What Is Fetoscopy?

Endoscopy is a surgical name. Mainly to check whether the uterus is normal.

Hysteroscopy

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Endoscopy is a surgical name. Mainly to check whether the uterus is normal.

Hysteroscopy

Hysteroscope hysteroscope hysteroscopy uterine endoscopy hysteroscopy

Obstetrics and Gynecology

68.1201

Hysteroscopy has further developed from diagnosis to surgical treatment. In addition to supplementing the deficiencies of laparoscopy, it has its own unique features, which makes a major leap in gynecological surgery, especially in the diagnosis and treatment of infertility and infertility. With greater development.

There are many types and types of hysteroscopes used at home and abroad, which are basically divided into two categories, that is, rigid tube type and flexible tube type. The rigid tube type is divided into straight tube type and elbow type. Taking domestically produced XG-3 as an example, it is a rigid tube-elbow type. It is suitable for liquid expansion devices. Its outer diameter is 160mm; 60 °; Magnification: 6.1 times at 4mm from the test object, and 1 time at 3cm. The lens body is composed of an observation system, a fiber guide beam, an operation channel, a liquid injection channel and a cervical tapered plug (stopper). The cold light sources for it are LG-250 cold light source and SLG-600 flash cold light source. The light source can also be equipped with a recording device such as a camera.

Hysteroscopic accessories include surgical instruments such as biopsy forceps, crab claw foreign body forceps and snare cutters, as well as micro-scissors, suction tubes, rulers and electrocoagulation electrodes, etc., which are essential.

Cleaning and maintenance: After using the hysteroscope, first rinse it with tap water, then repeatedly inject water or 75% ethanol with a syringe, rinse the operation channel and the water inlet channel, and finally use a rubber ball to blow into the channel to make it Dry; The surface of the lens should be lightly wiped with a thin cotton swab dipped in ethanol; The optical cable should not be bent to avoid breaking the optical fiber bundle (bending radius cannot be less than 50mm); The cold light source must be changed from dark to bright, and bright to slowly turn dark when disabled, Do not turn on or off abruptly. Do not use the light source for more than 2h each time. The device should be ventilated and dry to avoid mold and rust. It should not be smoked or soaked with formaldehyde solution for a long time, otherwise it will be rusted or corroded.

Choice of uterine dilation: Proper dilation of the uterine cavity is the key to successful endoscopic examination or surgery, and is generally divided into gas uterine dilation and liquid uterine dilation; gas uterine dilation: mainly use CO2 with negative pressure to suck the cervix The cervix is fixed so that it is airtight, and then CO2 is injected through the hysteroscopic sheath and the gap between the tubes to expand the uterine cavity. The advantages of using CO2 are relatively large vision and high definition. Disadvantages: CO2 may escape into blood vessels after pressurization, which can cause patients with arrhythmia, heart failure, acidosis and even life-threatening. In addition, a more complicated CO2 inflation device is needed. The rate of CO2 inflation of the hysteroscope must be controlled at 60 to 70 ml per minute, and the intrauterine pressure should be less than 2000kPa (150mmHg). Liquid dilatation: 5% glucose solution is used as dilatation solution for hysteroscopy, but the fallopian tube can only be seen when the perfusion pressure is above 13.33kPa (100mmHg). In the case of uterine bleeding, 3% medium molecular dextran-7 anhydride-70 can be dissolved in 10% glucose solution to become a colorless and transparent glue-like swelling solution. The effect of swelling is better, and it is not easy to mix with blood mucus. Disadvantages: expensive, bolus injection is difficult, soaking in hot water after use, not easy to clean, and easy to damage the instrument. In short, most of the recent companies use 5% glucose solution as the preferred expansion medium, and use continuous pressure to control the expansion device. The reason is that it is economical, simple, safe, readily available and effective, and the instrument is easy to flush.

(1) The trauma is small, the appearance is not cut, and it enters through the cervix, and the lesions in the uterine cavity can be observed.

