目的 比较宫腔镜下子宫内膜息肉切除术(TCRP)后采用地屈孕酮以及少腹逐瘀汤两种不同治疗方法对预防息肉复发的效果。方法 从北京中医药大学深圳医院(龙岗)妇科2019年1月—2020年7月间收治的子宫内膜息肉患者中随机选取150例作为研究对象,采取随机数字表法将患者随机分为对照组、地屈孕酮组和少腹逐瘀汤组,每组各50例。对照组患者实施TCRP治疗,地屈孕酮组实施TCRP+地屈孕酮治疗,少腹逐瘀汤组实施TCRP+地屈孕酮+少腹逐瘀汤治疗,术后对3组患者随访12个月,比较3组患者干预3、6、12个月息肉复发情况、子宫内膜厚度以及不良情况应发生率。结果 治疗第6、12个月时,地屈孕酮组及少腹逐瘀汤组复发率情况均低于对照组(P＜0.05),地屈孕酮组及少腹逐瘀汤组子宫内膜息肉复发率比较差异无统计学意义(P＞0.05)。少腹逐瘀汤组及地屈孕酮组3次复查子宫内膜厚度均小于对照组(P＜0.05);少腹逐瘀汤组治疗12个月时子宫内膜厚度小于地屈孕酮组(P＜0.05)。3组患者不良反应发生率比较,差异不具有统计学意义(P＞0.05)。结论 宫腔镜下息肉切除术后加服少腹逐瘀汤与地屈孕酮片对宫腔镜下子宫内膜息肉切除术后患者进行干预,可有效降低患者子宫内膜息肉复发率,促进患者术后月经恢复正常,且将两者联合应用疗效安全,具有较高的应用价值。

目的 比较采用一次性使用电子宫腔镜与可重复使用宫腔镜用于门诊宫腔镜检查的有效性与安全性。方法 采用平行随机对照的方法,在3间临床试验研究机构同时进行,一次性使用电子宫腔镜用于宫腔镜检查者82例为试验组,Storz Bettochi检查镜进行检查者82例为对照组。记录2组患者宫腔影像的临床诊断符合率、操作性能评分、不良事件发生率。结果 试验组临床诊断要求符合率98.8%（80/82）,对照组临床诊断要求符合率100%（82/82）;试验组与对照组宫腔影像的临床诊断要求符合率的差值为-1.22%,试验组和对照组符合率差值的95%可信区间下限为-3.60%,大于非劣效界值-10.00%。试验组与对照组之间的操作性能评分比较差异无统计学意义（P>0.05）。试验组不良事件发生率11.0%（9例,9件）,严重不良事件发生率1.2%（1例,1件）;对照组中不良事件发生率9.8%（8例,9件）,严重不良事件发生率0%（0例,0件）;不良事件发生率和严重不良事件发生率的组间比较差异均无统计学意义（P>0.05）。结论 一次性使用电子宫腔镜用于提供患者子宫内图像,整体性能与可重复使用的电子宫腔镜相当,并且安全性好。试验用一次性使用电子宫腔镜的使用性能可满足临床宫腔镜手术的需求,可作为宫腔镜技术的补充手段。

Objective To compare the efficacy and safety of single-use digital hysteroscope and reusable hysteroscope for outpatient hysteroscopy．Methods A parallel randomized control method was used in three clinical trials institutions．Eighty-two cases of outpatient patients who used single-use digital hysteroscope for hysteroscopy were included in experimental group,and 82 cases who underwent hysteroscopy by reusable hysteroscope（Storz Bettochi）were included in control group．The clinical diagnosis coincidence rate,performance score and incidence of adverse events of uterine imaging were recorded in the two groups．Results The coincidence rate of clinical diagnosis in the experimental group was 98.8%（80/82）,1.22% lower than the 100%（82/82）in control group．And the difference of lower limit of 95% confidence interval between the experimental group and the control group was-3.60%,which was greater than the non-inferiority margin-10.00%．There was no significant difference in performance scores between the experimental group and the control group（P>0.05）．The incidence of adverse events in the experimental group was 11.0%（9 cases,9 events）,and serious adverse events incidence was 1.2%（1 case,1 event）．In the control group,the incidence of adverse events was 9.8%（8 cases,9 events）,and no serious adverse events occurred（0 cases,0 events）．There was no significant difference in the incidence of adverse events or serious adverse events between two groups．Conclusions The overall performance of single-use digital hysteroscope for providing intrauterine images,observation and diagnosis is comparable to that of reusable hysteroscope,and the safety is also comparable．The performance of the single-use digital hysteroscope can meet the needs of outpatient hysteroscopy,and it can be an effective supplementary hysteroscopy technology．

