昆布與米索前列醇對育齡婦女宮腔鏡術前宮頸擴張效果的比較

張洪波 張毅 張英忠

【摘要】目的：比較昆布與米索前列醇對于育齡婦女宮腔鏡術前宮頸擴張的效果與安全性。方法：156例患者隨機分成3組，昆布擴張組52例患者術前宮頸內口放置3mm昆布棒，米索前列醇擴張組52例患者術前陰道后穹窿處放置米索前列醇200μg，機械擴張組52例患者術前使用Hegar擴張器擴張宮頸。結果：與陰道內置米索前列醇相比，昆布的使用增加了子宮和宮頸的長度，宮頸寬度沒有增加。宮腔鏡術后1個月子宮和宮頸的長度恢復到正常大小。機械擴張后的副反應是非常少的，昆布與米索前列醇引起的副反應是較多的。宮頸內置昆布棒在治療后顯著增加了宮頸管寬度。昆布擴張宮頸后需要額外宮頸擴張的病例數(shù)和額外擴張持續(xù)的時間與米索前列醇相比顯著較少（P<0.05）。在置入宮頸擴張器時及置入后，昆布組患者的疼痛感均較米索前列醇組強烈（P<0.05）。結論：與陰道內置米索前列醇相比，宮腔鏡術前昆布的應用是宮頸預處理中更為有效的手段，只是需要在使用前口服鎮(zhèn)痛藥。

【關鍵詞】昆布；米索前列醇；宮頸擴張；宮腔鏡術

Effectiveness of laminaria and misoprostol for cervical dilation before operative hysteroscopy in women of reproductive ageZHANG Hongbo， ZHANG Yi， ZHANG Yingzhong. Department of Obstetrics and Gynecology， Changan Hospital， Xian 710018， Shaanxi， China

【Abstract】Objectives： To compare the effectiveness and safety of laminaria and misoprostol for cervical dilation prior to operative hysteroscopy in women of reproductive age. Methods： 155 women participated in three groups randomly. For each of the 52 patients in laminaria dilation group， a single 3mm laminaria was inserted into the cervical canal. The 50 patients in the misoprostol dilation group received 200 mg intravaginal misoprostol into the posterior fornix. And the 50 patients in mechanical dilation used a Hegar dilator dilated cervical canal. Results： Intracervical laminaria increased uterine and cervical lengths but not the cervical width in comparison with intravaginal misoprostol； uterine and cervical lengths returned to their normal size one month after surgery. Adverse effects were fewer after mechanical dilation， and adverse effects were higher in patients administered intravaginal misoprostol and laminaria. The cervical canal widths were increased by intracervical laminaria preparation after treatment. The number of patients requiring additional cervical dilation and the duration of additional cervical dilation were substantially fewer after use of intracervical laminaria compared to intravaginal misoprostol （P<0.05）. Procedure-related pain was considerably more following the application of intracervical laminaria compared to intravaginal misoprostol （P<0.05）. Conclusions： The use of intracervical laminaria for cervical preparation is more effective， compared to intravaginal misoprostol for cervical preparation. Oral analgesic may be required before cervical preparation.

【Key words】Laminaria； Misoprostol； Cervical dilation； Operative hysteroscopy

【中圖分類號】R713.4【文獻標志碼】A

宮腔鏡術是一個常見的婦科微創(chuàng)手術，需要擴張宮頸進入子宮病變部位進行治療，如子宮內膜息肉、黏膜下肌瘤、子宮中隔和粘連。適當?shù)膶m頸擴張是宮腔鏡術成功的一個重要步驟。手術過程中的許多宮腔鏡并發(fā)癥通常發(fā)生在宮頸擴張期間，其中包括不成功的宮頸擴張、子宮穿孔、宮頸裂傷或形成假道[1，2]。陰道內置米索前列醇、宮頸內置滲透擴張器和機械擴張等方法已經(jīng)實現(xiàn)了宮頸擴張[3，4]。米索前列醇用于宮腔鏡術前促宮頸成熟已達成共識，口服或陰道內給米索前列醇增加了宮頸擴張基線和額外宮頸擴張的持續(xù)時間[5，6]，這有利于宮腔鏡手術的進行，并最大限度的減少了宮頸和子宮并發(fā)癥[7]。……