(2) The device is relatively simple, easy to operate, and has both diagnostic and therapeutic functions. It can solve some problems that cannot be solved under laparoscopy or conventional surgery, such as the discovery and removal of the mediastinum of the uterine cavity, so that many patients with repeated abortions can recover. Reproductive function.

(3) There is no need to be hospitalized or the length of stay is short, and the postoperative recovery is fast.

3. Disadvantages of hysteroscopic surgery

(1) The surgical field is limited, and the surgeon needs to have rich clinical experience.

(2) When intrauterine bleeding is active, there are some difficulties in hemostasis and surgery.

Hysteroscopy is suitable for:

1. Find the causes of infertility and infertility, such as tubal patency: if the tubal is unobstructed or not, you can slowly pressurize to distinguish the tubal from being unobstructed, unobstructed, or completely blocked. At the opening of the fallopian tube, a 1.4 mm diameter plastic catheter was used for fallopian tube intubation. 20 ml of normal saline plus dexamethasone 5 mg and 2% lidocaine 10 ml were used to measure the fallibility of the fallopian tubes. Infertility of unknown cause. Repeated abortions for unknown reasons.

2. Uterine malformations, intrauterine adhesions, and uterine mediastinum.

3. Endometrial lesions such as submucosal fibroids, tuberculosis, endometrial polyp endometrial scars, fetal membrane residues, and so on.

4. Non-menstrual uterine bleeding (such as excessive menstruation, frequent, prolonged menstruation, irregular uterine bleeding, uterine bleeding before and after menopause, etc.), find the cause and give treatment.

5. Intrauterine acoustic examination is abnormal.

6. IUD and intrauterine foreign body location, try to take. Endometrial changes caused by hormonal drugs (such as tamoxifen, HRT, etc.).

7. Family planning (IUD), location and removal of residual embryos.

8. Screening indications for hysteroscopic surgery.

9. Early diagnosis of cervical cancer and endometrial cancer.

1. Acute and subacute genital inflammation.

2. Active uterine bleeding.

3. Menstrual period and pregnancy.

4. Invasive cervical cancer.

5. The uterine cavity is too narrow.

6. Serious medical diseases.

1. The date of surgery is preferably 3 to 5 days after menstruation is clean, except for those with irregular uterine bleeding.

2. Intramuscular injection of 10mg and pethidine 50mg before surgery, to stabilize the patient's mood and reduce fear.

3. Carefully inspect and prepare the required equipment.

4. Talk to the patient before the operation and inform them of the steps and purpose of the examination in order to obtain full cooperation.

Local anesthesia. Bladder lithotomy position.

1. Routine disinfection of the vulva, spread with sterile hole towels. After local anesthesia on both sides of the cervix, place a sterile urinary catheter into the uterine cavity, connect a 20ml syringe, and infuse warm saline. The pressure should be light, so that the injected saline will flow out until the discharged fluid is clear.

2. Dilate the cervix first with the probe to understand the direction of the uterine cavity, and then use the black grid expansion bar to expand the cervix to 6.5. The domestic XG-3 fiber optic hysteroscope can pass through. Adjust the depth of entry at this time. The cavity is 7cm deep, and the upper limiter is installed at a considerable 6cm.

3. Insert the sight glass and connect it with the cold light source. Unscrew the light source to eliminate the air bubbles in the mirror, and then slowly insert the speculum into the cervix, while injecting the uterine fluid, so that when the mirror surface is wet, it is difficult to adhere to mucus and maintain a clear vision.

4. The front end of the speculum speculum is paused after reaching the uterine floor. Ask the assistant to pressurize the swelling fluid and adjust the lens body slightly. You can see that the uterine cavity is dilated. The wall of the palace is red and yellow. Sometimes the distribution of small blood vessels can be seen, pay careful attention to the presence of lesions in the uterine cavity. By tilting the lens to one side of the palace, you can see the fallopian tube orifice, and if necessary, take a picture to record its shape. Then slowly retract the speculum. In this process, the whole view of the entire uterine cavity is panoramic. In the state of continued dilation, entering the cervical canal, you can see that the cervical canal is cylindrical, yellow and white, and the endometrium is flat and smooth. Sometimes the cervical canal can be seen as a longitudinal fissure, like ridges and grooves, and sometimes the submucosa in the uterine cavity. Fibroids and cervical canal polyps.

