Department of Anesthesiology, Academic Medical Center, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Am J Obstet Gynecol. 2012 Oct;207(4):271.e1-6. doi: 10.1016/j.ajog.2012.07.027. Epub 2012 Jul 26.
The objective of the study was to determine the incidence and amount of gas embolism during hysteroscopic surgery using either monopolar or bipolar diathermia and to investigate the relationship between the severity of gas embolism and the amount of intravasation of distension fluid.
This was a randomized, observer-blinded trial. Fifty patients, scheduled for hysteroscopic surgery, were assigned to either monopolar or bipolar diathermia. Transesophageal echocardiography was used to detect and classify gas embolism (grade 0-IV). Intravasation of distension fluid was measured.
Venous gas embolism was observed in all but 1 patient. A higher incidence of more extensive (grade IV) was seen during bipolar diathermia (42% vs 13%; P = .031). Paradoxical embolism was observed in 2 patients. When intravasation exceeded 1000 mL, significantly more grade IV venous gas embolism was seen (P = .049).
During hysteroscopic surgery, gas embolism was equally observed irrespective of the type of diathermia. However, more extensive embolism was observed when intravasation of distension fluid exceeded 1 L. These results question the acceptance of up to 2500 mL intravasation of distension fluid if bipolar diathermia is used.
本研究旨在确定使用单极或双极电切术行宫腔镜手术时气体栓塞的发生率和程度，并探讨气体栓塞严重程度与膨宫液渗出量之间的关系。
这是一项随机、观察者设盲试验。50 例行宫腔镜手术的患者被分配至单极或双极电切术组。经食管超声心动图用于检测和分级气体栓塞（0-IV 级）。测量膨宫液渗出量。
除 1 例患者外，所有患者均出现静脉气体栓塞。双极电切术中更常见且更广泛（IV 级）的栓塞（42%比 13%；P =.031）。2 例患者出现反常栓塞。当渗出量超过 1000 mL 时，明显更易出现 IV 级静脉气体栓塞（P =.049）。
在行宫腔镜手术时，无论使用哪种电切术，均可观察到气体栓塞，但当膨宫液渗出量超过 1 L 时，更易出现广泛栓塞。这些结果对接受双极电切术时允许膨宫液渗出量达 2500 mL 提出质疑。
