Young Bruce K, Roman Ashley S, MacKenzie Andrew P, Stephenson Courtney D, Minior Victoria, Rebarber Andrei, Timor-Tritsch Ilan
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, NYU School of Medicine, New York, NY 10016, USA.
Fetal Diagn Ther. 2004 May-Jun;19(3):296-300. doi: 10.1159/000076715.
To describe a new technique for wound closure after endoscopic intrauterine procedures which prevents amniotic fluid leakage after the procedure.
This is an observational study which reviews a new technique under an IRB-approved protocol. The rationale for this study was the increasing frequency of intrauterine endoscopic procedures. The most common complication of these procedures is persistent leakage of amniotic fluid from puncture sites, which can result in preterm labor and preterm delivery. Thus, these procedures carry a high morbidity rate that may overcome the benefit of the intervention. We have employed a new technique, which has successfully prevented amniotic fluid leakage following the procedure. The instruments used for the endoscopic procedures were no larger than 3.5 mm for all cases. A sealant of platelets was rapidly injected followed by injection of fibrin glue and powdered collagen slurry at each puncture site. Sonography for modified AFI, clinical examination for nitrazine and ferning, and pad count were performed after each procedure at three intervals: immediately after the procedure, 24 h and 48 h.
Eight patients undergoing an endoscopic intrauterine procedure (either cord ligation for twin-twin transfusion syndrome or sealing of ruptured membranes after amniocentesis) were included. All patients were treated between 18 and 24 weeks of gestation. Sonography, clinical examination and pad count revealed no evidence of amniotic fluid leakage either intra-abdominally or vaginally in any of the patients. There was 1 patient who ruptured membranes 12 h after the procedure due to severe vomiting. Another patient elected to terminate the pregnancy 48 h after the procedure without evidence of leakage. The remaining patients continued for 8 weeks or more without fluid leakage.
The technique described, immediate sealing of puncture wounds following endoscopic intrauterine procedures, is effective in preventing amniotic fluid loss after the procedure.
描述一种用于内镜下宫内手术伤口闭合的新技术，该技术可防止术后羊水渗漏。
这是一项观察性研究，依据经机构审查委员会批准的方案对一种新技术进行评估。开展本研究的理由是宫内内镜手术的频率不断增加。这些手术最常见的并发症是穿刺部位持续羊水渗漏，这可能导致早产和分娩。因此，这些手术的发病率较高，可能抵消干预措施带来的益处。我们采用了一种新技术，该技术已成功预防了术后羊水渗漏。所有病例的内镜手术所用器械直径均不超过3.5毫米。在每个穿刺部位迅速注射血小板密封剂，随后注射纤维蛋白胶和胶原粉浆。每次手术后分别在三个时间点进行改良羊水指数超声检查、试纸酸碱度及羊齿状结晶的临床检查以及护垫计数：术后即刻、术后24小时和48小时。
纳入了8例行内镜下宫内手术的患者（双胎输血综合征脐带结扎术或羊膜穿刺术后胎膜破裂封堵术）。所有患者均在妊娠18至24周接受治疗。超声检查、临床检查和护垫计数显示，所有患者腹腔内或阴道均无羊水渗漏迹象。有1例患者术后12小时因严重呕吐导致胎膜破裂。另1例患者在术后48小时选择终止妊娠，无渗漏迹象。其余患者持续妊娠8周或更长时间，无羊水渗漏。
所描述的技术，即内镜下宫内手术后立即封闭穿刺伤口，可有效防止术后羊水流失。
