单极、等离子双极宫腔镜黏膜下肌瘤电切术的临床对照研究

目的 比较单极宫腔镜电切术和等离子双极宫腔镜电切术的安全性及优越性.方法 收集行宫腔镜黏膜下肌瘤电切术患者60例.所有患者均于术前、术后即刻检测外周静脉血Na~+、Cl~-、K~+、Glu浓度,记录手术时间、灌流液吸收量、术中出血量等指标,应用SPSS10.0统计软件进行比较分析.结果 ①单极电切组术后Na~+、Cl~-、K~+浓度较术前明显下降(P<0.05),而Glu则明显升高(P<0.05);等离子双极电切组术前、术后Na~+、Cl~-、K~+、Glu浓度变化均无统计学意义(P>0.05).②术后比较,两组间Na~+、Cl~-、Glu的变化具有统计学意义(P<0.05),手术时间差异无统计学意义(P>0.05);单极电切组灌流液吸收量、术中出血量均较等离子双极电切组为多(P<0.05).③单极电切组中,Ⅱ型肌瘤患者的Na~+、Cl~-、Glu浓度、灌流液吸收量、手术时间、术中失血量均明显高于Ⅰ型肌瘤及0型肌瘤患者;等离子双极电切组中,Ⅱ型肌瘤患者的灌流液吸收量、手术时间、术中失血量亦均明显高于Ⅰ型肌瘤及0型肌瘤患者,(P<0.05),但Na~+、Cl~-、K~+、Glu浓度变化3型之间无明显差异.结论 相对于单极宫腔镜电切术而言,等离子双极电切术不引起血电解质及血糖的明显变化,术中出血量相对较少.肌瘤类型对灌流液吸收量、手术时间、术中出血量影响较大,Ⅱ型肌瘤的灌流液吸收量、手术时间、术中出血量明显较0型及Ⅰ型增多.

A comparative study of monopolar technique and plasmakinetic technique in transcervical resection of myoma

Objective To evaluate and compare the safety and advantage of different kinds of electrode system (monopolar and plasmakinetic techniques) in transcervical resection of myoma (TCRM). Methods A total of 60 patients undergoing TCRM were enrolled. Serum sodium (Na~+), chlorine (Cl~-), potassium (K+) and glucose (Glu) were measured before and after the operation. Meanwhile, the operation time, absorption volume and bleeding volume were also recorded after the operation. Results ① There were significant decreases in Na~+, Cl~-, K~+ and Glu concentrations in the monopolar group (P<0.05), but Glu increased significantly (P<0.05). Na~+, Cl~-, K~+ and Glu concentrations in plasmakinetic group, however, did not change significantly before and after the operation (P>0.05). ② After the operation, there were significant differences between the two groups in Na~+, Cl~- and Glu changes (P<0.05). The absorption volume and volume of bleeding during the operation were increased in monopolar group compared with those in plasmakinetic group (P<0.05). ③ In monopolar group, Na~+, Cl~- and Glu concentrations, the operation time, absorption volume and volume of bleeding were significantly higher in patients with type Ⅱ myoma than in those with type Ⅰ and 0. In plasmakinetic group, the operation time, absorption volume and volume of bleeding were significantly increased in type Ⅱ myoma patients. No significant difference was observed of Na~+, Cl~- and Glu concentrations between patients with the three types of myoma (P>0.05). Conclusion Plasmakinetic technique is superior to monopolar one in that it does not cause obvious changes in blood electrolytes and glucose and there is less bleeding during the operation. Myoma type has a greater effect on the absorption volume, operation time and volume of bleeding during operation, which are increased in type Ⅱ myoma than in type 0 and 1.