Cicinelli Ettore, Schönauer Luca Maria, Barba Bruno, Tartagni Massimo, Luisi Diletta, Di Naro Edoardo
First Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy.
J Am Assoc Gynecol Laparosc. 2003 Aug;10(3):399-402. doi: 10.1016/s1074-3804(05)60272-1.
To assess acceptability and cardiovascular complications of hysteroscopy performed with minihysteroscopes compared with those performed with conventional hysteroscopes.
Prospective, randomized clinical trial (Canadian Task Force classification I).
Academic research center.
One hundred women with abnormal uterine bleeding.
Hysteroscopy with a 3.5-mm minihysteroscope or conventional 5-mm endoscope with no anesthesia.
Duration of examinations, pain, and occurrence of vasovagal reactions were recorded. Pain was assessed by visual analog scale ranging from zero to 20 before (pain expectancy) and at the end of the procedure. Occurrence of vasovagal reactions was assessed by monitoring blood pressure and pulse rate at 1-minute intervals during the procedure. A heart rate of less than 60/minute or a reduction greater than 20% compared with baseline was considered a vasovagal reaction; similarly, a reduction in blood pressure exceeding baseline value by 20% was considered a result of vagal stimulation. Mean duration was shorter for minihysteroscopy than for conventional hysteroscopy. The mean (SD) level of pain experienced during minihysteroscopy also was significantly lower (0.76 +/- 0.65 vs 1.46 +/- 0.86, 95% CI-1.0-0.4, p <0.0001). The number of instrumentally recorded (1 vs 11 cases) and clinical vasovagal reactions (0 vs 6 cases) was also significantly lower in the minihysteroscopy group than in the conventional hysteroscopy group (p <0.002 and <0.02, respectively).
New-generation minihysteroscopes make hysteroscopy easier and less painful, and carry a lower risk of vasovagal reactions than hysteroscopy performed with conventional instruments. In our experience, minihysteroscopy with vaginoscopic approach and saline distention is well tolerated, effective, and a true outpatient procedure.
评估与传统宫腔镜相比，使用微型宫腔镜进行宫腔镜检查的可接受性和心血管并发症。
前瞻性随机临床试验（加拿大工作组分类I）。
学术研究中心。
100名子宫异常出血的女性。
使用3.5毫米微型宫腔镜或传统5毫米内窥镜进行宫腔镜检查，不使用麻醉。
记录检查持续时间、疼痛情况和血管迷走神经反应的发生情况。在检查前（预期疼痛）和检查结束时，通过0至20的视觉模拟量表评估疼痛。在检查过程中，每隔1分钟监测血压和脉搏率，评估血管迷走神经反应的发生情况。心率低于60次/分钟或与基线相比降低超过20%被视为血管迷走神经反应；同样，血压降低超过基线值20%被视为迷走神经刺激的结果。微型宫腔镜检查的平均持续时间比传统宫腔镜检查短。微型宫腔镜检查期间经历的平均（标准差）疼痛水平也显著较低（0.76±0.65对1.46±0.86，95%可信区间-1.0至0.4，p<0.0001）。微型宫腔镜检查组仪器记录的血管迷走神经反应数量（1例对11例）和临床血管迷走神经反应数量（0例对6例）也显著低于传统宫腔镜检查组（分别为p<0.002和<0.02）。
新一代微型宫腔镜使宫腔镜检查更容易、疼痛更少，与使用传统器械进行的宫腔镜检查相比，血管迷走神经反应的风险更低。根据我们的经验，经阴道镜途径和盐水扩张的微型宫腔镜检查耐受性良好、有效，是一种真正的门诊手术。