目的 探讨围绝经期功能失调性子宫出血患者应用宫腔镜电切术联合炔诺酮治疗对临床效果的影响。方法 选取2017年1月—2020年9月在我院治疗的87例围绝经期功能失调性子宫出血患者,按照随机数字表法分成观察组(n=44)与对照组(n=43),观察组采用宫腔镜电切术联合炔诺酮治疗,对照组仅采用宫腔镜电切术治疗,比较2组临床疗效、手术情况、住院时间、不良反应发生率,分析治疗前后子宫形态、血红蛋白含量变化。结果 观察组治疗总有效率为100.00%,对照组为86.05%,观察组高于对照组(P<0.05);2组手术时间、术中出血量、膨宫液用量、住院时间比较无差异(P>0.05);2组治疗后子宫内膜厚度增加(P<0.05),血红蛋白水平下降(P<0.05),观察组子宫内膜厚度大于对照组(P<0.05),血红蛋白水平较对照组更低(P<0.05);观察组不良反应发生率为9.09%,对照组为27.91%,观察组低于对照组(P<0.05)。结论 宫腔镜电切术联合炔诺酮应用于围绝经期功能失调性子宫出血患者治疗中能够促进子宫状况改善,提高临床疗效,且安全性较高,值得临床推广。

目的 探究宫腔镜结合避孕药治疗子宫内膜息肉的临床疗效与对其安全性的分析。方法 随机选取2016年2月—2017年12月内160例子宫内膜息肉患者,分为对照组(80例,宫腔镜治疗)和观察组(80例,宫腔镜结合屈螺酮炔雌醇片治疗),对比两组临床疗效及不良反应的差异性。结果 与对照组相比,观察组患者月经改善效果更佳,其复发率更低,差异有统计学意义(P＜0.05);在不良反应的对比中,观察组结果与对照组结果相比较,不存在较大差异(P>0.05)。结论 宫腔镜结合避孕药治疗子宫内膜息肉取得了一定的临床疗效,不良反应并不显著,可推广运用。

Objective To explore the clinical efficacy and safety of hysteroscopy combined with contraceptives in the treatment of endometrial polyps. Methods From February 2016 to December 2017, 160 patients with endometrial polyps were randomly selected and divided into control group (80 cases treated by hysteroscopy) and observation group (80 cases treated by hysteroscopy combined with drospirenone and ethinyl estradiol tablets). The differences of clinical efficacy and adverse reactions between the two groups were compared. Results Compared with the control group, the observation group had better menstruation improvement effect and lower recurrence rate. The difference was statistically significant (P<0.05). In the comparison of adverse reactions, there was no significant difference between the observation group and the control group (P>0.05). Conclusion Hysteroscopy combined with contraceptives has achieved certain clinical efficacy in the treatment of endometrial polyps, and the adverse reactions are not significant, which can be popularized and applied.

目的 探讨将宫腔镜电切手术与高效孕激素治疗相联合,治疗青年女性子宫内膜癌的临床效果以及对患者生育功能的影响。方法 选取2018年5月—2020年5月我院收治的70例青年子宫内膜癌患者作为本次研究对象,根据患者入院时间单双号将患者分为对照组(n=35)和实验组(n=35),对照组患者应用高效孕激素治疗,实验组患者则在对照组的基础上联合应用宫腔镜电切术进行治疗。比较两组患者的临床疗效、再次妊娠的成功率,及血清CA125水平变化情况。结果 研究组患者在治疗后3个月的治疗有效率为94.2%,高于对照组患者治疗有效率74.2%,差异具有统计学意义(P<0.05);研究组在治疗后一年内成功受孕率91.4%高于对照组51.4%,差异具有统计学意义(P<0.05);治疗后,研究组血清CA125水平低于对照组(P<0.05)。结论 将宫腔镜电切术与高效孕激素治疗方式相结合,对治疗青年子宫内膜癌患者效果显著,能够保留患者生育功能的同时,降低血清CA125水平。

