Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
J Minim Invasive Gynecol. 2011 May-Jun;18(3):355-61. doi: 10.1016/j.jmig.2011.01.010. Epub 2011 Mar 26.
Transcervical resection of myomas (TCR-M) is considered a safe hysteroscopic procedure if intravasation is limited. Complications may occur if gas formation during myoma resection leads to gaseous embolism. However, the incidence of emboli during transcervical myoma resection is unknown. Therefore in this study the occurrence of physiological changes that indicate the formation of emboli was retrospectively determined in patients undergoing hysteroscopic myoma resection. In addition, these changes were related to the amount of fluid intravasation.
The anesthesia records and operation files of 234 patients were screened for physiological changes that indicate embolism, as measured with standard intraoperative monitoring. These patients underwent surgery for intrauterine myomas with either a monopolar resectoscope with electrolyte-free distension fluid containing 3% sorbitol (limited to 1500-mL intravasation) or a bipolar resectoscope with normal saline solution (limited to 2500-mL intravasation). The patients were grouped according to the amount of fluid intravasation during the operation: Group 1: 500 mL or less, group 2: 500-1000 mL, group 3: 1000-1500 mL, and group 4: 1500-2500 mL.
Physiological changes that could be attributed to gaseous embolism were observed in 33% to 43% of patients with 1000 to 2500 mL fluid intravasation during transcervical myoma resection. Nearly half of those patients had cardiovascular disturbances that indicated the formation of emboli.
During transcervical resection of myomas, physiological changes that could be attributed to gaseous embolism frequently occurred. Therefore cardiovascular disturbances that indicate gaseous embolism during transcervical resection of myomas may occur despite the limitation of intravasation according to current view.
经宫颈子宫肌瘤切除术（TCR-M）被认为是一种安全的宫腔镜手术，如果限制了血管内注射。如果在子宫肌瘤切除过程中形成气体导致气体栓塞，可能会发生并发症。然而，经宫颈子宫肌瘤切除术中发生栓塞的发生率尚不清楚。因此，在这项研究中，回顾性地确定了在接受宫腔镜子宫肌瘤切除术的患者中发生表明栓塞形成的生理变化的发生率。此外，这些变化与血管内注射量有关。
筛选了 234 名患者的麻醉记录和手术档案，以测量标准术中监测的表明栓塞的生理变化。这些患者因子宫内肌瘤而行手术，使用含有 3%山梨醇的无电解质膨胀液的单极切除术（限制 1500 毫升血管内注射）或生理盐水的双极切除术（限制 2500 毫升血管内注射）。根据手术过程中的血管内注射量将患者分为 4 组：第 1 组：500 毫升或更少，第 2 组：500-1000 毫升，第 3 组：1000-1500 毫升，第 4 组：1500-2500 毫升。
在经宫颈子宫肌瘤切除术中，血管内注射量为 1000 至 2500 毫升的患者中，有 33%至 43%观察到可归因于气体栓塞的生理变化。其中近一半的患者有心血管紊乱表明形成了栓塞。
在经宫颈子宫肌瘤切除术中，经常发生可归因于气体栓塞的生理变化。因此，尽管根据目前的观点限制了血管内注射，但在经宫颈子宫肌瘤切除术中可能会发生表明气体栓塞的心血管紊乱。
