一次性阴道内镜在日间手术中的临床应用

Clinical application of disposable vaginal endoscopy in daytime operation

目的探讨一次性阴道内镜在日间手术中的应用价值。方法选择陆军军医大学第二附属医院进行宫腔镜日间手术患者100例,年龄27~43岁,平均年龄35.97岁(标准差7.69岁);身体质量指数(BMI)19.6~26.8 kg/m^(2),平均BMI23.05 kg/m^(2)(标准差4.85 kg/m^(2));阴道分娩56例,剖宫产44例;宫腔操作史68例;疾病类型异常子宫出血20例,宫腔粘连20例,子宫内膜息肉20例,黏膜下子宫肌瘤20例,节育器取出20例。采用随机数字表法分为两组,每组50例。对照组患者采用常规复用宫腔镜手术,试验组患者采用一次性阴道内镜手术。统计两组患者手术时间、术中出血量、扩宫率,评估患者术后1 h疼痛情况及并发症情况,并统计患者满意度评分和出院1周阴道出血量。结果试验组患者术中出血量多占比4.00%(2/50),出血量一般占比8.00%(4/50),出血少占比88.00%(44/50),对照组患者分别为20.00%(10/50)、26.00%(13/50)、54.00%(27/50);两组差异有统计学意义(P<0.05)。试验组手术时间为(12.77±5.41)min,低于对照组[(38.38±7.62)min],两组差异有统计学意义(P<0.05)。试验组扩宫率为12.00%(6/50),对照组扩宫率为64.00%(32/50);前者明显更低,差异有统计学意义(P<0.05)。试验组术后1 h视觉模拟量表(VAS)评分为(1.12±0.45)分,对照组为(2.36±1.04)分;试验组明显低于对照组,差异有统计学意义(P<0.05)。两组患者均无宫颈裂伤、大出血发生,对照组子宫穿孔2例(4.00%),试验组无子宫穿孔发生,差异无统计学意义(P>0.05)。对照组出现恶心呕吐12例(24.00%),血压/心率异常11例(22.00%),试验组分别为4例(8.00%)、3例(6.00%);两组差异有统计学意义(P<0.05)。出院1周出血量试验组少量占比56.00%(28/50),中等占比36.00%(18/50),大量占比8.00%(4/50),对照组分别为30.00%(15/50)、54.00%(27/50)、16.00%(8/50),差异有统计学意义(P<0.05)。试验组患者满意度为94.00%(47/50),对照组为70.00%(35/50),差异有统计学意义(P<0.05)。结论相较于传统宫腔镜手术,一次性阴道内镜手术微创、高效等优势显著,可缩短患者出院时间,明显降低患者术后疼痛,提高患者满意度,值得在门诊日间手术广泛推广、开展。

Objective To explore the application value of disposable vaginal endoscopy in daytime operation.Methods A total of 100 patients underwent hysteroscopic day operation were enrolled,which aged 27-43 years old with mean age of 35.97 years old(standard deviation 7.69 years old);body mass index(BMI)was 19.6-26.8 kg/m2 with mean BMI of 23.05 kg/m2(standard deviation 4.85 kg/m2).There were 56 cases of vaginal delivery,44 of cesarean section and 68 of uterine cavity operation history;20 cases of abnormal uterine bleeding,20 of intrauterine adhesions,20 of endometrial polyps,20 of submucosal uterine fibroids and 20 of intrauterine device removal.All patients were divided into control group(n=50,conventional hysteroscopic operation)and experimental group(n=50,disposable vaginal endoscopic operation)by random number table method.The operative time,intraoperative bleeding volume and dilatation rate of 2 groups were counted.The pain and complications at 1-hour after operation were evaluated,the patient satisfaction score and vaginal bleeding volume 1-week post discharge were counted.Results In experimental group,the excessive intraoperative bleeding volume[accounted for 4.00%(2/50)],moderate intraoperative bleeding volume[8.00%(4/50)],and restrained intraoperative bleeding volume[88.00%(44/50)]were statistically significantly lower than those of control group[20.00%(10/50),26.00%(13/50),and 54.00%(27/50)](P<0.05),respectively.The operative time of experimental group[(12.77±5.41)minutes]was statistically significantly less than that of control group[(38.38±7.62)minutes](P<0.05).The dilatation rate of experimental group[12.00%(6/50)]was significantly lower than that of control group[64.00%(32/50)],and the difference was statistically significant(P<0.05).The visual analogue scale(VAS)score at 1-hour after operation in experimental group[(1.12±0.45)scores]was statistically significantly lower than that in control group[(2.36±1.04)scores](P<0.05).There were no cervical laceration and massive hemorrhage in 2 groups,and 2 cases(4.00%)of uterine perforation in control group and non-uterine perforation in experimental group,the difference was no statistically significant(P>0.05).There were 12 cases(24.00%)of nausea and vomiting,11(22.00%)of abnormal blood pressure/heart rate in control group,and 4 cases(8.00%)and 3(6.00%)in experimental group,respectively.the difference between 2 groups was statistically significant(P<0.05).At 1-week after discharge,the restrained intraoperative bleeding volume accounted for 56.00%(28/50),moderate intraoperative bleeding volume accounted for 36.00%(18/50),and excessive intraoperative bleeding volume accounted for 8.00%(4/50)in experimental group,which were significantly lower in control group[20.00%(10/50),26.00%(13/50),and 54.00%(27/50)](P<0.05),respectively.Conclusion It is demonstrated that disposable vaginal endoscopic operation is more minimally invasive and efficient than traditional hysteroscopic operation,it could shorten discharge time,significantly reduce postoperative pain,and improve patient satisfaction,which is worthy of extensive promotion in outpatient daytime operation.