间苯三酚在绝经期患者宫腔镜手术中的应用
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摘要
目的探讨间苯三酚在绝经期患者宫腔镜手术中应用的可行性及安全性。方法 2016年6月～2018年6月选取首都医科大学附属北京妇产医院妇科微创中心和航天中心医院妇产科176例绝经期患者,根据宫腔镜手术前宫颈预处理的方法分为间苯三酚组(n=84)和Foley尿管组(n=92),比较2组扩张宫颈时间、4.5 mm宫腔检查镜的镜体直接通过宫颈管的例数、术前并发症等。结果宫腔镜手术中无须扩宫,间苯三酚组54例,Foley尿管组60例,2组比较差异无显著性(χ~2=0.017,P=0.897)。间苯三酚组扩张宫颈管时间(20.6±7.5) s,Foley尿管组(21.8±8.0) s,2组比较差异无显著性(t=-1.024,P=0.307)。间苯三酚组术前均无腹痛、心率增快和(或)血压升高,Foley尿管组12例腹痛(P=0.000)、5例心率增快(P=0.037)和6例血压升高(P=0.019)。2组均无经尿道前列腺电切综合征、子宫穿孔、子宫出血、感染及静脉血栓等并发症发生。结论在充分评估患者手术风险的基础上,间苯三酚应用于绝经期患者宫腔镜手术前的宫颈预处理,疗效肯定,安全可行。
Objective To investigate the feasibility and safety of the application of phloroglucinol for cervix pretreatment before hysteroscopic surgery in postmenopausal patients.Methods Clinical data of 176 postmenopausal patients undergoing cervix pretreatment before hysteroscopic surgery in Beijing Obstetrics and Gynecology Hospital and Aerospace Central Hospital between June2016 and June 2018 were analyzed.They were divided into two groups according to pretreatment methods,the phloroglucinol group(84 cases) and the Foley balloon group(92 cases).Results There was no need to dilate uterus in hysteroscopy.The numbers of patients for who the 4.5 mm hysteroscopy could enter cervical canal were 54 in the phloroglucinol group and 60 in the Foley balloon group.The difference of the two groups was not statistically significant(χ~2=0.017,P=0.897).The cervical entry time of hysteroscopic surgery was(20.6±7.5) s in the phloroglucinol group and(21.8±8.0) s in the Foley balloon group.The difference of two groups was not statistically significant(t=-1.024,P=0.307).There was no abdominal pain,or HR/BP changes before operation in the phloroglucinol group.However,in the Foley balloon group,there were 12 cases of abdominal pain(P=0.000),5 cases of heart rate increase(P=0.037),and 6 cases of elevated BP before operation(P=0.019).No complications such as transurethral resection of prostate syndrome,uterine perforation,uterine bleeding,infection,or venous thrombosis were noted in both groups.Conclusion On a preoperative risk-assessment basis,the efficacy of application of phloroglucinol for cervix pretreatment before hysteroscopic surgery in postmenopausal patients is positive and safe.
Objective To investigate the feasibility and safety of the application of phloroglucinol for cervix pretreatment before hysteroscopic surgery in postmenopausal patients.Methods Clinical data of 176 postmenopausal patients undergoing cervix pretreatment before hysteroscopic surgery in Beijing Obstetrics and Gynecology Hospital and Aerospace Central Hospital between June2016 and June 2018 were analyzed.They were divided into two groups according to pretreatment methods,the phloroglucinol group(84 cases) and the Foley balloon group(92 cases).Results There was no need to dilate uterus in hysteroscopy.The numbers of patients for who the 4.5 mm hysteroscopy could enter cervical canal were 54 in the phloroglucinol group and 60 in the Foley balloon group.The difference of the two groups was not statistically significant(χ~2=0.017,P=0.897).The cervical entry time of hysteroscopic surgery was(20.6±7.5) s in the phloroglucinol group and(21.8±8.0) s in the Foley balloon group.The difference of two groups was not statistically significant(t=-1.024,P=0.307).There was no abdominal pain,or HR/BP changes before operation in the phloroglucinol group.However,in the Foley balloon group,there were 12 cases of abdominal pain(P=0.000),5 cases of heart rate increase(P=0.037),and 6 cases of elevated BP before operation(P=0.019).No complications such as transurethral resection of prostate syndrome,uterine perforation,uterine bleeding,infection,or venous thrombosis were noted in both groups.Conclusion On a preoperative risk-assessment basis,the efficacy of application of phloroglucinol for cervix pretreatment before hysteroscopic surgery in postmenopausal patients is positive and safe.
