[1]左欣曌 孔伟 彭蓉 张继梅 成星函 熊光武*.宫腔镜刨削刀系统治疗稽留流产34例[J].中国微创外科杂志,2019,01(1):31-49.
　Zuo Xinzhao,Kong Wei,Peng Rong,et al.Hysteroscopic Shaving System for the Treatment of 34 Patients with Missed Abortion[J].Chinese Journal of Minimally Invasive Surgery,2019,01(1):31-49.
点击复制

宫腔镜刨削刀系统治疗稽留流产34例()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2019年1期
页码:
31-49
栏目:
临床研究
出版日期:
2019-01-25

文章信息/Info

Title:
Hysteroscopic Shaving System for the Treatment of 34 Patients with Missed Abortion
作者:
左欣曌 孔伟 彭蓉 张继梅 成星函 熊光武*
（重庆医科大学附属第三医院妇产中心，重庆401120）
Author(s):
Zuo Xinzhao;  Kong Wei;  Peng Rong;  et al.
Center of Obstetrics and Gynecology, Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
关键词:
宫腔镜; 刨削系统; 稽留流产
Keywords:
Hysteroscopy; Shaving system; Missed abortion
文献标志码:
A
摘要:
目的探讨宫腔镜刨削系统治疗稽留流产的安全性及可行性。方法2017年3月~2018年3月我院对34例稽留流产经宫腔镜刨削系统清宫，先用卵圆钳钳夹出残留的大部分妊娠组织，再置入宫腔镜观察宫腔内残留机化妊娠组织大小、部位，与子宫肌层的关系，然后置入刨削刀头对残留妊娠组织进行刨削清除，刨削清除完毕后检查有无残留及活动性出血。钳夹清宫组织及刨削组织全部送病理检查。结果34例宫腔镜刨削手术均顺利完成。术中无经尿道前列腺电切（transurethral resection of prostate, TURP）综合征、子宫穿孔、宫颈裂伤发生，术后无宫颈管粘连、感染等并发症发生。1例宫腔残留（2.9%），行二次宫腔镜探查，见胚物残留于右侧宫角，膨宫良好时方能看清，再次刨削清除。术后6个月有生育要求的8例，成功妊娠4例。5例自觉月经量较术前轻度减少，余29例均自觉月经量无明显变化。术后6个月疗效：满意率85.3%（29/34），基本满意率11.8%（4/34），不满意率2.9%（1/34）。结论宫腔镜刨削系统应用于稽留流产安全、可行。
Abstract:
ObjectiveTo summarize the feasibility and safety of hysteroscopic shaving system(Integrated Bigatti Shaver) in the treatment of missed abortion.MethodsThirtyfour patients with missed abortion were treated with Integrated Bigatti Shaver from March 2017 to March 2018. At first, we used the sponge clamp to remove the most embryonic organization. Then the hysteroscope was used to inspect the residual tissue. Finally, the shaving system was inserted to clear the residual tissue and examine the uterine cavity again. The removed tissue was all in pathological examination.ResultsThe hysteroscopic shaving surgery was accomplished in all the cases. No transurethral resection of prostate (TURP) syndrome, uterine perforation, cervical laceration occurred during the operation, and no complications such as cervical adhesion or infection occurred after the operation. Complete removal of the residual tissue was achieved in 33 of 34 patients. One patient (2.9%) received the second operation. The residual tissue was in right horn of uterus which could be seen only after satisfied uterine distention. We used the hysteroscopic shaving system to clear the residual tissue again. Eight patients wanted to have a baby in six month while four of them got pregnant. Five patients felt menstrual quantity decrease, and the remaining patients had normal menstrual quantity.Curative effects at 6 months after surgery showed a satisfaction rate of 85.3%(29/34),a most satisfaction rate of 11.8%(4/34), and a dissatifaction rate of 2.9%(1/34).ConclusionIntegrated Bigatti Shaver is feasible and safe for the treatment of missed abortion.

参考文献/References:

[1]谢幸，孔北华，段涛，主编.妇产科学.第9版.北京：人民卫生出版社，2018.72.
[2]黄福利.稽留流产致子宫切除1例教训分析.医学理论与实践,2016,29(24):3381.
[3]Touboul C, Fernandez H, Deffieux X. Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility. Fertil Steril,2009,92(5):1690-1693.
[4]孔伟,成星函,张继梅，等.宫腔镜刨削系统治疗子宫黏膜下肌瘤.中国微创外科杂志,2018,18(2):177-180.
[5]［No authors listed］ The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril,1988,49(6):944-955.
[6]Philipp T, Kalousek DK. Generalized abnormal embryonic development in missed abortion: embryoscopic and cytogenetic findings. Am J Med Genet,2002,111(1):43-47.
[7]杨月芬，黄凌云.阴道加德纳氏菌感染与稽留流产的关系.实用临床医药杂志,2010,14(3):77-81．
[8]Amegah AK, Jaakkola JJ. Work as a street vendor, associated trafficrelated air pollution exposures and risk of adverse pregnancy outcomes in Accra, Ghana. Int J Hyg Environ Health,2014,217(2-3):354-362.
[9]Chen BA, Creinin MD. Contemporary management of early pregnancy failure. Clin Obstet Gynecol,2007,50(1):67-88.
[10]Hassan R, Bhala K, Joseph B. The need for repeat evacuation of retained products of conception: how common is it? J Obstet Gynaecol,2013,33(1):75-76.
[11]Nicopoullos JDM, Treharne A, Raza A. The use of a hysteroscopic resectoscope for repeat evacuation of retained products of conception procedures: a case series. Gynecol Surg,2010,7(2):163-166.
[12]Cohen SB, KalterFerber A, Weisz BS. Hysteroscopy may be the method of choice for management of residual trophoblastic tissue. J Am Assoc Gynecol Laparosc,2001,8 (2):199-202.
[13]夏恩兰，主编.宫腔镜学及图谱.第3版.郑州：河南科学技术出版社，2016.402.
[14]Jansen FW, Vredevoogd CB, van Ulzen K. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol,2000,96(2):266-270.
[15]黄晓武,夏恩兰.解读宫腔镜手术并发症——TURP综合征.国际妇产科学杂志,2014,41(5):566-569,574.

备注/Memo

备注/Memo:
*通讯作者，Email：xionggw@163.com
更新日期/Last Update: 2019-04-09