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目的:探讨双极等离子宫腔镜子宫内膜电切术中组织的热损伤情况,寻找安全有效的电极功率设置。方法:设置电切电极功率为160 W、200 W、280 W,电凝电极功率为80 W、200 W,作用时间分别为3～5 s和6～8 s,作用于离体子宫后行HE染色和尼克酰胺腺嘌呤核苷酸-黄递酶(NADH-d)染色,观察热损伤深度及组织病理学变化。结果:①相同功率及作用时间下,凝固电极下方的组织热损伤深度明显大于切割电极;②电凝时热损伤深度与功率、作用时间均有一定相关性;③在设定功率及作用时间下,对离体子宫最大热破坏深度为3.68 mm,占宫壁厚度的17.6%。结论:①双极等离子宫腔镜电手术是一种有效治疗功能失调性子宫出血的新兴技术,施术最佳电切功率为200 W,电凝功率为160～200 W。②离体实验证明双极等离子宫腔镜行子宫内膜电切术是安全的,其组织热损伤带小,可避免意外电损伤,降低子宫穿孔及周围脏器损伤的发生率。③离体实验研究表明双极等离子宫腔镜手术中凝固电极下方的热损伤带大于切割电极,电切术中尤应注意对电凝电极功率及作用时间的选择。
Objective: To investigate the thermal damage of tissue during bipolar plasma hysteroscopic endometrial resection in search of a safe and effective electrode power setting. METHODS: The power of the electrode was set to 160 W, 200 W, 280 W, and the power of the electrode was 80 W, 200 W for 3 ~ 5 s and 6 ~ 8 s, respectively. Staining and NADH-d staining. The depth of heat injury and histopathological changes were observed. Results: ① Under the same power and action time, the depth of tissue thermal damage below the coagulation electrode was significantly larger than that of the cutting electrode; ② The depth of thermal injury was related to the power and the action time; ③ Under the set power and action time , The maximum thermal destruction of uterine depth of 3.68 mm, accounting for 17.6% of the wall thickness. Conclusions: Bipolar plasma hysteroscopic electrosurgery is an emerging technique for the treatment of dysfunctional uterine bleeding. The best power-cut power is 200 W and the coagulation power is 160-200 W. ② In vitro experiments show that bipolar plasma hysteroscopy is safe for endometrial resection and its tissue thermal damage is small, which can avoid accidental electrical injury and reduce the incidence of uterine perforation and peripheral organ injury. ③ In vitro experiments show that bipolar plasma hysteroscopy in the coagulation electrode below the thermal injury zone is greater than the cutting electrode, especially in the resection of electrocautery should pay attention to the choice of coagulation electrode power and duration of action.