Gynaecological Endoscopy最新文献

Objective To investigate the cause of uterine bleeding in tibolone users who were referred to an endoscopy unit.

Design Hysteroscopy followed by endometrial biopsy was carried out in all patients. The endometrial echo was measured by transvaginal sonography prior to hysteroscopy and compared with hysteroscopic findings.

Results Endometrial polyps were the pathological lesions most frequently diagnosed by hysteroscopy in tibolone users. However, their diagnosis was missed by blind endometrial biopsy in all cases. The surrounding endometrium was always atrophic even when a polyp was present in the uterine cavity. There was one case of endometrial carcinoma which occurred in association with a polyp.

Conclusion Tibolone does not exert any stimulatory effect on the normal endometrium. However, intrauterine lesions such as polyps can grow in response to this treatment. The presence of polyps is associated with abnormal uterine bleeding in these patients.

Objective Hysteroscopic septal resection for subseptate uterus is a modern alternative to the classic procedures of Tompkins and Jones. We therefore investigated whether this new operation, which is less stressful for the patient, and can usually be carried out on an outpatient basis, can produce results similar to those of the classic laparotomy methods in patients receiving treatment for infertility.

Design Questionnaires were sent to 14 women who had undergone hysteroscopic surgery for infertility and known subseptate uterus at the University Department of Gynaecology in Frankfurt-am-Main.

Results Nine patients responded, six of whom had become pregnant after hysteroscopic resection of the septum. This corresponds to the results achieved with laparotomy methods.

Conclusion These results, like those of the few other studies on the topic in the literature, show that hysteroscopic septal resection in infertile patients offers a low-stress, fast and outpatient alternative to the elaborate classic techniques of Tompkins and Jones.

Objective To determine the proportion of hysterectomies done by the vaginal route for all benign gynaecological indications, at our centre, and to assess our performance with respect to the feasibility of bilateral salpingo-oöphorectomy, and also to identify any major complications.

Design A retrospective analysis of case notes on 99 consecutive hysterectomies done for benign gynaecological indications.

Setting A district general hospital.

Results Out of 99 hysterectomies, 92 were done by the vaginal route, (excluding four laparoscopy-assisted vaginal hysterectomies), with no significant major complications except for one conversion to laparotomy. Bilateral salpingo-oöphorectomy was successfully performed in 98.3% of patients in whom it was planned. There was no significant uterine prolapse in 78% of patients undergoing vaginal hysterectomy, and the largest uterus removed vaginally weighed 1146 g.

Conclusions Vaginal hysterectomy is feasible in most patients with benign gynaecological indications. Where possible contraindications exist, the use of preliminary laparoscopy should be encouraged, to help in the proper selection of patients and perhaps to remedy any relative contraindications. Gynaecologists need to appraise the vaginal route, and there is a strong need to address training issues as far as vaginal surgery is concerned.

Objectives To determine the depth of tissue necrosis following microwave endometrial ablation (MEA) after perioperative saline hysteroscopy, and to determine the effects of varying endometrial thickness on depth and regularity of necrosis after gas hysteroscopy.

Subjects 15 premenopausal women undergoing hysterectomy for dysfunctional uterine bleeding at Aberdeen Royal Infirmary.

Methods Endometrial thickness was measured by transvaginal ultrasound scanning. After cervical dilation a hysteroscopy was performed with carbon dioxide or saline before proceeding to MEA and then hysterectomy. A vital stain was used to assess the depth and regularity of endomyometrial necrosis in the excised uterus.

Results The nitroblue tetrazolium stain was a simple and effective way of demonstrating the depth of necrosis. In this small study, saline hysteroscopy led to cornual sparing in some cases. There was no clear effect of endometrial thickness up to 8 mm with gas hysteroscopy.

Conclusions Saline hysteroscopy may affect the clinical outcome of MEA. Aspiration of residual saline may minimize any negative effect. The depth and regularity of necrosis did not seem to be affected by endometrial thicknesses of up to 8 mm after gas hysteroscopy. It seems reasonable to proceed to a clinical trial to assess the outcome of postmenstrual MEA without hormonal endometrial preparation.

Objective To compare flexible and rigid hysteroscopy in an outpatient hysteroscopy clinic.

Design A randomized, single-blinded prospective study.

Setting A one-stop, outpatient hysteroscopy clinic in a district general hospital.

Subjects 96 women referred to the clinic with abnormal uterine bleeding.

Main outcome measures Patient pain scores, local anaesthetic usage, need for cervical dilation, quality of view, correlation of clinical and histological findings, duration of procedure, operator's assessment of the ease of the procedure.

Results Data from 83 women were analysed; three declined to enter the study, one failed to complete the pain scores and nine also had an operative hysteroscopy. Immediate median pain scores were statistically lower in the flexible hysteroscopy group, 1.2 vs. 3.6 (P = 0.001). The difference persisted 30 min after the procedure (0.4 vs. 1.1, P = 0.031). Pain experienced with endometrial biopsy was similar in the two groups (2.5 vs. 3.0, P = 0.16). There were no statistical differences between the two study arms with regard to procedure duration, quality of view, need for cervical dilation, anaesthetic usage or operator assessment of the ease of the procedure. There was agreement in clinical and histological diagnoses in all cases. The operators’ assessment of patients’ pain level correlated highly with patient pain scores. There were no statistically significant differences in any end-point between the two operators.

Conclusion Flexible hysteroscopy is associated with lower levels of patient discomfort than rigid hysteroscopy. Other study variables were comparable for the two types of hysteroscopy.