背景:在采用机械宫腔镜分割器的息肉切除术中,组织去除程序继续,直到没有息肉组织剩余。基于视觉评估做出完全去除息肉样组织的决定。在这种情况下,息肉组织在视觉上被完全去除,毫无疑问,息肉已经被完全去除,在大多数患者中,息肉地板上的短纺锤形组织碎片仍然存在。文献中没有关于视觉评估是否在许多患者的细胞水平上提供足够的信息的研究,这些患者的息肉样组织已被确定为完全去除。本研究的目的是分析刮宫术的病理结果,这是应用后完成息肉切除手术宫腔镜检查,并评估机械宫腔镜切碎器无法去除的短纺锤形组织碎片中是否有残留的息肉组织。本研究的次要目的是比较传统的宫腔镜环切术与宫腔镜碎裂术在血红蛋白/血细胞比容变化方面的子宫内膜息肉的去除。息肉切除时间和中度缺陷的数量。
方法:共70例患者,单个带蒂息肉图像为1.5-2cm,主要通过办公室宫腔镜检查来观察,包括在研究中。接受宫腔镜息肉切除术的患者根据所使用的手术装置分为两组:粉碎器组(n=35,M组)和电切镜组(n=35,R组)。评估在宫腔镜手术结束时进行了刮宫的患者的宫腔镜标本和刮宫材料的组织病理学结果。此外,术后24小时Hb/HCT下降的百分比,从碎裂开始测量的息肉切除时间,并比较各组之间的赤字差异。
结果:总计,粉碎器组中的7名患者在完全刮治材料中检测到残留的息肉组织。粉碎器组的失血量低于电切镜组(M,R;(-0.07±0.08),(-0,11±0.06),(p<0.05),分别)。分割器组的赤字值较高(M,R;(500毫升),(300毫升),(p<0.05),分别)。切碎器组的息肉切除时间较短(M,R;平均值(2.30分钟),(4.6分钟),(p<0.05))。
结论:即使在宫腔镜碎裂术中病灶完全可见,对于残留组织的可能性应格外小心.需要新的研究来调查残余息肉组织的存在。
BACKGROUND: In polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic
morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit.
METHODS: A total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of
morcellation, and deficit differences were compared between groups.
RESULTS: In total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)).
CONCLUSIONS: Even if the lesion is completely visibly removed during hysteroscopic
morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue.