Hysteroscopic surgery, as a surgical method through women's natural orifice-vaginal, has the advantages of less trauma, shorter hospital stay (usually one day), quick recovery, and so on. Hysteroscopy mainly uses a flexible tube with a camera to enter the uterus to understand the situation in the uterus. After entering the uterine cavity, it can find the uterine cavity and abnormal conditions of the uterus, and can check whether there are any vegetations in the uterine cavity, the size of the uterine cavity and Whether there is a problem with the structure, and whether the fallopian tubes are normal or not, and whether the endometrium is ectopic, and even if there are uterine problems such as intrauterine adhesions, hysteroscopic surgery can also be used for treatment.
Is hysteroscopy painful?
When it comes to various invasive examinations, most patients immediately think of pain, including hysteroscopy, and even some women reject the examination because of the unbearable pain caused by hysteroscopy, but in fact hysteroscopy is checking The main thing is to put a 5mm tube with a mirror into the uterine cavity, and then use the mirror to understand the situation in the uterine cavity and fallopian tubes, and display these conditions on the electronic device. During the process of entering, women will feel uncomfortable in the lower abdomen, but It does not feel pain, as long as you relax your body during the examination and do not let the muscles tense, there will be no pain.
Are there any precautions for hysteroscopy?
Before doing hysteroscopy, you need to check to determine whether you have reproductive diseases, such as vaginitis. Since the tube will enter the uterus through the vagina during the examination, you need to treat the inflammation to heal before doing this examination to prevent inflammation from entering the uterus. In addition, it is normal to have a small amount of vaginal bleeding after the examination. Don't worry too much, just do a good job of cleaning and hygiene.
Hysteroscopy is mainly used in the following aspects:
1. Abnormal uterine bleeding
Abnormal uterine bleeding (AUB) is a common gynecological disease that affects normal life and work in severe cases. Including abnormal bleeding during reproductive period, peri-menopause and post-menopause, such as: heavy menstruation, excessive menstruation, prolonged menstrual period, irregular bleeding, and uterine bleeding before and after menopause. There are often no abnormal findings during gynecological examination, and B-ultrasound or blind curettage are often misdiagnosed or missed. It is reported that the missed diagnosis of intrauterine lesions is as high as 10% to 35%; it is explained by abnormal hysterosalpingography (HSG) images. 30% to 50% are uncertain or even wrong. The clinical application of hysteroscopy can not only accurately determine the location, size, appearance and scope of the lesion, but also conduct careful observation of the tissue structure on the surface of the lesion. diagnostic accuracy.
The common lesions presented by hysteroscopy are uterine fibroids, endometrial hyperplasia and endometrial polyps. Followed by endometrial atrophy and endometrial lesions.
2. Infertility or habitual abortion
The cervical canal, uterine cavity and bilateral fallopian tube openings are examined by hysteroscopy to find lesions that interfere with the implantation and (or) development of fertilized eggs; at the same time, hysteroscopy is used to directly view the fallopian tube intubation to pass fluid to understand the patency of the fallopian tubes. .
The intrauterine factors of infertility and habitual abortion found by hysteroscopy include congenital uterine malformation, submucosal and intramural uterine fibroids, intrauterine adhesions, endometrial polyps, intrauterine foreign bodies and fallopian tubes block.
3. Intrauterine foreign body
Abnormal echoes or space-occupying lesions in the uterine cavity found by various abnormal sonography are indirect examination results, and hysteroscopy can be used to confirm, evaluate, and locate them, and decide whether to use hysteroscopy to remove them.
Intrauterine foreign bodies found by hysteroscopy are the common intrauterine device (incarcerated, fragmented residue) and embryo residue, followed by residual embryonic bone or endometrial calcification, broken cervical dilation rod or seaweed rod residue and Non-absorbable sutures left over from cesarean section.
4. Uterine submucosal myomectomy
Uterine fibroids are common benign tumors of female genitalia, and the main clinical manifestations are menorrhagia and prolonged menstrual periods. The traditional treatment methods mostly use open abdominal myomectomy or hysterectomy to achieve the purpose of treatment, but this surgical method is a kind of physical injury and psychological trauma to women who have fertility requirements or are unwilling to remove the uterus. Hysteroscopic treatment of submucosal fibroids is a unipolar or bipolar resection of submucosal fibroids and intramural fibroids using resectoscope. Postoperative menstrual flow was significantly reduced, and fertility was still possible.
5. Endometrial polyp removal
Endometrial polyps are a major cause of abnormal uterine bleeding and infertility. The usual method is blind curettage, but often encounter incurable problems, and the recurrence rate is high. Hysteroscopic endometrial polypectomy (TCRP) is the use of hysteroscopic ring electrodes to remove endometrial polyps and 2 to 3 mm of muscle tissue at their pedicle attachments. It is targeted and does not damage the surrounding normal endometrium. Best way.
6. Intrauterine adhesions
Intrauterine adhesion is a pathological phenomenon formed by partial or complete adhesion of endometrial damage, most of which are caused by curettage and curettage, mainly manifested as abdominal pain, decreased menstrual flow, amenorrhea, and infertility. Before the advent of hysteroscopy, the diagnosis of intrauterine adhesions relied on history, physical examination, laboratory data, and HSG. HSG can judge the degree of uterine cavity closure for suspected intrauterine adhesions, but cannot indicate the toughness and type of adhesions. Under the direct vision of hysteroscopy, 30% of abnormal HSG results can be excluded, and the final diagnosis can be made.
7. Hysterectomy
Uterine septum is a common uterine malformation, prone to premature birth, miscarriage, abnormal fetal position and postpartum placenta retention. Before the advent of hysteroscopic surgery, the uterine septum had to be opened and uterine incision was required. The patient was hospitalized for a long time, and the postoperative recovery was slow. Pregnancy could be considered at least 6 months after the operation. The uterus had scars, and the pregnancy could be maintained to term. Cesarean section rate is high, to prevent uterine rupture and ovarian, fallopian tube and pelvic adhesions. Hysteroscopic septal resection (TCRS) is an operation that uses hysteroscopic ring electrodes and needle electrodes to cut, remove or cut the uterine mediastinal tissue to restore the normal shape of the uterine cavity and reproductive function. There is no obvious bleeding during the operation, the postoperative morbidity rate is low, and it is easily accepted by patients. Pregnancy can be considered 4 weeks after the operation.
8. Endometrial lesions
Endometrial lesions are common malignant tumors of the female reproductive tract. Suspected endometrial lesions are mainly perimenopausal and postmenopausal women over 45 years old. In order to identify endometrial lesions, the traditional method is diagnostic curettage, which may miss those located deep in the uterine horns or behind the submucosal fibroids. Small lesions, part of the endometrial area can not be scraped, it is difficult to make a correct judgment. Endometrial cytology smears have the potential to provide false-negative results, especially for well-differentiated or small tumors. Numerous data show that direct biopsy of hysteroscopy and pathological examination of AUB women over 45 years old are the methods for screening high-risk groups, early detection and accurate diagnosis of endometrial lesions and their precursors.