Lindheim S R, Cohen M, Sauer M V
Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA.
J Assist Reprod Genet. 1998 Oct;15(9):542-6. doi: 10.1023/a:1022582120168.
A procedure using transvaginal sonohysterography (SHG) to perform operative intrauterine biopsies and resections is described.
Seven women, six with intrauterine pathology noted on diagnostic SHG and one with a thickened endometrium noted on transvaginal ultrasonography, underwent attempted operative SHG. The indications were peri- and postmenopausal bleeding (n = 4) and infertility requiring assisted reproduction (n = 3). Access to the uterine cavity was accomplished with a 9-F cervical access catheter (CAC) with a 3-ml balloon (BEI Medical Systems, ZSI Gynecology Products Division, Chatsworth, CA), which was placed in the cervical canal or lower uterine segment. Depending on the position of the noted uterine pathology, a 6-F uterine ostial access catheter (UOAC) (BEI Medical Systems, ZSI Gynecology Products Division) was placed through the CAC. The uterine cavity was distended with 5-10 ml of 1% Lidocaine and a 3-F loop grasper or finger-like biopsy grasper was then passed through the UOAC or a 5-F operative instrument directly within the CAC with attempted resection under ultrasound guidance. Biopsied samples were sent to pathology for definitive diagnosis. Office hysteroscopy was then performed to confirm adequate resection.
Three of six patients had adequate resection or biopsy of intrauterine pathology, while the seventh patient successfully had a directed biopsy of the fundal cavity under ultrasound guidance. In one case, the visualized lesion could not be grasped. In the other two cases, each patient had severe cervical stenosis and declined in-office cervical dilation precluding the procedure. Each procedure was well tolerated, with an average time from start to finish of about 25 min (range, 18-43 min) without complications.
Operative SHG makes it possible to resect and biopsy intrauterine pathology often missed on Pipelle sampling. If found to be as effective as hysteroscopy, operative SHG would provide a cost-effective alternative. Further study is ongoing to perfect the existing instruments to allow removal of larger lesions both safe and possible.
描述一种使用经阴道超声子宫造影术（SHG）进行宫内手术活检和切除术的方法。
7名女性接受了经阴道超声子宫造影术的手术尝试，其中6名在诊断性SHG检查中发现有宫内病变，1名在经阴道超声检查中发现子宫内膜增厚。适应证包括围绝经期和绝经后出血（n = 4）以及需要辅助生殖的不孕症（n = 3）。使用带有3毫升球囊的9F宫颈接入导管（CAC）（BEI Medical Systems，ZSI Gynecology Products Division，Chatsworth，CA）进入子宫腔，该导管放置在宫颈管或子宫下段。根据所发现的子宫病变位置，通过CAC放置一根6F子宫开口接入导管（UOAC）（BEI Medical Systems，ZSI Gynecology Products Division）。用5 - 10毫升1%利多卡因扩张子宫腔，然后将一根3F环形抓钳或指状活检抓钳通过UOAC或直接通过5F手术器械经CAC插入，在超声引导下进行切除尝试。活检样本送病理科进行明确诊断。然后进行门诊宫腔镜检查以确认切除是否充分。
6名患者中有3名对宫内病变进行了充分切除或活检，第7名患者在超声引导下成功对宫底腔进行了定向活检。1例中，可见病变无法抓取。另外2例中，每位患者均有严重宫颈狭窄且拒绝在门诊进行宫颈扩张，因此无法进行该手术。每个手术耐受性良好，从开始到结束的平均时间约为25分钟（范围为18 - 43分钟），无并发症。
手术性SHG使得切除和活检宫内病变成为可能，而这些病变在Pipelle取样时常常被遗漏。如果发现与宫腔镜检查效果相同，手术性SHG将提供一种经济有效的替代方法。正在进行进一步研究以完善现有器械，使安全、可行地切除更大病变成为可能。
