张洪波 张毅 张英忠

【摘要】目的：比较昆布与米索前列醇对于育龄妇女宫腔镜术前宫颈扩张的效果与安全性。方法：156例患者随机分成3组，昆布扩张组52例患者术前宫颈内口放置3mm昆布棒，米索前列醇扩张组52例患者术前阴道后穹窿处放置米索前列醇200μg，机械扩张组52例患者术前使用Hegar扩张器扩张宫颈。结果：与阴道内置米索前列醇相比，昆布的使用增加了子宫和宫颈的长度，宫颈宽度没有增加。宫腔镜术后1个月子宫和宫颈的长度恢复到正常大小。机械扩张后的副反应是非常少的，昆布与米索前列醇引起的副反应是较多的。宫颈内置昆布棒在治疗后显著增加了宫颈管宽度。昆布扩张宫颈后需要额外宫颈扩张的病例数和额外扩张持续的时间与米索前列醇相比显著较少（P<0.05）。在置入宫颈扩张器时及置入后，昆布组患者的疼痛感均较米索前列醇组强烈（P<0.05）。结论：与阴道内置米索前列醇相比，宫腔镜术前昆布的应用是宫颈预处理中更为有效的手段，只是需要在使用前口服镇痛药。

【关键词】昆布；米索前列醇；宫颈扩张；宫腔镜术

Effectiveness of laminaria and misoprostol for cervical dilation before operative hysteroscopy in women of reproductive ageZHANG Hongbo， ZHANG Yi， ZHANG Yingzhong. Department of Obstetrics and Gynecology， Changan Hospital， Xian 710018， Shaanxi， China

【Abstract】Objectives： To compare the effectiveness and safety of laminaria and misoprostol for cervical dilation prior to operative hysteroscopy in women of reproductive age. Methods： 155 women participated in three groups randomly. For each of the 52 patients in laminaria dilation group， a single 3mm laminaria was inserted into the cervical canal. The 50 patients in the misoprostol dilation group received 200 mg intravaginal misoprostol into the posterior fornix. And the 50 patients in mechanical dilation used a Hegar dilator dilated cervical canal. Results： Intracervical laminaria increased uterine and cervical lengths but not the cervical width in comparison with intravaginal misoprostol； uterine and cervical lengths returned to their normal size one month after surgery. Adverse effects were fewer after mechanical dilation， and adverse effects were higher in patients administered intravaginal misoprostol and laminaria. The cervical canal widths were increased by intracervical laminaria preparation after treatment. The number of patients requiring additional cervical dilation and the duration of additional cervical dilation were substantially fewer after use of intracervical laminaria compared to intravaginal misoprostol （P<0.05）. Procedure-related pain was considerably more following the application of intracervical laminaria compared to intravaginal misoprostol （P<0.05）. Conclusions： The use of intracervical laminaria for cervical preparation is more effective， compared to intravaginal misoprostol for cervical preparation. Oral analgesic may be required before cervical preparation.

【Key words】Laminaria； Misoprostol； Cervical dilation； Operative hysteroscopy

【中图分类号】R713.4【文献标志码】A

宫腔镜术是一个常见的妇科微创手术，需要扩张宫颈进入子宫病变部位进行治疗，如子宫内膜息肉、黏膜下肌瘤、子宫中隔和粘连。适当的宫颈扩张是宫腔镜术成功的一个重要步骤。手术过程中的许多宫腔镜并发症通常发生在宫颈扩张期间，其中包括不成功的宫颈扩张、子宫穿孔、宫颈裂伤或形成假道[1，2]。阴道内置米索前列醇、宫颈内置渗透扩张器和机械扩张等方法已经实现了宫颈扩张[3，4]。米索前列醇用于宫腔镜术前促宫颈成熟已达成共识，口服或阴道内给米索前列醇增加了宫颈扩张基线和额外宫颈扩张的持续时间[5，6]，这有利于宫腔镜手术的进行，并最大限度的减少了宫颈和子宫并发症[7]。……