5. After the microscopy, you can perform corresponding operations under hysteroscopy under direct vision, such as endometrial biopsy, tubal intubation and injection, or removal of intrauterine adhesions to remove the uterine mediastinum and submucosal fibroids.

6. Record in detail on the medical record, take pictures, and record videos if necessary.

1. Before the endoscope is inserted into the cervical canal, it must be discharged despite the internal air bubbles, so as to prevent gas from entering the uterine cavity and disturbing the visual field.

2. The dilation of the cervix must be just right. Too tight is not conducive to the insertion of hysteroscopy, too loose will make the cervix leak water, affecting the effect of uterine swelling.

3. Uterine bleeding is the main reason that affects the clarity of microscopy. It is best to arrange the date of surgery 3 to 5 days after menstruation, but less bleeding. Avoid bleeding or check during bleeding. It should be noted that: uterine bleeding may come from cancerous tumors, polyps and other lesions, but more common are fresh injuries during operation, which should be reduced as much as possible, and the operation should be gentle and slow; If cervical cancer is suspected, try to avoid expansion The cervix; The small blood clots, mucus and other tissue fragments in the uterine cavity should be washed as far as possible and the drainage hole should be closed to further swell the uterine cavity; The examination should be started from the inner mouth of the cervix, the lower part of the uterus and the posterior wall, and finally the bottom of the uterus This can avoid the dissatisfaction of the lower part of the final blood vague examination.

4. During the microscopic examination, the visual field is red, and the vision is blurred. The common reasons are: excessive bleeding in the uterine cavity, the blood and the dilated uterine fluid are mixed, and it should be washed as much as possible until it is clear. The effect of dilatation is poor, and the pressure of perfusion of dilatation should be increased. The objective lens of the uterine cavity is too close to the test object. There may be blood pieces, mucus or endometrial fragments attached to the mirror surface, and they should be removed and checked again. Examination time is too long, or the perfusion of the uterine fluid is too fast, causing endometrial edema.

After hysteroscopy, do the following:

1. If bleeding occurs after surgery, give hemostatic drugs and antibiotics.

2. Watch for 1 to 2 hours after the operation, ask the patient to rest for 1 week, avoid fatigue, and prohibit sex and tub bath for 2 weeks.

3. Treat diseases found by microscopy.

1. Cervical laceration and perforation of the uterus may occur, but it is very rare, and can be prevented by careful and gentle operation. Special care should be taken for thin and brittle menopause and lactation uterus.

2. There is generally not much bleeding after bleeding, especially after the microscopic examination has cleared the cause of the bleeding, and can be treated symptomatically.

3. If the infection has been inflamed or operated too much, antibiotics should be given to prevent the spread of the infection. If there is untreated endometrial tuberculosis, tuberculosis may spread after surgery and anti-diarrheal treatment should be strengthened.

4. Air plugs rarely occur if they are operated according to the routine, but if the operation time is too long, the amount of CO2 perfusion in the uterine cavity is too large or too fast, it is likely to occur. When shortness of breath, chest tightness, and cough occur, it should be stopped immediately Operate, release gas, treat symptomatically.

5. Cardio-cerebral syndrome due to dilation of the cervix and uterine cavity, excite the vagus nerve, dizziness, chest tightness, sweating, nausea, pale face, slowed pulse, etc., similar to the phenomenon that occurs during induced abortion. 0.5mg is enough. Pause the operation until the situation improves and then continue the operation.

6. In very rare cases, due to the high intrauterine pressure, the distally closed fallopian tube is also expanded and ruptured, or due to intrauterine high-frequency current treatment, resulting in uterine perforation, bowel perforation and other injuries.

7. Occasionally, there have been reports of allergies to dextran-7 anhydride-70 and hydroxymethyl cellulose.

8. After hysteroscopy, endometritis, endometrial cancer, and tuberculosis are at risk of spreading to the abdominal cavity through the fallopian tube.