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Офисная гистероскопия в диагностике и лечении внутриматочной патологии
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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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.
Key words: office hysteroscopy, endometrial pathology, stationary substitution technology.
Ключевые слова: офисная гистероскопия, внутриматочная патология, стационарзамещающие технологии.
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Key words: office hysteroscopy, endometrial pathology, stationary substitution technology.
Полный текст
Список литературы
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2. Serden SP. Diagnostic hysteroscopy to evaluate the cause of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27 (2): 277–86.
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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.
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.
Авторы
В.В.Коренная*
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*drkorennaya@mail.ru
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
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*drkorennaya@mail.ru
________________________________________________
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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