宮腔鏡手術并發癥宮腔粘連的治療
超聲介導擴宮腔:在腹(fu)部B超掃查下了解子宮(gong)位(wei)置,宮(gong)頸管與子宮(gong)體(ti)之間的屈(qu)度,粘連水平(ping)上方液性暗(an)區的范圍,粘連下緣與宮(gong)頸口的距離(li),然(ran)(ran)后(hou)放入探(tan)(tan)針沿(yan)子宮(gong)中線探(tan)(tan)測宮(gong)腔的深度,如果探(tan)(tan)針頂端即為積血區,可按照B超提(ti)示(shi)方向,稍稍用力向前(qian)推(tui)動探(tan)(tan)針,然(ran)(ran)后(hou)左右擺動探(tan)(tan)針,憑手(shou)的感覺分離(li)粘連,待有(you)暗(an)紅色或(huo)咖(ka)啡陳舊血流出后(hou),再用Hegar擴(kuo)張器逐號(hao)擴(kuo)張至6-7號(hao),術后(hou)應用抗(kang)生素預(yu)防(fang)感染。
宮腔鏡手術分離粘連:如粘(zhan)(zhan)(zhan)(zhan)連區域廣泛,探(tan)針探(tan)擴失敗(bai),可通過再次宮(gong)(gong)腔(qiang)(qiang)鏡(jing)(jing)手術(shu)分(fen)(fen)離(li)粘(zhan)(zhan)(zhan)(zhan)連,按上述方法探(tan)針先探(tan)擴宮(gong)(gong)腔(qiang)(qiang)并用(yong)Hegar擴宮(gong)(gong)器擴張宮(gong)(gong)頸,置(zhi)入手術(shu)宮(gong)(gong)腔(qiang)(qiang)鏡(jing)(jing),然后在直視下(xia)利用(yong)環形電(dian)極切(qie)割(ge)粘(zhan)(zhan)(zhan)(zhan)連帶,也可以用(yong)針形電(dian)極分(fen)(fen)離(li)粘(zhan)(zhan)(zhan)(zhan)連面(mian),宮(gong)(gong)腔(qiang)(qiang)鏡(jing)(jing)術(shu)后的粘(zhan)(zhan)(zhan)(zhan)連多為(wei)纖維肌肉組織粘(zhan)(zhan)(zhan)(zhan)連,粘(zhan)(zhan)(zhan)(zhan)連面(mian)廣,缺(que)乏內膜(mo)標志,故(gu)分(fen)(fen)離(li)過程(cheng)需在B超監護下(xia)進行,避(bi)免盲目分(fen)(fen)離(li)引起子宮(gong)(gong)肌壁的過度(du)損傷,導(dao)致(zhi)術(shu)中大出(chu)血或子宮(gong)(gong)穿(chuan)孔。這里需要指出(chu)的是,對宮(gong)(gong)腔(qiang)(qiang)鏡(jing)(jing)術(shu)后宮(gong)(gong)腔(qiang)(qiang)粘(zhan)(zhan)(zhan)(zhan)連進行分(fen)(fen)離(li)的目的不(bu)是為(wei)了重建宮(gong)(gong)腔(qiang)(qiang),而致(zhi)死為(wei)了解(jie)除宮(gong)(gong)腔(qiang)(qiang)積血或積液,緩解(jie)周期性(xing)腹痛,在分(fen)(fen)離(li)過程(cheng)中,不(bu)必暴露雙側(ce)輸卵管部位,能使(shi)殘存的積血完全排(pai)出(chu)即可。
難得一見現象下,TCRE果酸換膚宮腔子宮子宮子宮粘連合在一起孕期,子宮子宮子宮粘連的瘢痕被限了孕期囊的發肓,而將孕期囊擠向無子宮子宮子宮粘連的摩擦處,在手工無痛人流時可誘發高周波波定位功能和內窺鏡手術的難關。子宮切除術:對于(yu)上述治療方法無效或子(zi)宮體(ti)部(bu)粘(zhan)連面(mian)致(zhi)密廣泛,輸卵管(guan)口區域由積血而(er)病人痛經癥(zheng)狀嚴重時,可考慮子(zi)宮切除術。
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