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Офисная гистероскопия в диагностике и лечении внутриматочной патологии
Коренная В.В. Офисная гистероскопия в диагностике и лечении внутриматочной патологии. Гинекология. 2015; 17 (4): 23–26.
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Korennaya V.V. Office hysteroscopy in the diagnosis and treatment of intrauterine pathology. Gynecology. 2015; 17 (4): 23–26.
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Аннотация
Основным методом диагностики внутриматочной патологии на амбулаторном этапе является ультразвуковое исследование органов малого таза. Несмотря на высокую точность и специфичность, ложноположительные или ложноотрицательные результаты, по данным разных авторов, могут встречаться в 20–30% случаев. Уточнить состояние цервикального канала и полости матки, а также одномоментно провести терапию по принципу «увидел–вылечи» – «see-and-treat» (англ.) в амбулаторных условиях возможно при помощи офисной гистероскопии. Возможно проведение таких хирургических манипуляций, как биопсия эндометрия, разделение перегородок и синехий полости матки, удаление полипов и субмукозных миом, стерилизация и извлечение инородных тел полости матки. Выполнение каждой из них требует применения стандартизованных приемов, позволяющих сократить время операции и повысить безопасность вмешательства. Для снижения вероятности осложнений важно соблюдать ряд технических условий, касающихся положения пациентки, особенностей дилатации полости матки и правил использования электрохирургического оборудования. При соблюдении этих условий, около 60% всех женщин с внутриматочной патологией могут быть пролечены амбулаторно.
Ключевые слова: офисная гистероскопия, внутриматочная патология, стационарзамещающие технологии.
Ключевые слова: офисная гистероскопия, внутриматочная патология, стационарзамещающие технологии.
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The main method of endometrial pathology diagnosis is outpatient ultrasonography (US) of the pelvic organs. Despite its high accuracy and specificity, false-positive or false-negative results, according to different authors, can occur in 20–30% of cases. To clarify the status of the cervix and uterus, as well as provide treatment ("see-and-treat" principle) in the outpatient setting it becomes possible with using office hysteroscopy. Carrying out such surgical procedures as an endometrial biopsy, separation walls and uterine adhesions, removal of polyps and submucous myomas, sterilization and removal of foreign bodies of the uterus is also possible. Each of these manipulations requires the use of standardized methods, allowing to reduce the operation time and improve the safety of the intervention. To reduce the risk of complications, it is important to observe a number of technical specifications relating to the situation of the patient, the characteristics of dilation of the uterus, and the rules for the use of electrosurgical equipment. Should these conditions be met, about 60% of all patients with endometrial pathology can be treated as outpatients.
Key words: office hysteroscopy, endometrial pathology, stationary substitution technology.
Полный текст
Список литературы
1. Di SpiezioSardo I, Bramante MS et al. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Rep Update 2008; 14 (2): 101–19.
2. Serden SP. Diagnostic hysteroscopy to evaluate the cause of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27 (2): 277–86.
3. Gebauer G, Hafner A, Siebzehnrübl E, Lang N. Role of hysteroscopy in detection and extraction of endometrial polyps: results of a prospective study. Am J Obstet Gynecol 2001; 184 (2): 59–63.
4. Bettocchi S, Selvaggi L. A vaginoscopic approach to reduce the pain of office hysteroscopy. J Am Assoc Gynecol Laparosc 1997; 4 (2): 255–8.
5. Cohen S, Greenberg JA. Hysteroscopic morcellation for treating intrauterine pathology. Rev Obstet Gynecol 2011; 4 (2): 73–80.
6. Valle RF. Hysteroscopy in the evaluation of female infertility. Am J Obstet Gynecol1980; 137 (4): 425–31.
7. Bettocchi S, Nappi L, Ceci O, Selvaggi L. Office hysteroscopy. Obstet Gynecol Clin North Am 2004; 31 (3): 641–54.
8. Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010; 17 (6): 703–8.
9. Bettocchi S, Ceci O, Nappi L et al. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc 2004; 11 (1): 59–61.
10. Carta G, Palermo P, Marinangeli F et al. Waiting time and pain during office hysteroscopy. J Minim Invasive Gynecol 2012; 19 (3): 360–4. Doi: 10.1016/j.jmig.2012.01.017. Epub 2012 Mar 3.
