Hysteroscopic Operations: Six Year Experience

Yıl 2013, Cilt: 15 Sayı: 1, 1 - 3, 01.03.2013

İsmail Bıyık Seyit Ali Köse Mustafa Albayrak Fatih Keskin Ahmet Karataş

Öz

Objective: The hysteroscopy provides seeing of endoservix and uterin cavity with a camera andtreatment of pathologies by this way. It can be used as diagnostically and operatively. We decidedto present the hysteroscopic operations and findings performed for diagnostic and operativereason in gynecology clinic at last six year.Material and Methods: The hysteroscopic operations which performed between January 2006 December 2011 were retrospectively evaluated. A totaly 166 cases in which the hysteroscopywas done for diagnostic and operative purpose were included into study. The prostoglandin E1analogue (misoprostol 200 mcg 1 tablet ) was used for cervical priming vaginaly beforeoperation night in all cases.Results: The mean age, gravida, parity and living child numbers of cases were 43 ± 11 years,2.4 ± 1.4, 2.6 ± 1.5 and 2.3 ± 1.6, respectively. The diagnostic hysteroscopy carried out in 12cases for infertiliy, and while operative hysteroscopy was performing in 59 cases for endometrialand endocervical polips, it was used for abnormal uterin bleeding and uterin leiomyomasindication in 35 and 24 cases respectively. While the endometrial hyperplasia was detected ineight cases, the endometrial adenocarsinom was detected in three cases. The uterin perforationdeveloped in five (3%) cases during operation.Conclusions: The hysteroscopy should be used more effectively in abnormal uterin bleedingand especially in postmenopausal bleedings. To prevent uterin perforation, the bimanualexamination of cases under anesthesia before presedure will be useful

Anahtar Kelimeler

Hysteroscopy, hysteroscopic surgery, hysteroscopy complications

Histeroskopik Operasyonlarımız: Altı Yıllık Deneyim

Öz

Amaç: Histeroskopi endoserviksin ve uterin kavitenin kamera ile görülmesi ve bu yollapatolojilerin tedavi edilmesini sağlar. Tanısal veya operatif olarak uygulanabilmektedir. Son altıyılda kliniğimizde tanısal ve operatif nedenlerle yapılan histeroskopi operasyonlarımızı vebulgularımızı paylaşmak istedik.Materyal ve Metod: Ocak 2006 - Aralık 2011 tarihleri arasında tanısal veya operatif amaçlıuygulanan histeroskopik operasyonlar retrospektif olarak incelendi. Dosya bilgilerine ulaşılan166 olgu çalışmaya dahil edildi. Tüm olgulara servikal olgunlaştırma amacıyla prostoglandinE1 analoğu (misoprostol 200 mcg / 1 tablet) operasyon öncesi gece vajinal yoldan uygulandı.Bulgular: Olguların ortalama yaşları 43 ± 11 yıl, gravidaları 2.4 ± 1.4, pariteleri 2.6 ± 1.5,yaşayan çocuk sayıları 2.3 ± 1.6 olarak hesaplandı. Tanısal histeroskopi 12 olguya infertilitenedeniyle, operatif histeroskopi ise en fazla endometrial ve endoservikal polip nedeniyle 59olguya, anormal uterin kanama ve myoma uteri nedeniyle sırasıyla 35 ve 24 olguya uygulandı.Sekiz olguda endometrial hiperplazi, üç olguda endometrium adenokarsinomu saptandı.Operasyon esnasında beş (%3) olguda uterus perforasyonu gelişti.Sonuç: Histeroskopi anormal uterin kanamada ve özellikle postmenopozal kanamalarda dahaetkin kullanılmalıdır. Uterus perforasyonunu önlemek için anestezi altında olgunun işlem öncesibimanuel muayenesi faydalı olacaktır

Anahtar Kelimeler

Histeroskopi, histeroskopik cerrahi, histeroskopi komplikasyonları

Kaynakça

• Technology assessment No. 7: Hysteroscopy. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117(6):1486-1491.
• Jadoul P, Donnez J. Complications of laparoscopic surgery in gynecology. In: Donnez J, ed. Atlas of Operative Laparoscopy and Hysteroscopy. 3rd ed. London: Informa 2007;553-560. Healthcare
• Jansen FW, Vredevoogd CB, van Ulzen K, Hermans J, Trimbos JB, Trimbos-Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol. 2000;96(2):266-270.
• Koskas M, Mergui JL, Yazbeck C, Uzan S, Nizard J. Office hysteroscopy for infertility: a series of 557 consecutive cases. Obstet Gynecol Int. 2010;168096. Epub 2010 Apr 14.
• Varasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol. 1999;94(2):168-171.
• Menzies R, Wallace S, Ennis M, Bennett A, Jacobson M, Yip G, Wolfman W. Significance of abnormal sonographic findings in postmenopausal women with and without bleeding. J Obstet Gynaecol Can. 2011;33(9):944-951.
• Twu NF, Chen SS. Five-year follow-up of patients with recurrent postmenopausal bleeding. Zhonghua Yi Xue Za Zhi (Taipei) 2000;63(8):628-633.
• Overton C, Hargreaves J, Maresh M. A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. Minimally Invasive Surgical Techniques--Laser, EndoThermal or Endorescetion. Br
• J Obstet Gynaecol 1997;104(12):1351-1359.
• Kresowik JD, Syrop CH, Van Voorhis BJ, Ryan GL. Ultrasound is the optimal choice for guidance in difficult hysteroscopy. Ultrasound Obstet Gynecol. 2011 Dec 15. doi: 10.1002/uog.11072. [Epub ahead of print]
• Gkrozou F, Koliopoulos G, Vrekoussis T, Valasoulis G, Lavasidis L, Navrozoglou I, Paschopoulos M. A systematic review and meta-analysis of randomized studies comparing misoprostol versus placebo for cervical ripening prior to hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2011;158(1):17-23.
• Selk A, Kroft J. Misoprostol in operative hysteroscopy: a systematic review and meta-analysis. Obstet Gynecol. 2011;118(4):941-949.