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目的探讨宫腔镜手术中子宫内膜细胞腹腔播散的特点及其影响因素。方法收集121例行宫腹腔镜联合手术的患者宫腔镜手术前后腹腔冲洗液,进行离心与细胞固定,分别在显微镜下观察腹腔冲洗液中细胞种类的变化及子宫内膜细胞阳性率的差异,根据宫腔镜手术后腹腔冲洗液中是否存在子宫内膜细胞分为阳性组和阴性组,比较两组的宫腔镜手术时间、膨宫压力、灌流液用量和子宫内膜状态等因素对子宫内膜细胞腹腔播散的影响。结果宫腔镜手术后,腹腔冲洗液中子宫内膜细胞阳性者62例(51.2%,62//21),术前腹腔冲洗液子宫内膜细胞阳性者46例(38.0%,46/121),两者比较,差异有统计学意义(P=0.020);阳性组平均手术时间为(38±16)min,阴性组为(27±13)min,两组比较,差异有统计学意义(P=0.003);两组患者术中灌流液用量、膨宫压力、子宫内膜状态等比较,差异均无统计学意义(P>0.05)。结论宫腔镜手术能够造成子宫内膜细胞的腹腔播散;在设定膨宫压力下,子宫内膜细胞的腹腔播散与宫腔镜手术时间有关。
Objective To investigate the characteristics and influential factors of peritoneal dissemination of endometrial cells during hysteroscopic surgery. Methods 121 cases of laparoscopic combined surgery before and after hysteroscopy in patients with intraperitoneal lavage fluid for centrifugation and cell fixation were observed under the microscope of intraperitoneal fluid changes in cell types and the difference of the positive rate of endometrial cells based on Hysteroscopic surgery after intrauterine irrigating fluid is divided into positive group and negative group, comparing the two groups of hysteroscopic surgery time, uterine pressure, fluid volume and endometrial status and other factors on the intrauterine Effect of membrane cells peritoneal dissemination. Results After hysteroscopic surgery, 62 cases (51.2%, 62/21) of endometrial cells were positive in peritoneal washings, 46 cases (38.0%, 46/121) of preoperative peritoneal lavage fluid endometrial cells were positive, (P = 0.020). The mean operative time in the positive group was (38 ± 16) min and that in the negative group was (27 ± 13) min. The difference was statistically significant (P = 0.003). There was no significant difference between the two groups in the amount of perfusion fluid, the pressure of the uterus and the state of endometrium (P> 0.05). Conclusion Hysteroscopic surgery can cause peritoneal dissemination of uterine endometrial cells; in the setting of edema pressure, the peritoneal dissemination of endometrial cells is related to the time of hysteroscopic surgery.