不同沖洗液於子宮鏡手術引發體液過量之病例報告

Complications of Fluid Overloading with Different Distention Media in Hysteroscopy-- A Report of Two Cases

子宮鏡的併發症相當少見，且多發生於以子宮鏡手術的病人。因子宮鏡手術暨安全又有效，目前取代子宮切除，用來治療經血過多或子宮肌瘤，但有可能置病人於子宮沖洗液經血管吸收的危險中。沖洗液吸收過量可造成體液過多、肺水腫、心衰竭及電解質不平衡。治療因子宮鏡手術後造成的體液過量，應視沖洗液的性質而定；且須緊急處置以防腦部傷害。幾乎此類併發症只要術中小心，且婦產科醫師、麻醉醫師及護士間能有良好配合即可避免。此文主要報告二例接受子宮鏡手術的病人，雖以不同的子宮沖洗液仍造成急性肺水腫及電解質不平衡。

Complications arising from hysteroscopy are relatively rare events. They occur more frequently with operative hysteroscopy than with diagnostic hysteroscopy. Hysteroscopic procedures, which are alternatives to hysterectomy for surgical treatment of menorrhagia and uterine fibroids, place women to run the risk of intravasation of uterine distention fluid. Excessive intravasion can entail fluid overload, pulmonary edema, congestive heart failure, and electrolyte imbalances. The prerequisite for treatment of hysteroscopic fluid overload is knowing the nature of the intrayasation fluid and it should be promptly treated to prevent neurological sequelae. Almost all serious complications of operative hysteroscopy can be avoided if proper precautions are taken and close communication is maintained between the gynecologic surgeon, the anesthesiologist, and nursing staff. Here, we present two cases of fluid overload with acute pulmonary edema and electrolyte imbalance from hysteroscopy with different distention media.