11. Vleugels M. Hysteroscopic procedures in the office. Gyn Endoscopy 2001; 10.
12. Filiz T, Doğer E, Çorakçx A et al. The efficacy, cost and patient satisfaction of classic versus office hysteroscopy in cases with suspected intrauterine space occupying lesions with 3-dimension ultrasound and abnormal uterine bleeding, J Turk Ger Gynecol Assoc 2009; 10: 189–93.
13. Cararach M, Penella J, Ubeda A, Labastida R. Hysteroscopic incision of the septate uterus: scissors versus resectoscope. Hum Reprod 1994; 9 (1): 87–9.
14. Bettocchi S, Di SpiezioSardo A, Ceci O et al. A new hysteroscopic technique for the preparation of partially intramural myomas in office setting (OPPIuM technique): A pilot study. J Minim Invasive Gynecol 2009; 16 (6): 748–54. Doi: 10.1016/j.jmig.2009.07.016.
15. Савельева Г.М., Бреусенко В.Г., Каппушева Л.М. Гистероскопия. Атлас и руководство. М.: ГЭОТАР-Мед, 2014. / Savel'eva G.M., Breusenko V.G., Kappusheva L.M. Gisteroskopiia. Atlas i rukovodstvo. M.: GEOTAR-Med, 2014. [in Russian]
16. Gulumser C, Narvekar N, Pathak M et al. See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations. Reprod Biomed Online 2010; 20: 423–9.
17. Van Kerkvoorde TC, Veersema S, Timmermans A. Long-term complications of office hysteroscopy: analysis of 1028 cases. J Minim Invasive Gynecol 2012; 19 (4): 494–7. Doi: 10.1016/j.jmig.2012.03.003.
2. Serden SP. Diagnostic hysteroscopy to evaluate the cause of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27 (2): 277–86.
3. Gebauer G, Hafner A, Siebzehnrübl E, Lang N. Role of hysteroscopy in detection and extraction of endometrial polyps: results of a prospective study. Am J Obstet Gynecol 2001; 184 (2): 59–63.
4. Bettocchi S, Selvaggi L. A vaginoscopic approach to reduce the pain of office hysteroscopy. J Am Assoc Gynecol Laparosc 1997; 4 (2): 255–8.
5. Cohen S, Greenberg JA. Hysteroscopic morcellation for treating intrauterine pathology. Rev Obstet Gynecol 2011; 4 (2): 73–80.
6. Valle RF. Hysteroscopy in the evaluation of female infertility. Am J Obstet Gynecol1980; 137 (4): 425–31.
7. Bettocchi S, Nappi L, Ceci O, Selvaggi L. Office hysteroscopy. Obstet Gynecol Clin North Am 2004; 31 (3): 641–54.
8. Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010; 17 (6): 703–8.
9. Bettocchi S, Ceci O, Nappi L et al. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc 2004; 11 (1): 59–61.
10. Carta G, Palermo P, Marinangeli F et al. Waiting time and pain during office hysteroscopy. J Minim Invasive Gynecol 2012; 19 (3): 360–4. Doi: 10.1016/j.jmig.2012.01.017. Epub 2012 Mar 3.
11. Vleugels M. Hysteroscopic procedures in the office. Gyn Endoscopy 2001; 10.
12. Filiz T, Doğer E, Çorakçx A et al. The efficacy, cost and patient satisfaction of classic versus office hysteroscopy in cases with suspected intrauterine space occupying lesions with 3-dimension ultrasound and abnormal uterine bleeding, J Turk Ger Gynecol Assoc 2009; 10: 189–93.
13. Cararach M, Penella J, Ubeda A, Labastida R. Hysteroscopic incision of the septate uterus: scissors versus resectoscope. Hum Reprod 1994; 9 (1): 87–9.
14. Bettocchi S, Di SpiezioSardo A, Ceci O et al. A new hysteroscopic technique for the preparation of partially intramural myomas in office setting (OPPIuM technique): A pilot study. J Minim Invasive Gynecol 2009; 16 (6): 748–54. Doi: 10.1016/j.jmig.2009.07.016.
