Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
J Obstet Gynaecol Res. 2022 Sep;48(9):2459-2465. doi: 10.1111/jog.15327. Epub 2022 Jun 13.
To compare the efficacy and safety of in-office hysteroscopy with a see-and-treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC).
We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy. Between 2018 and 2019, all cases of RPOC less than 2 cm in size were hysteroscopically removed by the see-and-treat approach in the office setting. Sociodemographic, clinical, and procedure characteristics along with complications were retrieved from medical records.
Between 2015 and 2019, 119 women underwent hysteroscopic removal of RPOC equal to or smaller than 2 cm: 53 patients by in-office hysteroscopy, and 66 by operative hysteroscopy. The two groups were similar in preoperative characteristics. Although the time required to complete the RPOC removal was similar, the total procedure and assistant time were significantly higher in the operative hysteroscopy group (p < 0.001). Moreover, operative hysteroscopy was associated with a higher proportion of cases complicated by excessive bleeding, cervical tear, or uterine perforation (p = 0.016). Failure to complete the procedure was similarly reported in the two groups (p = 0.58).
In-office hysteroscopy with the see-and-treat approach for RPOC equal to or smaller than 2 cm appears as effective as operative hysteroscopy, but safer. In-office hysteroscopy may be considered the first choice for treating RPOC equal to or smaller than 2 cm.
比较门诊宫腔镜下即诊即治与手术宫腔镜治疗妊娠物残留（RPOC）的疗效和安全性。
我们回顾性地确定了 2015 年至 2019 年间接受宫腔镜 RPOC 治疗的所有连续患者。我们排除了术前经阴道超声检查 RPOC 大于 2cm 的患者。2015 年至 2017 年，所有 RPOC 的宫腔镜切除均采用手术宫腔镜进行。2018 年至 2019 年，所有大小小于 2cm 的 RPOC 病例均在门诊环境下通过即诊即治的方法进行宫腔镜切除。从病历中检索了社会人口统计学、临床和手术特征以及并发症。
2015 年至 2019 年间，119 名女性接受了大小等于或小于 2cm 的 RPOC 宫腔镜切除：53 名患者在门诊进行宫腔镜检查，66 名患者进行手术宫腔镜检查。两组患者术前特征相似。虽然完成 RPOC 切除所需的时间相似，但手术宫腔镜组的总手术和辅助时间明显较高（p<0.001）。此外，手术宫腔镜与更多的过度出血、宫颈撕裂或子宫穿孔并发症相关（p=0.016）。两组均报告有类似的手术失败病例（p=0.58）。
对于大小等于或小于 2cm 的 RPOC，门诊宫腔镜下的即诊即治方法与手术宫腔镜一样有效，但更安全。门诊宫腔镜可能是治疗大小等于或小于 2cm 的 RPOC 的首选方法。