引文
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2 Margalioth EJ,Ben-Chetrit A,Gal M,et al.Investigation and treatment of repeated implantation failure following IVF-ET.Hum Reprod,2006,21(12):3036-3043.
3蔡妮.间苯三酚用于宫腔镜术前宫颈软化效果观察.海南医学,2015,26(9):1354-1355.
4汤光,主编.现代临床药物学.北京:化学工业出版社,2003.635-636.
5 Tonini M,ed.Martindale:The Complete Drug Reference 32th eds.London:Pharmaceutical Press UK,1999.1618.
6 Andersenm FA.Final report on the safety assessment of phloroglucinol.J Am Cell Toxicol,1996,14(6):468-475.
7 Hurault-Delarue C,Lacroix I,Vidal S,et al.Drugs in pregnancy:study in the EFEMERIS database(2004 to 2008).Gynecol Obstet Fertil,2011,39(10):554-558.
8 Erb H.A comparison of the analgesic effects of pentazocine and pethidine in post-operative pain.Gynaecologia,1966,162(4):275-282.
9李霞.间苯三酚注射液在宫腔镜术前应用的临床观察.中国实用医药,2015,10(9):148-150.
10郝焰,卢丹,盛洁,等.间苯三酚在宫腔镜手术中的应用.中国微创外科杂志,2011,11(6):498-501.
11张宇迪,吴霞,高丽丽,等.间苯三酚不同给药途径在宫腔镜手术前宫颈扩张效果的比较.中国临床医生杂志,2016,44(2):53-54.
12 Xu D,Zhang X,He J.A prospective,randomized comparison of intramuscular phloroglucinol versus oral misoprostol for cervix pretreatment before diagnostic hysteroscopy.Int Surg,2015,100(7-8):1207-1211.
13 Keith Isaacson,原著.夏恩兰,主译.妇科内镜手术并发症.第1版.北京:人民卫生出版社,2008.176-177.
14 Mazzon I,Favilli A,Grasso M,et al.Pain in diagnostic hysteroscopy:a multivariate analysis after a randomized,controlled trial.Fertil Steril,2014,102(5):1398-1403.
2 Margalioth EJ,Ben-Chetrit A,Gal M,et al.Investigation and treatment of repeated implantation failure following IVF-ET.Hum Reprod,2006,21(12):3036-3043.
3蔡妮.间苯三酚用于宫腔镜术前宫颈软化效果观察.海南医学,2015,26(9):1354-1355.
4汤光,主编.现代临床药物学.北京:化学工业出版社,2003.635-636.
5 Tonini M,ed.Martindale:The Complete Drug Reference 32th eds.London:Pharmaceutical Press UK,1999.1618.
6 Andersenm FA.Final report on the safety assessment of phloroglucinol.J Am Cell Toxicol,1996,14(6):468-475.
7 Hurault-Delarue C,Lacroix I,Vidal S,et al.Drugs in pregnancy:study in the EFEMERIS database(2004 to 2008).Gynecol Obstet Fertil,2011,39(10):554-558.
8 Erb H.A comparison of the analgesic effects of pentazocine and pethidine in post-operative pain.Gynaecologia,1966,162(4):275-282.
9李霞.间苯三酚注射液在宫腔镜术前应用的临床观察.中国实用医药,2015,10(9):148-150.
10郝焰,卢丹,盛洁,等.间苯三酚在宫腔镜手术中的应用.中国微创外科杂志,2011,11(6):498-501.
11张宇迪,吴霞,高丽丽,等.间苯三酚不同给药途径在宫腔镜手术前宫颈扩张效果的比较.中国临床医生杂志,2016,44(2):53-54.
12 Xu D,Zhang X,He J.A prospective,randomized comparison of intramuscular phloroglucinol versus oral misoprostol for cervix pretreatment before diagnostic hysteroscopy.Int Surg,2015,100(7-8):1207-1211.
13 Keith Isaacson,原著.夏恩兰,主译.妇科内镜手术并发症.第1版.北京:人民卫生出版社,2008.176-177.
14 Mazzon I,Favilli A,Grasso M,et al.Pain in diagnostic hysteroscopy:a multivariate analysis after a randomized,controlled trial.Fertil Steril,2014,102(5):1398-1403.
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