Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology
Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology
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DOI：
10.1097/aog.0000000000004898
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发表时间：
2022-09-01
影响因子：
7.2
通讯作者：
Bradley, Linda D.
中科院分区：
文献类型：
--
作者：
Orlando, Megan S.;Bradley, Linda D.
宫腔镜检查提供了一种微创策略，以评估子宫内病理学和管理诸如异常子宫出血、不孕症、子宫内粘连、苗勒管异常和子宫内异物等病症。增加在办公室进行宫腔镜检查的机会，可以最大限度地减少经济和后勤障碍，帮助简化诊断和治疗计划，并可能避免不必要的手术和麻醉，从而有可能改善患者护理。宫腔镜检查是指在门诊进行的手术，其中疼痛管理不涉及药物，口服非镇静药物，局部麻醉剂，或口服或吸入清醒镇静。我们提出了在办公室环境中实施宫腔镜检查的最佳实践。这些包括适当的患者选择，最佳的手术时机，宫颈狭窄或扩张疼痛风险最高的患者的宫颈准备，个性化的疼痛管理策略，使用扩张介质，以及视频监控，以使患者参与手术。我们描述了在办公室环境中使用的小型化设备和“无接触”阴道镜方法，以限制患者的不适。通过适当的培训和经验，门诊宫腔镜检查为我们的患者提供了一种简单且具有成本效益的妇科护理模式。
Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, mullerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.