宫腔镜单极和双极区别 等离子双极宫腔镜电切术治疗子宫黏膜下肌瘤的临床价值研究

　　[摘要] 目的 探讨等离子双极宫腔镜电切术治疗子宫黏膜下肌瘤的临床疗效。 方法 回顾分析2005年1月～2009年12月本院收治的行宫腔镜电切术治疗的子宫黏膜下肌瘤患者172例，将其随机分为对照组和观察组各86例，对照组行单极宫腔镜电切术，观察组行等离子双极宫腔镜电切术，所有患者均于术前、术后即刻检测外周静脉血Na+、Cl-、K+、血糖（Glu）的浓度，记录手术时间、灌流液吸收量、术中出血量等指标的变化。 结果 对照组手术后Na+、Cl-、K+浓度明显降低，Glu浓度则明显升高；而观察组手术后Na+、Cl-、K+、Glu浓度的改变较术前差异无统计学意义（P ＞ 0.05）。两组患者的手术时间差异无统计学意义（P ＞ 0.05），但观察组灌流液吸收量及术中失血量较对照组明显减少（P ＜ 0.05）。对照组子宫肌瘤类型对患者的手术时间、灌流液吸收量、术中出血量及电解质、血糖的影响较大，Ⅱ型肌瘤患者手术时间、灌流液吸收量、术中出血量、Na+、Cl-、Glu浓度均高于0型及Ⅰ型肌瘤患者，差异有统计学意义（P ＜ 0.05）；0型及Ⅰ型肌瘤患者上述各指标差异不明显。观察组Ⅱ型肌瘤患者手术时间、灌流液吸收量、术中出血量均高于0型及Ⅰ型肌瘤患者，差异有统计学意义（P ＜ 0.05）；0型及Ⅰ型肌瘤患者上述各指标差异不明显；且3种肌瘤类型间Na+、Cl-、K+、Glu浓度差异无统计学意义（P ＞ 0.05）。 结论 等离子双极宫腔镜电切术治疗子宫黏膜下肌瘤不会引起血电解质及血糖的明显变化，术中出血量相对较少，肌瘤类型对灌流液吸收量、手术时间、术中出血量影响较大，Ⅱ型肌瘤的灌流液吸收量、手术时间、术中出血量明显较0型及Ⅰ型增多。
　　[关键词] 子宫黏膜下肌瘤；等离子双极宫腔镜电切术；单极宫腔镜电切术
　　[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2012）07（b）-0023-03
　　Clinical value of plasma bipolar hysteroscopic in the treatment of Submucous mucosa
　　WU Rufang
　　Department of Gynecology and Obstetrics, the Central Hospital of Wuhan City, Hubei Province, Wuhan 430014, China
　　[Abstract] Objective To evaluate clinical efficacy of plasma bipolar hysteroscopic in the treatment of submucous mucosa. Methods A total of 172 patients undergoing hysteroscopic electrosurgery were retrospective analyzed from January 2005 to December 2009, who were randomly divided into control group and observation group 86 cases in each group. The control group were used single-stage hysteroscopic electrosurgery, observation group were used Plasma bipolar hysteroscopic electrosurger. Serum sodium (Na+), chlorine (Cl-), potassium (K+) and Glucose (Glu) were measured before and after the operation. Meanwhile, the operation time, absorption volume and bleeding volume were also recorded after the operation. Results Na+, Cl-, K+ and Glu concentrations in the control group after the operation were significantly decreased, but GLU increased significantly; Na+, Cl-, K+ and Glu concentrations in observation group, however, did not change significantly before and after the operation (P > 0.05). There was no significant difference of the operation time between the two groups (P ＞ 0.05), but the absorption volume and volume of bleeding during the operation were increased in control group compared with those in observation group (P 0.05). Conclusion Plasma bipolar hysteroscopic electrosurgery in treatment of submucous myoma do not cause significant changes in serum electrolytes and blood sugar, bleeding volume is relatively small. Fibroids type greatly impact the absorption volume, operation time and bleeding volume, and the operation time, absorption volume and bleeding volume on type Ⅱ myoma is significantly increased than the type 0 and type Ⅰ.