15. Савельева Г.М., Бреусенко В.Г., Каппушева Л.М. Гистероскопия. Атлас и руководство. М.: ГЭОТАР-Мед, 2014. / Savel'eva G.M., Breusenko V.G., Kappusheva L.M. Gisteroskopiia. Atlas i rukovodstvo. M.: GEOTAR-Med, 2014. [in Russian]
16. Gulumser C, Narvekar N, Pathak M et al. See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations. Reprod Biomed Online 2010; 20: 423–9.
17. Van Kerkvoorde TC, Veersema S, Timmermans A. Long-term complications of office hysteroscopy: analysis of 1028 cases. J Minim Invasive Gynecol 2012; 19 (4): 494–7. Doi: 10.1016/j.jmig.2012.03.003.
________________________________________________
1. Di SpiezioSardo I, Bramante MS et al. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Rep Update 2008; 14 (2): 101–19.
2. Serden SP. Diagnostic hysteroscopy to evaluate the cause of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27 (2): 277–86.
3. Gebauer G, Hafner A, Siebzehnrübl E, Lang N. Role of hysteroscopy in detection and extraction of endometrial polyps: results of a prospective study. Am J Obstet Gynecol 2001; 184 (2): 59–63.
4. Bettocchi S, Selvaggi L. A vaginoscopic approach to reduce the pain of office hysteroscopy. J Am Assoc Gynecol Laparosc 1997; 4 (2): 255–8.
5. Cohen S, Greenberg JA. Hysteroscopic morcellation for treating intrauterine pathology. Rev Obstet Gynecol 2011; 4 (2): 73–80.
6. Valle RF. Hysteroscopy in the evaluation of female infertility. Am J Obstet Gynecol1980; 137 (4): 425–31.
7. Bettocchi S, Nappi L, Ceci O, Selvaggi L. Office hysteroscopy. Obstet Gynecol Clin North Am 2004; 31 (3): 641–54.
8. Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010; 17 (6): 703–8.
9. Bettocchi S, Ceci O, Nappi L et al. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc 2004; 11 (1): 59–61.
10. Carta G, Palermo P, Marinangeli F et al. Waiting time and pain during office hysteroscopy. J Minim Invasive Gynecol 2012; 19 (3): 360–4. Doi: 10.1016/j.jmig.2012.01.017. Epub 2012 Mar 3.
11. Vleugels M. Hysteroscopic procedures in the office. Gyn Endoscopy 2001; 10.
12. Filiz T, Doğer E, Çorakçx A et al. The efficacy, cost and patient satisfaction of classic versus office hysteroscopy in cases with suspected intrauterine space occupying lesions with 3-dimension ultrasound and abnormal uterine bleeding, J Turk Ger Gynecol Assoc 2009; 10: 189–93.
13. Cararach M, Penella J, Ubeda A, Labastida R. Hysteroscopic incision of the septate uterus: scissors versus resectoscope. Hum Reprod 1994; 9 (1): 87–9.
14. Bettocchi S, Di SpiezioSardo A, Ceci O et al. A new hysteroscopic technique for the preparation of partially intramural myomas in office setting (OPPIuM technique): A pilot study. J Minim Invasive Gynecol 2009; 16 (6): 748–54. Doi: 10.1016/j.jmig.2009.07.016.
15. Савельева Г.М., Бреусенко В.Г., Каппушева Л.М. Гистероскопия. Атлас и руководство. М.: ГЭОТАР-Мед, 2014. / Savel'eva G.M., Breusenko V.G., Kappusheva L.M. Gisteroskopiia. Atlas i rukovodstvo. M.: GEOTAR-Med, 2014. [in Russian]
16. Gulumser C, Narvekar N, Pathak M et al. See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations. Reprod Biomed Online 2010; 20: 423–9.
17. Van Kerkvoorde TC, Veersema S, Timmermans A. Long-term complications of office hysteroscopy: analysis of 1028 cases. J Minim Invasive Gynecol 2012; 19 (4): 494–7. Doi: 10.1016/j.jmig.2012.03.003.
Авторы
В.В.Коренная*
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*drkorennaya@mail.ru
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*drkorennaya@mail.ru
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V.V.Korennaya*
Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 125995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*drkorennaya@mail.ru
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