Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.
J Minim Invasive Gynecol. 2011 Jul-Aug;18(4):489-93. doi: 10.1016/j.jmig.2011.03.015. Epub 2011 May 14.
To estimate the influence of oxytocin infusion on operative blood loss and glycine deficit during hysteroscopic transcervical endometrial resection (TCRE) for abnormal uterine bleeding (AUB).
Prospective, randomized, placebo-controlled study (Canadian Task Force classification I).
Tertiary Care University Hospital.
Forty-eight women with abnormal uterine bleeding that was unresponsive to conservative medical management were randomly assigned to undergo hysteroscopic TCRE with either oxytocin infusion (group A) or saline (group B). Intravenous Ringer's lactate solution was used during surgery.
TCRE was carried out with glycine 1.5% mixed with 2% ethanol as a distension medium. For group A: one ampoule of oxytocin (10 U/mL/amp) was added to 500 mL Ringer's lactate solution running at a rate of 400 mU/min during surgery. In group B, one ampoule of saline solution was added to the Ringer's solution and run at a similar rate. The amount of distension medium used, fluid deficit, blood levels of albumin and ethanol, hematocrit, hemoglobin, changes in serum sodium levels (Na+), and central venous pressure were compared between the groups.
The mean volume of distension fluid used and operating time were not significantly different in both groups (4.18 ± 0.2 vs 4.5 ± 0.5 L, and 28.3 ± 4.2 vs 27.5 ± 5.4 min, respectively). Although operating time, volume of distension fluid used, decrease in albumin level and hematocrit were less in the oxytocin than in the saline group, the differences were not statistically significant. The ethanol levels in blood, decrease in serum Na+, and glycine deficit were significantly lower in the oxytocin than in the saline group (17.4 ± 3.8 vs 25.3 ± 4.2 mg/ml, 6.7 ± 1.2 vs 9.1 ± 0.9 mEq/L, and 0.49 ± 0.08 vs 0.66 ± 0.05 L, respectively; p <.05). There was no significant difference in mean total uterine size, endometrial thickness, weight of resected tissue, and other demographic data between the study groups.
Oxytocin infusion combined with skillful surgical techniques may prevent fluid overload and glycine deficit during hysteroscopic TCRE for abnormal uterine bleeding. Although there is a trend toward a decrease in operative blood loss, further randomized trials are required to confirm this finding.
评估缩宫素输注对宫腔镜下经宫颈子宫内膜切除术（TCRE）治疗异常子宫出血（AUB）术中失血量和甘氨酸缺乏的影响。
前瞻性、随机、安慰剂对照研究（加拿大任务组分类 I）。
三级保健大学医院。
48 例异常子宫出血患者，经保守药物治疗无效，随机分为缩宫素输注组（A 组）或生理盐水组（B 组）行宫腔镜 TCRE。手术期间使用静脉林格氏乳酸溶液。
TCRE 采用甘氨酸 1.5%与 2%乙醇混合作为扩张介质进行。对于 A 组：术中以 400mU/min 的速度向 500mL 林格氏乳酸溶液中加入 1 安瓿（10U/mL/安瓿）缩宫素。B 组向林格氏溶液中加入 1 安瓿生理盐水，并以类似速度输注。比较两组间扩张液用量、液体不足量、白蛋白和乙醇血水平、血细胞比容、血红蛋白、血清钠水平（Na+）变化和中心静脉压。
两组间扩张液用量和手术时间的平均值无显著差异（分别为 4.18±0.2 升和 4.5±0.5 升，28.3±4.2 分钟和 27.5±5.4 分钟）。尽管缩宫素组的手术时间、扩张液用量、白蛋白水平和血细胞比容下降均低于生理盐水组，但差异无统计学意义。缩宫素组的乙醇血水平、血清 Na+下降和甘氨酸缺乏程度明显低于生理盐水组（分别为 17.4±3.8 毫克/毫升与 25.3±4.2 毫克/毫升、6.7±1.2 毫当量/升与 9.1±0.9 毫当量/升、0.49±0.08 升与 0.66±0.05 升；p<.05）。研究组间子宫总大小、子宫内膜厚度、切除组织重量和其他人口统计学数据的平均值无显著差异。
缩宫素输注联合熟练的手术技术可能预防宫腔镜 TCRE 治疗异常子宫出血时的液体过载和甘氨酸缺乏。尽管术中失血量有减少的趋势，但需要进一步的随机试验来证实这一发现。
