子宮鏡於生殖醫學之應用

Application of Hysteroscopy in Reproductive Medicine

對不孕婦女而言，子宮腔病灶可能阻礙胚胎著床或導致流產，而子宮鏡是處理這些病灶最合適的工具。診斷性子宮鏡在沒有麻醉情形下檢查子宮腔，而手術性子宮鏡則是進一步在麻醉之後，於手術室中清除這些子宮腔病灶。常見的子宮腔（及子宮頸通道）病灶包括子宮內膜瘜肉、黏膜下子宮肌瘤、子宮腔黏連、子宮中膈、胚胎組織或胎盤殘留、子宮頸懷孕、剖腹產疤痕懷孕、子宮內膜增生、及子宮內膜癌等。子宮鏡手術有許多好處，包括無外在傷口、手術時間短、疼痛感低、身體復原迅速、受孕等待期短等。當然子宮鏡手術有其限制，並非所有子宮腔病灶都可使用子宮鏡完全清除，手術前必須篩選合適案例，以避免不必要之手術併發症。

For infertile women, intrauterine lesions might either impede embryo implantation or result in miscarriage, and hysterosocpy is the best tool to diagnose and treat them. Diagnostic hysteroscopy is able to observe the uterine cavity at out-patient clinics, whereas operative hysteroscopy is generally used to remove intrauterine lesions under anesthesia in the operation theater. Frequently encountered intrauterine lesions are endometrial polyps, submucous myomas, intrauterine adhesion, uterine septum, retained gestational tissues and/or placenta, cervical pregnancy, Cesarean scar pregnancy, endometrial hyperplasia, and endometrial cancer, etc. Merits of hysteroscopic surgeries include: no abdominal incision wound, short operation time, less painful, quick recovery, short interval for subsequent conception, etc. However, not every intrauterine lesion can be treated with operative hysteroscopy, and case selection before surgery is important.