膨宫压力调节器在宫腔镜电切手术中的应用

目的评价自主研发的膨宫压力调节器在宫腔镜电切手术中应用的可行性与安全性。方法选择2019年10月至2022年2月行宫腔镜子宫黏膜肌瘤电切术60例,按随机数字表法分为观察组与对照组。观察组使用膨宫压力调节器;对照组使用常规连续灌流膨宫装置。两组患者全身麻醉气管插管后经口将食道超声探头放置在食管中段;记录手术开始前(T0)、冲洗量5,000 mL(T1)、冲洗量10,000 mL(T2)、冲洗量15,000 mL(T3)时膨宫泵显示的膨宫压力,患者血清Na^(+)浓度、血红蛋白(Hb)及校正血流时间(FTc);记录两组患者FTc≥360 ms发生次数,过度水化综合征发生情况;调查医师满意度。结果与T0时比较,观察组患者T3时Na^(+)浓度降低,T2、T3时Hb明显降低,T3时FTc升高(P<0.05);对照组患者T2、T3时Na^(+)及Hb均明显降低,T1~T3时FTc均升高(P<0.05)。与观察组比较,对照组患者T2、T3时Na^(+)明显降低,T3时Hb降低,T2、T3时FTc升高(P<0.05)。对照组有5例患者T3时FTc≥360 ms,观察组未发生,差异有统计学意义(P<0.05);两组患者均未发生过度水化综合征。结论自制膨宫压力调节器可自动调节膨宫压力,使宫腔压力始终保持在低压状态且不影响手术视野,降低过度水化综合征的发生率,使宫腔镜电切手术更具安全性。

Objective To evaluate the feasibility and safety of the self-developed dilatation pressure regulator in hysteroscopic electrotomy.Methods A total of 60 cases of hysteroscopic uterine mucosal myomectomy in our hospital from October 2019 to February 2022 were selected and divided into group A and group B according to the random number table method.Group A used a dilatation pressure regulator,group B used a conventional continuous perfusion uterine dilatation device.After tracheal intubation under general anesthesia,the esophageal ultrasound probe was placed in the middle of the esophagus orally in the two groups of patients.The volume pressure,serum Na^(+)concentration,haemoglobin(Hb)and correct blood flow time(FTc)of patients were recorded before operation(T0),at 5,000mL irrigation(T1),10,000mL irrigation(T2)and 15,000mL irrigation(T3).The frequency of FTc≥360 ms and the occurrence of water poisoning in the two groups were recorded.Investigated physician satisfaction.Results Compared with T0,Na^(+)concentration in group A decreased at T3,Hb decreased significantly at T2 and T3,and FTc increased at T3(P<0.05);Na^(+)and Hb in group B were significantly decreased at T2 and T3.FTc increased at T1~T3(P<0.05).Compared with group A,Na^(+)in group B were significantly decreased at T2 and T3,Hb decreased at T3 and FTc increased at T2 and T3(P<0.05).There were 5 patients in group B with FTc≥360 ms at T3,which did not occur in group A,and the difference was statistically significant;none of the patients suffered from water intoxication.Conclusion The uterine distention pressure regulator can automatically reduce the uterine distention pressure,so that the uterine cavity pressure is always kept at a low state without affecting the surgical field,fundamentally reducing the probability of excessive hydration syndrome,and making hysteroscopic electric resection more safe.