Comparison of the Efficacy of Diagnosis with Carbon Dioxide and Fluid Hysteroscopy

　　　　　目的：雖然子宮鏡手術已發明多年，但最近才廣泛地被婦產科醫生使用。不同的子宮腔撐開物有不同的效果和不同的併發症。本研究的目的是比較二氧化碳和液體子宮鏡在門診診斷的效益。 方法：從1996年6月至1996年12月，97位病人在門診做診斷性子宮鏡。受診的原因主要為子宮病變。每位病人先以二氧化碳子宮鏡，再用液體性子宮鏡作檢查，以比較兩者的清晰度，操作時間等。 結果：53位（54.6%）位病人其檢查所見正常。在97位病人中，有64位（66.0%）同時可以二氧化碳及液體性子宮鏡得到清晰的影像，但有5位（5.2%）病人，使用二氧化碳子宮鏡可得到清晰的影像，而使用液體性子宮鏡時產生模糊的影像。在操作時間方面，用二氧化碳子宮鏡的平均操作時間比液體性子宮鏡來得短。兩種方法均無併發症出現。 結論：以熟練的技巧操作二氧化碳子宮鏡，其影像優於液體性子宮鏡。二氧化碳性子宮鏡可節省操作時間，及避免要監視液體進出之不便和灌注過多液體於體內的危險。診斷性二氧化碳子宮鏡可提供清潔、簡便、安全、迅速方法，可作為診斷重要的利器。
　　　　　OBJECTIVES: Hysteroscopy is now widely used by gynecologists. Some distention media have the potential for complications and problems of efficacy. This study compares the efficacy of carbon dioxide (CO??) versus fluid (Dextrose 10% water) hysteroscopy and determines the more suitable hysteroscopic medium for outpatient clinical diagnosis. METHODS: From june to December 1996, 97 women with uterine problems successfully received CO?? hysteroscopy followed by fluid hysteroscopy. Paracervical anesthesia was used. The visibility afforded by and time required for these two hysteroscopic procedures were compared. RESULTS: Fifty-three patients (54.6%) were diagnosed as having normal hysteroscopic findings. Menorrhagia (n=37,38.1%) was the most common indication for the procedure. In the whole series, clear visibility was obtained with both CO?? and fluid media in 64 (66.0%) cases, while in 5 (5.2%) cases clear visibility was only obtained with CO?? medium. The time required to perform CO?? hysteroscopy was shorter than when using fluid. No complications occurred during the study. CONCLUSIONS: With proper methods, the visibility of CO?? hysteroscopy is superior to that of fluid hysteroscopy CO?? hysteroscopy can save time and avoid the inconvenience of fluid monitoring and the risk of fluid overloading during fluid hysteroscopy. Diagnostic outpatient CO?? hysteroscopy provides a neat, simple, safe, and rapid tool for the preliminary diagnosis of intrauterine pathology in a gynecology outpatient department.