hysteroscopic surgery

Hysteroscopy is an optical instrument used to observe, diagnose, and treat uterine cavity. Hysteroscopy can be divided into diagnostic and surgical types, as well as soft and hard. The soft diagnostic hysteroscope is made of advanced optical fiber. It has small diameter and can be bent at will. It is easy to observe and diagnose the whole uterine cavity. The inspection process is fast (about 2~5 minutes), it does not hurt, it does not hurt the uterus. . Hysteroscopy is an advanced device for the diagnosis and treatment of intrauterine diseases. It can clearly observe various changes in the uterine cavity and make a clear diagnosis. Hysteroscopic techniques can be used to directly examine the lesions in the uterus, and to collect and collect lesions for diagnosis. The diagnosis is accurate, timely, comprehensive and intuitive. Early detection of cancer; tubal intubation, examination of tubal patency, and obstruction of tubal interstitial obstruction Accurate and effective; hysteroscopic surgery for removal of endometrium, submucosal fibroids, endometrial polyps, uterine mediastinum, intrauterine adhesions and removal of foreign bodies, good curative effect, no laparotomy, less trauma, less bleeding, less pain, rehabilitation fast Treatment of diseases: uterine fibroids, menstrual irregular menstruation, female infertility Indication Indications for hysteroscopy: Abnormal uterine bleeding, menorrhagia, rare menstruation, irregular menstrual cycle, uterine fibroids, uterine uterus, contraceptive shift, infertility, habitual abortion, follow-up after natural or artificial abortion, abnormal ultrasound image Long-term abdominal pain, artificial pregnancy, and preoperative evaluation of IVF. Indications for hysteroscopic surgery: Endometrial polypectomy, uterine mediastinal resection, uterine cavity adhesion decomposition, cervical intracranial neoplasm, uterine myomectomy, submucosal fibroids less than 7 cm in diameter, uterine muscle wall fibroids protruding into the uterine cavity, The diameter is about 4-5 cm, and the diameter of the cervical fibroids is less than 3-4 cm. Contraindications There are no clear absolute contraindications, the following are relative contraindications. 1, vaginal and pelvic infections. 2, a lot of uterine bleeding. 3, want to continue pregnancy. 4, the current uterine perforation. 5, the uterine cavity is too narrow or the cervix is too hard, it is difficult to expand. 6, acute subacute inflammation of the reproductive tract. 7, severe heart, liver, lung and kidney disease. 8, cervical invasive cancer. 9, genital tuberculosis without anti-caries treatment. 10, patients with serious medical problems, it is difficult to tolerate the expansion of the operator. 11, genital tuberculosis, without anti-caries treatment. 12. Those who have no follow-up treatment for blood diseases. Preoperative preparation 1, for cardiopulmonary examination, blood pressure, pulse, check the white belt routine, cervical smear. 2, the choice of inspection time: In addition to special circumstances, generally within 5 days after menstruation is clean. Surgical procedure 1. Anesthesia and analgesia: You can choose any of the following: (1) Indomethacin suppository: 50-100mg of indomethacin suppository is inserted into the deep anus 20 minutes before the examination. (2) Cervical nerve block anesthesia: 5% of procaine was injected into each side of the cervix. (3) Cervical mucosal surface anesthesia: a 2% lidocaine solution was inserted into the cervical canal with a long cotton swab, and the inner cervix was leveled for 1 minute. (4) Uterine mucosal spray anesthesia: 0.25% bupivacaine 8ml was sprayed on the surface of the endometrium through a special lumen injector, and examined after 5 minutes. 2, inspection method: Take the lithotomy position, routinely disinfect the vulva and vagina, use the cervical forceps to clamp the anterior lip of the cervix, probe the depth and direction of the uterine cavity, and expand to the 6.5-7 according to the outer diameter of the sheath. Commonly used 5% glucose solution or saline to expand the palace, first empty the air between the mirror sheath and the optical tube, slowly put into the hysteroscopy, open the light source, inject the uterine fluid, the expansion pressure 13-15kPa (1kPa = 7.5mmHg ), after the uterine cavity is filled, the field of vision is bright, the mirror can be rotated and observed in order. First check the uterine fundus and the anterior, posterior, left and right wall of the uterine cavity and then check the uterine horn and the fallopian tube opening. Pay attention to the morphology of the uterus, the presence or absence of endometrial abnormalities or space-occupying lesions, the necessary uterine morphology, the presence or absence of endometrial abnormalities or space-occupying lesions, local biopsy if necessary, and careful examination of the cervix when slowly pushing out the scope Inner mouth and cervical canal. complication 1, injury: more related to rough operation, can cause cervical tear, uterine perforation, fallopian tube false tract, fallopian tube rupture. 2, bleeding: hysteroscopy does not cause serious bleeding, if excessive bleeding should be treated for the primary disease. 3, infection: rare, more than a history of chronic pelvic inflammatory disease, should strictly control the indications. 4, CO2 expansion complications: excessive operation time, excessive intrauterine perfusion can cause CO2 air embolism, should immediately stop operation, oxygen, intravenous dexamethasone. 5, cardio-cerebral syndrome: dilatation of the cervix and dilatation of the uterine cavity can lead to increased vagal nerve tension, indicating the occurrence of the same as abortion.

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