目的 探讨B超与MRI、宫腔镜联合诊断对宫腔占位性病变的临床意义。方法 选择2017年1月1日— 12月31日我院收治的108例疑似宫腔占位性病变患者为研究对象。所有患者均于宫腔操作前行阴道彩色多普勒超声(以下简称B超)检查、MRI检查及宫腔镜检查。与病理检查结果对比,分别分析其灵敏度、特异度。结果 108例患者中宫腔无病理变化者27例,子宫内膜息肉39例,子宫内膜增生27例,子宫黏膜下肌瘤10例,子宫内膜癌5例。B超、MRI、宫腔镜诊断灵敏度分别为72.84%、71.60%、75.31%,特异度分别为62.96%、85.19%、66.67%。B超+MRI诊断子宫黏膜下肌瘤和子宫内膜癌灵敏度100%,特异度分别为87.76%和99.03%。B超+MRI+宫腔镜诊断子宫内膜增生、子宫黏膜下肌瘤、子宫内膜癌灵敏度均为100%。结论 宫腔占位病变以良性病变居多,B超联合宫腔镜和MRI检查可提高诊断率。对子宫内膜癌高危人群应进行B超与MRI联合检查,宫腔镜定位活检仅在必要时实施。

Objective To explore the clinical significance of B-ultrasound, MRI and hysteroscopy in the diagnosis of uterine space occupying lesions. Methods 108 patients with suspected uterine space occupying lesions admitted to our hospital from January 1 to December 31 2017 were selected as the study objects. All patients were examined by vaginal color Doppler ultrasound, MRI and hysteroscopy before uterine operation. Compared with the results of pathological examination, the sensitivity and specificity were analyzed. Results Among the 108 patients, 27 had no pathological changes in uterine cavity, 39 had endometrial polyps, 27 had endometrial hyperplasia, 10 had submucous myoma, and 5 had endometrial cancer. The sensitivity of B-ultrasound, MRI and hysteroscopy were 72.84%, 71.60% and 75.31% respectively, and the specificity were 62.96%, 85.19% and 66.67% respectively. The sensitivity of B-ultrasound+MRI in the diagnosis of submucous myoma and endometrial carcinoma was 100% and the specificity was 87.76% and 99.03%, respectively. The sensitivity of B-ultrasound+MRI+hysteroscopy in the diagnosis of endometrial hyperplasia, submucous myoma and endometrial carcinoma was 100%. Conclusion Most of the uterine space occupying lesions are benign. B-ultrasound combined with hysteroscopy and MRI may improve the diagnosis rate. The high-risk group of endometrial cancer should be examined by B-ultrasound and MRI, and hysteroscopic biopsy would be performed only when necessary.

目的 研究宫腔镜治疗子宫粘连性所致不孕症的临床疗效,为临床相关治疗提供参考。方法 选取我院于2016年11月—2017年11月收治的180例子宫粘连性所致不孕症患者作为观察对象,按照随机数表法平均分成两组。其中观察组90例采用宫腔镜治疗,对照组90例采用传统输卵管通液治疗。对比两组患者治疗前后性激素水平、临床指标及妊娠结局变化。结果 两组间相比,治疗前后 LH、FSH、E2、P等性激素水平无变化,且治疗后观察组与对照组相比,差异均无统计学意义(P>0. 05);两组间相比,治疗后观察组患者的术中出血量、手术时间、住院天数均少于对照组,差异有统计学意义(P<0. 05);两组间相比,治疗后观察组患者的足月分娩率高于对照组,早产率低于对照组,差异有统计学意义(P<0. 05)。结论 宫腔镜治疗子宫粘连性所致不孕症,与传统输卵管通液治疗相比,对性激素水平无影响,但可显著降低患者住院时间及术中出血量,有效提高足月分娩率,值得在临床上推广。

目的 观察喉罩通气下全凭七氟醚吸入麻醉在妇科宫腔镜手术中的应用价值。方法 60例拟行妇科宫腔镜手术的患者随机分为七氟醚和丙泊酚组,每组30例,记录不同时间点两组患者的平均动脉压(MAP),脉搏血氧饱和度(SpO₂)、苏醒时间以及术后恶心,呕吐、躁动的发生率。结果 A组患者血流动力学指标波动较少,苏醒时间A组明显短于B组,差异有显著性(P<0.05)。两组患者诱导后MAP,HR均较诱导前显著下降(P<0.05)。B组患者术中MAP,HR值显著低于A组(P<0.05),拔除喉罩即刻两组MAP,HR差异无显著性(P>0.05)。结论 喉罩下全凭七氟醚吸入麻醉对患者的血流动力学的影响较小,适用于妇科宫腔镜手术。

