Brandner P, Neis K J, Ehmer C
Caritasklinik St. Theresia, Frauenklinik mit Neonatologie und Hebammenschule, Akademisches Lehrkrankenhaus der Universität des Saarlandes, Rheinstrasse 2, D-66113 Saarbrücken, Germany; fax 49 681 406 1383.
J Am Assoc Gynecol Laparosc. 1999 Nov;6(4):421-8. doi: 10.1016/s1074-3804(99)80005-x.
To assess the frequency of clinically apparent and undetected cardiopulmonary emboli during diagnostic CO(2) hysteroscopy, to determine the causes of these events, and to define a risk profile.
Retrospective and prospective case study (Canadian Task Force classification II-2).
Obstetric-gynecologic clinic of an academic teaching hospital.
Five thousand one hundred ninety-three women.
Diagnostic CO(2) hysteroscopy performed between September 1990 and December 1998.
From September 1990 to December 1996, 1 (0.03%) severe but nonfatal embolism occurred in 3932 diagnostic CO(2) hysteroscopies. Undetected emboli were present in 20 patients (0.51%). Starting in January 1997 the gas supply tube (volume 40 ml) was deaerated before the procedures, and no emboli occurred in the next 1261 examinations up to December 1998. The decrease in frequency was statistically significant (p = 0.009). No pathologic flow sounds were found in any of 50 hysteroscopies monitored by Doppler stethoscope.
A manifest gas embolism is rare in diagnostic CO(2) hysteroscopy. The 10% to 50% frequency of undetected gas emboli cited by other authors could not be confirmed. If the supply tube system that holds room air is purged with CO(2) before the procedure, the already low risk drops to zero or almost zero, confirming the theory that emboli that occur during CO(2) hysteroscopy are caused by room air.
评估诊断性二氧化碳宫腔镜检查期间临床明显和未被发现的心肺栓塞的发生率，确定这些事件的原因，并定义风险特征。
回顾性和前瞻性病例研究（加拿大工作组分类II-2）。
一所学术教学医院的妇产科诊所。
5193名女性。
1990年9月至1998年12月期间进行诊断性二氧化碳宫腔镜检查。
1990年9月至1996年12月，在3932例诊断性二氧化碳宫腔镜检查中发生1例（0.03%）严重但非致命的栓塞。20例患者（0.51%）存在未被发现的栓塞。从1997年1月开始，在操作前对气体供应管（容积40毫升）进行除气，在1998年12月前的接下来1261次检查中未发生栓塞。发生率的下降具有统计学意义（p = 0.009）。在50例经多普勒听诊器监测的宫腔镜检查中均未发现病理性血流声音。
在诊断性二氧化碳宫腔镜检查中明显的气体栓塞很少见。其他作者引用的未被发现的气体栓塞发生率为10%至50%这一情况未得到证实。如果在操作前用二氧化碳冲洗容纳室内空气的供应管系统，原本就很低的风险会降至零或几乎为零，这证实了二氧化碳宫腔镜检查期间发生的栓塞是由室内空气引起的这一理论。
