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1、医药论坛杂志2009年11月第30卷第22期·1··论著·宫腔镜电切术并发急性肺水肿的病因分析及防治李田,许成芳,方莉,刘穗玲,张宇中山大学附属第三医院妇科广州市510630摘要目的讨论宫腔镜电切术中并发急性肺水肿的潜在因素、临床特点及防治措施。方法对2006年1月至2008年12月中宫腔镜电切术中发生急性肺水肿的病例进行临床分析。结果252例宫腔镜电切术中有3例发生急性肺水肿,占1119%,且均为全身麻醉患者。宫腔镜子宫肌瘤电切术(宫腹腔镜联合术)2例,其中多发性子宫肌瘤1例,黏膜下子宫肌瘤合并陈旧性子宫穿孔并大网膜嵌顿1例;宫腔粘连分离术
2、1例,重度粘连,以肌性粘连为主,创面大。3例患者经利尿脱水、纠正低钠血症、强心等治疗后治愈。结论急性肺水肿的发生与复杂的宫腔内操作有关。早期诊断治疗预后好。控制宫腔灌流压力及手术时间,减少灌流液的吸收,以及术中严密监测是预防其发生的关键。关键词宫腔镜检查;电外科手术;手术并发症;急性肺水肿中图分类号:R71314文献标识码:B文章编号:167223422(2009)2220001203Pathogenesis,TreatmentandPreventionofAcutePulmonaryEdemaduringHysteroscopicElect
3、roresectionLITian,XUChengfang,FangLi,etalTheThirdAffiliatedHospitalofZhongshanUniversity,Guangzhou510630,ChinaABSTRACTObjectiveToinvestigatethecause,clinicalcharacteristics,treatmentandpreven2tionofacutepulmonaryedemaduringthehysteroscopicelectroresection.MethodsTotal3cases
4、ofacutepulmonaryedemaduringthehysteroscopicelectroresection,whichtookplacefromJanuary2006toDe2cember2008,wereclinicalanalyzed.ResultsTotal3casesofacutepulmonaryedemaoccurredduringthehysteroscopicelectroresection252cases.Themorbiditywas1.19%.Theyweregeneralanaesthesia.2cases
5、weretranscervicalresectionofmyoma(TCRM),includingonemultiplehysteromyoma,oneuter2ineperforationcomplicatedwithincarcerationofomentumandsubmucosalmyoma.Anotheronecasewastranscervicalresectionofuterineadhesion(TCRA),withtheextensivemyogenicadhesion,manybloodvesselwereexposure
6、d.Thesecaseswerecuredbydiureticagent,salineinfusion,andcardiotonic.Con2clusionAcutepulmonaryedemaisinducedbythecomplexproceduresintra-uterine.Theearlierdiag2nosisishelpfulforfavorableprognosis.It’sthekeymethodstopreventacutepulmonaryedemabycon2trollingoperatingtime,thepress
7、ureintheuterinecavityandtheabsorptionofirrigatingflow.KEYWORDSHysterescopy;Electrosurgery;Intraoperativecomplications;Pulmonaryedema宫腔镜手术在妇科治疗中应用广泛,其手术并院共行宫腔镜电切术252例,其中宫腔镜下子宫肌发症的防治尤其重要。宫腔镜电切术中出现肺水肿瘤电切术(TCRM)63例,子宫内膜电切术(TCRE)是严重的手术并发症,一旦发生可危及生命。现将11例,子宫纵隔电切术(TCRS)13例,宫腔粘连分我院
8、在宫腔镜电切术中发生急性肺水肿的病例进行离术(TCRA)14例,子宫内膜息肉电切术(TCRP)分析,探讨其发病原因、早期临床特点及防治措施。139例,其他12例。共
