目的：评估有经验的外科医师使用微型宫腔镜进行门诊宫腔镜检查时宫颈管特征对疼痛的影响。
方法：对303例接受诊断性宫腔镜检查的妇女进行了一项前瞻性观察性研究。通过宫颈管时，使用视觉模拟量表（VAS）评估疼痛强度。根据VAS评分将患者分为两组：无痛或轻度疼痛（VAS<4）和中度或重度疼痛（VAS≥4）。宫颈管特征之间的关系(长度，版本,和屈曲姿势，宫颈干预史，狭窄,synehiae)，妇产科史，术前焦虑水平，程序持续时间,并检查疼痛强度。
结果：38％的患者（n=117）出现中度疼痛（4≤VAS<7），14例患者（5％）出现重度疼痛（VAS≥7）。在多变量分析中，无效性(p=0.01；OR，4.6；95%CI，1.7-13.2），绝经后状态（p=0.02；OR，2.2；95%CI，1.2-4.3），子宫颈过度屈曲和子宫后倾(p<0.001；OR，4.1；95%CI，2.0-8.5）被确定为疼痛手术的危险因素。98％的患者诊断性宫腔镜检查成功。疼痛是宫腔镜检查失败的主要原因。
结论：除了无胎和绝经后状态，宫颈管的不利特征，如子宫颈过度屈曲和子宫逆行是门诊宫腔镜检查时疼痛的重要原因。
OBJECTIVE: To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope.
METHODS: A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined.
RESULTS: Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy.
CONCLUSIONS: In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.
