,随机数字表法分两组各91例,对照组应用宫腔镜电切术,观察组应用多部位局部麻醉MyoSure宫腔镜机械旋切术,对比两组围手术期指标,术后疼痛视觉模拟评分(VAS),月经失血量(PBAC)评分,子宫内膜厚度、子宫动脉血流阻力指数(RI)及搏动指数(PI)、并发症、复发率及妊娠率。结果:观察组手术时间(17.3±4.1min)及术后阴道出血持续时间(2.5±0.8d)均短于对照组(24.6±4.7 min、5.4±1.3d),术中出血量(14.6±2.9ml)少于对照组(18.4±4.0ml),术后12h VAS两组均高于术后2h但观察组(4.3±1.0分)低于对照组(5.5±1.1分);术后3个月PBAC得分观察组(63.8±7.1分)高于对照组(50.3±6.3分),排卵期子宫内膜厚度(8.3±1.5mm)高于对照组(6.9±1.3mm),RI(0.55±0.08)、PI(1.45±0.31)低于对照组(0.64±0.13、1.67±0.29),并发症总发生率(2.2%)低于对照组(9.9%),术后6个月时,有生育要求患者妊娠率观察组(71.4%)高于对照组(48.7%)(均P<0.05)。结论:多部位局部麻醉下美奥舒宫腔镜行EP机械旋切术临床效果较高,可缩短术中操作时间、降低出血量及减轻疼痛,患者术后恢复快,提高术后妊娠率,安全性好。

Objective:To investigate the effect and safety of the MyoSure hysteroscopic mechanical circumcision for treating endometrial polyps(EP) of patients under multi-site local anesthesia.Methods:182 patients with EP were selected and were randomly divided into two groups(91 cases in each group) from May 2019 to May 2022.The patients in the control group were treated with hysteroscopic electrotomy of EP,while the patients in the observation group were treated with MyoSure hysteroscopic mechanical circumcision of EP under the multiple site local anesthesia.The perioperative indicators values,the visual analog score(VAS),the menstrual blood loss assessment chart(PBAC) score,the endometrial thickness,the values of resistance index(RI) and pulsatility index(PI) of uterine artery blood flow,the complications rate,the recurrence rate,and the pregnancy rate of the patients were compared between the two groups.Results:The operative time(17.3±4.1min) and the duration of postoperative vaginal bleeding(2.5±0.8d) of the patients in the observation group were significantly shorter than those(24.6±4.7min and 5.4±1.3d) of the patients in the control group.The amount of intraoperative bleeding(14.6±2.9ml) of the patients in the observation group was significantly less than that(18.4±4.0ml) of the patients in the control group.The VAS score of the patients at 12h after operation in the observation group was significantly higher than that of the patients at 2h after operation.The VAS score of the patients in the observation group(4.3±1.0) was significantly lower than that(5.5±1.1) of the patients in the control group.The PBAC score(63.8±7.1 points) of the patients in the observation group in 3 months after operation was significantly higher than that(50.3±6.3points)of the patients in the control group.The endometrial thickness of the patients during ovulation(8.3±1.5mm)in the observation group was significantly higher than that(6.9±1.3mm)of the patients in the control group.The values of RI(0.55±0.08)and PI(1.45±0.31)of the patients in the observation group were significantly lower than those(0.64±0.13and 1.67±0.29)of the patients in the control group.The total complication rate(2.2%)of the patients in the observation group was significantly lower than that(9.9%)of the patients in the control group.The pregnancy rate(71.4%)of the patients with fertility requirements in the observation group was significantly higher than that(48.7%)of the patients in the control group(all P<0.05).Conclusion:Multi-site local anesthesia used during the MyoSure hysteroscopic mechanical circumcision for treating the patients with EP can improve their effect of PE,shorten their operation time,reduce their bleeding volum,alleviate their pain,and which can improve the postoperative recovery and pregnancy rate,with better safety.