Clinical data of 1
There are 26 patients with functional uterine bleeding in this group, aged 35-57. No cardiopulmonary dysfunction, no fertility requirements, except gynecological malignant diseases. All the patients underwent endometrial electrotomy under epidural block. The operation time was 20 ~ 85 minutes, with an average of 42 minutes. All the operations were successful, and no complications were reported in the literature. Antibiotics were used on the day of operation, and you can leave the hospital after 1 ~ 3 days. Follow-up for 2 ~ 8 months showed that 18 cases were completely menopausal, accounting for 69.2%. Menstruation decreased significantly in 6 cases and lost in 2 cases.
2 preoperative preparation
2. 1 Prepare instruments and parts. The STORZ electric burner, photoelectric video converter, monitor and cold light source were placed in the operating room one day before the operation to ensure good performance. Japan Olympus rigid tube hysteroscope and its accessories, electrocautery electrode, input water pipe, output water pipe, electrocautery wire, cold light source wire and video conversion wire (except video conversion lens) were put into a formaldehyde fumigation box for fumigation.
2.2 Prepare basic articles, and package and disinfect disinfection forceps, uterine dilators, speculums, uterine probes, uterine curetters, cervical forceps, tongs and conventional dressings for gynecological perineal surgery. Prepare 1500 ~ 3000ml 5% glucose solution as uterine dilating fluid.
3 Key points of intraoperative cooperation
3. 1 The patient establishes 1 upper limb venous access after entering the room. After epidural block, take the lithotomy position of bladder, and the height of leg frame should not exceed 30cm. Put a cotton pad in the nest and gently fix the knee on the leg frame with a bandage. The separation angle of patients' legs was 1 10 ~ 120. Older patients are correspondingly smaller.
3.2 routine perineum disinfection sheet, correctly connect the wires and operating parts of each instrument, and turn on the power supply to make it in working condition.
3.2. 1 Place the negative plate of the electrocautery on the plump part of the patient's muscle, and contact with the skin completely to prevent burns. Generally choose in the buttocks.
3.2.2 Adjust the brightness of the cold light source to keep the brightness appropriate.
3.2.3 Adjust the photoelectric video converter until the video screen image is clear, and wipe the video conversion lens with 0.5% iodophor solution for disinfection. First, dip the iodophor solution in sterile gauze and wipe it repeatedly on the outer wall of the lens for 3 minutes, and then wipe the iodophor solution with sterile dry gauze. Bacterial culture proves that the disinfection effect of this method is reliable. The iodophor solution wiping disinfection method also has the advantages of simplicity and rapidity.
3.3 Dilate the cervix and put it into the speculum. Nurses arrange uterine expansion rods from small to large, and operators gradually expand the cervix until it can accommodate the hysteroscope sheath and put it into the hysteroscope. When expanding the uterus, closely observe the patient's consciousness, heart rate, blood pressure, breathing range and blood oxygen saturation, and report to the anesthesiologist and operator in time if there is any abnormality.
3.4 Hang the infusion bottle-type disposable infusion set (hereinafter referred to as infusion bottle) on the infusion stand, pour 500ml of 5% glucose solution as uterine dilation liquid, and connect the input water pipe and the output water pipe to ensure smooth perfusion and discharge of uterine dilation liquid. Adjust the height of the infusion stand to make the liquid level in the infusion bottle higher than the operating bed surface1m. Using the liquid level difference of uterine dilation fluid to maintain the uterine dilation pressure. The amount of perfusion at one time should be based on the fact that the operator can see the bottom of uterus and the opening of fallopian tube. 5% glucose solution is a non-ionic solution, which will not cause electric shock to patients during electrotomy. Enlarging the uterus can enlarge the uterine cavity, make the surgical field clear and facilitate the operation. The amount of liquid in the uterine cavity keeps a dynamic balance, and the uterine dilating liquid flowing out through the output tube can not only take away the tissue that has been cut off by electricity, but also reduce the temperature of the uterine cavity, contract local blood vessels and reduce bleeding. The total dose of uterine dilating fluid is generally 65438 0000 ~ 3000 ml.
3.5 Under the monitoring of the video screen, the operator cut the endometrium in turn by using the electric cutting ring, and then blanched the slices with the spherical electrode. Visiting nurses adjust the intensity of electrocautery according to the operator's needs. The output power of electrocautery is generally 100w, and the electrocoagulation is 40 W. The excised tissue fragments are sent for pathological examination.
3.6 After the electrotomy, connect a microwave therapeutic instrument for adjuvant therapy.
4 sports meeting
4. 1 Do a good job of preoperative visit. This operation is a new technology developed by our hospital, but patients lack understanding about it and have doubts about the prognosis. Therefore, the visiting nurse visited the patients in the ward one day before operation, and introduced the surgical methods, surgical positions and advanced and safe operations, so that they could relieve their psychological pressure and accept the operation with a good attitude. At the same time, guide patients to cooperate with ward nurses to make preoperative intestinal and vaginal preparations.
4.2 Do a good job in monitoring and preventing intraoperative complications, mainly including: 4.2. 1 venous air embolism: foreign literature reports that [1] venous air embolism may occur during hysteroscopy. In order to prevent it from happening, we think that when taking the cystolithotomy position, we should avoid lowering our heads and raising our hips. If the operator needs surgery, the whole operating bed should be raised or the stool of the operator should be lowered. During the operation, if it is found that the patient has difficulty breathing, the blood oxygen saturation decreases, and there is a waterwheel sound in the precordial auscultation, which suggests that venous air embolism may occur and should be rescued immediately.
4.2.2 Water poisoning: Water poisoning is caused by too much liquid for uterine dilatation and too much water absorption. When the operation time is too long and a large amount of uterine dilator is used, the visiting nurse should report the perfusion and discharge to the operator. Olson found that during the operation, under normal pressure, a small to moderate amount of liquid would be absorbed through the fallopian tube. [2] Observe the situation during the operation. When water poisoning is suspected, drip diuretics or a small amount of hypertonic saline intravenously according to the doctor's advice, and limit the amount of liquid.
4.2.3 Uterine perforation: The hard tube hysteroscope has a thick sheath, and the electrosurgical electrode is a telescopic arc electrode. Patients with extreme uterine flexion and retroflexion will occasionally cause uterine perforation if they are not skilled and exert too much force under the condition of limited vision and not looking directly. The main symptoms of patients are restlessness, hyperhidrosis, blood pressure drop and abdominal distension. At this time, the pressure of uterine dilation fluid should be reduced. Oxytocin 20U and dexamethasone 10mg were given intravenously as required.
4.2.4 Prevention of electric burn: Carefully check the uterine dilation liquid to avoid pouring electrolyte solution into the uterine dilation liquid bottle. During operation, always check whether the negative plate is loose.
4.3 Do a good job in instrument maintenance. After the operation, rinse the hysteroscope and the surgical site with clear water and dry them, and wipe the metal joint with paraffin oil for later use. Don't break the cold light source line to avoid damaging the light beam. All knobs of electric burner, cold light source, photoelectric video converter and display shall be reset to zero, and covered for protection.