| Hysteroscopic electrotomy which began in the mid 80s of the 20th century, has been gradually carried out as a new technology in the gynecological field in nearly 10 years, it has virtue of no open surgery, less trauma, less bleeding, less pain, shorter operative time, rapid postoperative recovery, short hospital stay and no effect on ovarian function and so on. Transcervical resection of endometrium is an ideal treatment for the patients who are with abnormal uterine bleeding, have no requirement of procreation and require to retain the uterus. The basic principle of Endometrial resection is to destroy the whole endometrial layer and the superficial layer of the muscle tissue, to prevent endometrial regeneration, so as to control excessive uterine bleeding—amenorrhea or reducing menstruation.The serious complications of Monopolar hysteroscopic resection—(non-electrolyte) liquid overload syndrome, accidental electrical burns or even death, uterine perforation etc, have drawn increasing attention, and prompt people to go for further studies on new minimal invasive techniques to reduce or avoid these complications, so a new Plasma bipolar resection comes into being. The features of Plasma bipolar electrode technology is that a working electrode and a circuit electrode are located in the resectoscope, the current is not through the body, high-frequency electrical energy through saline constituted to streamline the local control loop, the working electrode resectoscope loop with its own electrode with high heat to form a plasma beam, endometrial tissue within the plasma beam can be cut, broken, vaporizatied, loop generated through the bipolar energy will power all organizations around the conductive medium into plasma, interrupted by removal of the organic molecular bonds within the organization, will organize vaporization, excision, for therapeutic purposes. Bipolar plasma cutting system with merit of power cut, coagulation, vaporization, hemostasis, havingh clear vision, is easier to be manipulated.It uses saline to avoid hyponatremia uterine distention, and no current through the body to avoid electrical injury. In addition, the temperature of bipolar cutting is below 100℃and it reduces unnecessary carbonization and burn, reduces bleeding, it is the surgical innovation for unipolar TCRE, but the clinical study of plasma bipolar resection is infrequent in the current. This study randomly selects 20 patients using bipolar plasma endometrial surgery and 30 patients with unipolar endometrial resection going into clinical comparison, to explore the Security and effectiveness and related issues of the Plasma bipolar resection in the Endometrial resection.Objective:To explore the activity and advantage of the Plasma bipolar resection in the Endometrial resection, and further to promote Plasma bipolar resection in clinical applications.Methods:Selecting patients of menorrhagia, who had dysfunctional uterine bleeding, endometrial polyps causing irregular vaginal bleeding and other symptoms treated by surgery from January to September in 2009 in our hospital, the experimental group (20 case) were treated by Plasma bipolar endometrial resection and the control group (30 cases) by Monopolar endometrial resection. All records are first tested by hysteroscopy and endometrial biopsy, excluding endometrial malignancy. Under the B-ultrasound-guided application of plasma bipolar resectoscope and monopolar resectoscope cutted endometrim, resection was carried by the same surgeon. We did the comparison between the two groups on during and after surgery in operative time, blood loss, intraoperative expansion Palace liquid dosage, complications, vaginal bleeding and liquid discharge after they were out of the hospital,conditions of treatment. To observe the B-ultrasonographic monitoring changes when the bipolar plasma resectoscope was doing endometrial resection, and to contrast preoperative and postoperative changes in plasma by venous blood in bipolar resection group.Results:1. Bipolar resection group of 20 patients:the average operation time (24.35±5. 76) min, the average blood loss (20.70±6.00)ml, the average fluid volume of perfusate (1877.50±408.62)ml; monopolar resection group of 30 patients:The average operation time (30.07±9.78)min, the mean blood loss (25.07±5.78) ml, the average fluid volume of perfusate (2330.00±689.90) ml, The operation time, blood loss and perfusion fluid volume of bipolar group are all lower than the unipolar group.2. Bipolar group and unipolar group all had no uterine perforation, no air embolism. TURP syndrome did not occur in the bipolar group, There was 1 case of TURP syndrome in monopolar group. Because fewer cases observed, we need further study.3. In the bipolar group, the preoperative serum sodium, potassium, chlorine, calcium changes in value are:(139.73±3.91) mmol/L, (4.08±0.37)mmol/L, (104.14±4.11) mmol/L, (2.27±0.19) mmol/L; postoperative serum sodium, potassium, chlorine, calcium changes in value are:(141.93±4.62) mmol/L, (3.84±0.39) mmol/L, (105.03±3.30) mmol/L, (2.22±0.25) mmol/L; compared the preoperative electrolyte to the postoperative electrolyte:the difference changes of serum sodium, potassium, chlorine, calcium is (2.20±4.99) mmol/L, (-0.23±0.34) mmol/L, (0.89±4.08) mmol/L, (0.05±0.23) mmol/L. After compared with Preoperative ion, blood Na+, Cl-, Ca2+ have no significant changes; blood K+ is lower, but it is still in the normal range. The data indicates plasma bipolar electrode system can maintain a stable electrolyte balance.4. B-ultrasonic imaging shows that all cases emerge a "cloud-like" strong band of light echo in uterine myometrium when cutting endometrium in the bipolar group. The cause of this phenomenon is the powerful electric power and the stronger role of tissue vaporization. compared with the B-Ultrasound-monitoring-image in monopolar electrode, the light points of echo band of bipolar has light density, a wide range and rapid speed, but monopolar electrode only appeared electrode in adenomyosis lesions. This phenomenon shows that the ultrasound monitoring is more difficult in bipolar surgery; strong bipolar vaporization effect may increase the risk of air embolism in patients.5. Postoperative follow-up:the follow-up of 1 month of bipolar group, days of vaginal bleeding or discharge liquid number is (20.30±4.71) d, unipolar group is (25.87±6.01) d, the difference is significant (P<0.01), the number of days of vaginal bleeding or discharge liquid of bipolar group is less than the unipolar group, and the recent recovery of bipolar group is better than the unipolar group. The followed-up for amenorrhea extent in 6 months, the total effective rate of bipolar group is 95.0%, the effective rate of unipolar group is 93.3%, the difference has no significant (P>0.05). The effect of Bipolar plasma endometrial resection and Monopolar endometrial resection is same. Bipolar plasma endometrial resection is an alternative pole of Monopolar endometrial resection.Conclusion:1. Bipolar plasma endometrial resection is fast, safe and effective. Compared to Monopolar Endometrial resection, it has the merit of less bleeding, shorter operative time, with less uterine distention medium, lower complication rate, more effective, and is worthy of further promotion.2. The image of B-ultrasound monitoring of Bipolar plasma endometrial resection is more complex and Changeable.3. Plasma bipolar electrode system has great advantage in the maintenance of electrolyte balance, preventing the occurrence of water intoxication.4. During Bipolar plasma resection system excise endometrium, the cutting power is powerful, the evaporation is strong, so we should pay attention to the prevention of air embolism.
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