Objective To observe the effect of laryngeal mask airway(LMA) combined with sevoflurane inhalation anaesthesia in gynecological hysteroscopy operation. Methods Sixty patients, classified from ASAⅠtoⅡscheduled for hysteroscopic operation were randomly divided into sevoflurane inhalation anesthesia group (group A) and propofol intravenous anesthesia group(group B).The mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), recovery time and the incidence of nausea, vomiting and recovery time were recorded at different time points of the two groups. Results The hemodynamic index of the patient in the group A fluctuated seldom,and the recovery time was significantly shorter than that in the B group, and the differences were significant (P<0.05).The MAP and the HR were all decreased after anesthesia induction compared with those of before in both groups (P<0.05).The MAP and the HR in the group B was significantly lower than that in the group A (P<0.05), there were no significant differences in MAP and HR between the two groups of patients with laryngeal mask airway removal. Conclusion Small hemodynamic influence is taken with the technique of laryngeal mask airway(LMA) combined with sevoflurane inhalation anesthesia. It is suitable for gynecological hysteroscopic operation.

       目的   比较宫腔镜病灶切除术与超声监测下吸宫术治疗剖宫产瘢痕部位妊娠（CSP）的有效性。方法   回顾性分析2021年7月—2023年10月在南宁市妇幼保健院确诊为I、Ⅱ型CSP并接受治疗的129例患者，停经时间在38～83 d，中位停经时间48 d。其中42例患者接受了宫腔镜病灶切除术治疗（A组），87例患者接受超声监测下吸宫术治疗（B组），比较两组患者术后1、3、7、14 d的人绒毛膜促性腺激素水平以及手术出血量、手术时间、住院时间、住院花费。结果   两组患者在术后1 d，血清HCG水平下降，下降幅度均超过50%，且A组患者术后1 d血清HCG的下降幅度及下降速率大于B组患者（P＜0.05）；术后3、7、14 d，两组血清HCG水平仍持续下降。另外，A组患者手术出血量、手术时间、住院时间、住院花费分别为（15.35±14.53）mL、（60.73±53.05）min、（4.33±1.90）d、（6 689.23±2 216.19）元；B组患者手术出血量、手术时间、住院时间、住院费用分别为（26.09±29.24）mL、（51.59±54.46）min、（4.82±1.83）d、（6 270.34±2 547.85）元。A组患者术中出血量低于B组、住院时间短于B组（P＜0.05），手术时间及住院费用与B组比较差异无统计学意义（P均＞0.05）。结论   宫腔镜病灶切除术与超声监测下吸宫术均能有效治疗CSP，但宫腔镜病灶切除术在术后血清HCG的下降幅度及下降速率、术中出血量、住院时间等方面优于超声监测下吸宫术，而且手术时间和住院费用并没有显著增加。

       Objective  To compare the efficacy between hysteroscopic  resection surgery and ultrasound-guided uterine aspiration in the treatment of cesarean scar pregnancy（CSP）．Methods  A  retrospective analysis was performed in 129 patients diagnosed with CSP（type I or Ⅱ）and treated in Nanning Maternal and Child Health Hospital from July 2021 to October 2023．Their duration of amenorrhea was between 38～83 d，with a median of 48 days．Among them，42  patients were treated with hysteroscopic resection surgery therapy（group A），87 patients were treated with ultrasound-guided uterine aspiration therapy and（group B）．Then，the levels of human chorionic gonadotropin（HCG），the amount of the intraoperative bleeding volume，surgical time，hospitalization time，and hospitalization expenses were compared between the two groups at one，three，seven and 14 days postoperativey．Results  After one day of surgery，the serum HCG levels of two groups significantly decreased，with a decrease of more than 50%，and the magnitude and  rate of  decrease in  serum HCG levels of group A were  significantly larger than those of group B（P＜0.05）；After three，seven，and 14 day of surgery，serum HCG levels continued to decrease．Furthermore，the intraoperative bleeding volume，surgical time，hospitalization time，hospitalization expenses in group A were（15.35±14.53）mL，（60.73±53.05）min，（4.33±1.90）d，（6 689.23±2 216.19）yuan，respectively．That in group B were（26.09±29.24）mL，（51.59±54.46）min，（4.82±1.83）d，（6 270.34±2 547.85）yuan，respectively．Compared to group B，the intraoperative bleeding volume of group A was significantly lower（P＜0.05），and the hospitalization time is shorter，while there was no significant difference in surgical time and hospitalization expenses．Conclusions  Both of hysteroscopic resection surgery and ultrasound-guided uterine aspiration can treat cesarean scar pregnancy effectively，but the former is superior to the latter in terms of the magnitude and rate of decrease in serum HCG levels after surgery，intraoperative bleeding volume，and hospitalization time，with no significant increase in surgical time and hospitalization expenses．