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目的 探讨在门诊实施宫腔镜子宫纵隔切开术(TCRS)的安全性和可行性。方法 回顾性分析168例经阴道超声扫描、子宫输卵管碘油造影(HSG)、宫腔镜和腹腔镜检查明确诊断为子宫纵隔患者的临床资料,比较住院与门诊条件下实施宫腔镜TCRS在手术时间、出血量、膨宫液体消耗量、术后住院时间、手术耐受性方面的差异。综合评价门诊宫腔镜TCRS在时效比方面是否具有优越性。结果 48例住院患者中,行全身麻醉或区域麻醉16例,局部浸润麻醉8例,无麻醉24例;120例门诊患者中,行宫颈浸润麻醉38例,无麻醉82例。术中腹腔镜监护7例,均为同时行输卵管整形或卵巢囊肿剥出术者;B超监护22例;未监护139例(82.7%,139/168例)。应用宫腔镜微型剪刀完成TCRS 17 例(10. 1%, 17/168 例),双极汽化电极切开术120 例(71.4%,120/168例),宫腔镜微型剪刀结合汽化电极切开术31例(18.5%,31/168例)。168例宫腔镜TCRS均一次完成,未发生电损伤、子宫穿孔、水中毒、大出血等严重并发症。住院患者的手术时间、出血量、膨宫液用量与门诊手术患者的差异无显著性;但术后住院时间[(51.78±39.65) h]较门诊手术患者[(1.35±0.76) h]明显延长(P<0.001)。结论 在门诊实施宫腔镜TCRS安全、有效、可行,能节省时间和费用,对患者的生活、工作影响较小。
Objective To investigate the safety and feasibility of hysteroscopic hysterectomy (TCRS) in outpatients. Methods A retrospective analysis of 168 cases of transvaginal ultrasound scan, hysterosalpingography (HSG), hysteroscopy and laparoscopy diagnosed as uterine mediastinal patients with clinical data to compare hospitalization and outpatient conditions under the implementation of hysteroscopic TCRS in surgery Time, amount of bleeding, liquid consumption of discoid, postoperative hospital stay, and surgical tolerance. Comprehensive evaluation of outpatient hysteroscopic TCRS in the aspect ratio is superior. Results Among the 48 inpatients, 16 were under general anesthesia or regional anesthesia, 8 were locally infiltrated anesthesia, and 24 were not anesthetized. Of the 120 outpatients, 38 were treated with cervical infiltration and 82 without anesthesia. Intraoperative laparoscopic monitoring in 7 cases, both at the same time ovarian tubal or ovarian cyst stripping surgery; 22 cases of B-monitoring; unmasked 139 cases (82.7%, 139/168 cases). TCRS was performed in 17 cases (10.1%, 17/168 cases) with hysteroscopic miniature scissors, 120 cases (71.4%, 120/168 cases) with bipolar vaporization electrode dissection, hysteroscopic micro scissors combined with vaporization electrode cutting Open surgery in 31 cases (18.5%, 31/168 cases). 168 cases of hysteroscopic TCRS were completed in one time, no electrical injury, uterine perforation, water poisoning, bleeding and other serious complications. There was no significant difference in the operation time, bleeding volume, the amount of uterine fluid and the number of outpatients in hospitalized patients, but the postoperative hospital stay [(51.78 ± 39.65) h] was significantly longer than that of outpatients (1.35 ± 0.76 h) (P <0.001). Conclusions The implementation of hysteroscopic TCRS in the outpatient department is safe, effective and feasible, which can save time and expense and has little impact on patients’ life and work.