Witz C A, Silverberg K M, Burns W N, Schenken R S, Olive D L
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio 78284-7836.
Fertil Steril. 1993 Nov;60(5):745-56. doi: 10.1016/s0015-0282(16)56268-2.
To review the literature concerning complications resulting from absorption of hysteroscopic fluid distension media and to describe methods to treat and prevent these complications.
All pertinent literature on fluid distension media used for endoscopy, as well as relevant reports concerning the management of fluid and electrolyte imbalance, was reviewed.
The absorption of large volumes of electrolyte-free, low-viscosity fluid may result in volume overload with water intoxication. Volume overload may cause pulmonary edema, and water intoxication may lead to hyponatremia, hypo-osmolarity, and cerebral edema. In contrast, the absorption of dextran-70 may cause volume overload secondary to the oncotic effect of intravascular dextran. Dextran-70 has been associated with anaphylaxis and coagulation disorders.
The use of diuretics is advocated. Urine output must be closely monitored. Judicious correction of electrolyte imbalance will prevent morbidity.
Meticulous attention to intraoperative fluid balance is imperative. A multichannel hysteroscope is necessary to keep intrauterine pressure low. Extensive surgical procedures may need to be performed in stages.
Severe volume overload and electrolyte imbalance may result from fluid absorption during operative hysteroscopy. Most complications may be avoided by closely monitoring fluid balance intraoperatively.
回顾关于宫腔镜检查液体膨宫介质吸收所致并发症的文献，并描述治疗和预防这些并发症的方法。
回顾了所有关于用于内镜检查的液体膨宫介质的相关文献，以及有关液体和电解质失衡管理的相关报告。
大量无电解质、低粘度液体的吸收可能导致容量超负荷伴水中毒。容量超负荷可能导致肺水肿，而水中毒可能导致低钠血症、低渗透压和脑水肿。相比之下，右旋糖酐-70的吸收可能因血管内右旋糖酐的渗透效应而导致容量超负荷。右旋糖酐-70与过敏反应和凝血障碍有关。
提倡使用利尿剂。必须密切监测尿量。明智地纠正电解质失衡可预防发病。
必须密切关注术中液体平衡。需要使用多通道宫腔镜以保持宫腔内压力低。广泛的手术操作可能需要分阶段进行。
手术宫腔镜检查期间的液体吸收可能导致严重的容量超负荷和电解质失衡。通过术中密切监测液体平衡，大多数并发症是可以避免的。
