Diagnostic Curettage (Dilation and Curettage, abbreviated as D&C) is a combined diagnostic and therapeutic intrauterine surgical procedure. Its primary purpose is to remove endometrial tissue for analysis of abnormal tissue or to resolve specific gynecological issues. This procedure is commonly used for managing uterine bleeding, residual tissue after miscarriage, or suspected endometrial hyperplasia or malignancy, serving both diagnostic and therapeutic functions.
The surgery is typically performed under local or general anesthesia, involving dilation of the cervix followed by the use of a curette to remove endometrial tissue. The obtained tissue samples are sent to the laboratory for examination to confirm the presence of infection, malignancy, or other pathological changes. Due to its minimally invasive nature and ability to directly obtain tissue samples, D&C has become one of the standard gynecological treatment methods.
D&C mainly divides into "diagnostic" and "therapeutic" modes. Diagnostic D&C involves scraping endometrial tissue for histopathological analysis to help diagnose endometrial carcinoma, polyps, or infections. Therapeutic D&C targets excessive bleeding or residual tissue after miscarriage, directly removing diseased tissue to stop bleeding or prevent infection.
Mechanistically, dilating the cervix allows the physician to safely access the uterine cavity, and the mechanical removal by the curette can thoroughly clear the tissue. This process not only provides immediate symptom relief but also yields tissue samples that facilitate accurate pathological diagnosis, aiding in subsequent treatment planning.
Indications include abnormal uterine bleeding outside of menstruation, recurrent uterine bleeding, residual tissue after miscarriage or abortion, and suspicion of endometrial hyperplasia or malignancy. Additionally, D&C is often chosen to confirm complete tissue removal after artificial abortion.
For diagnostic purposes, if endometrial biopsy results are inconclusive or ultrasound reveals abnormal shadows within the uterine cavity, physicians may recommend D&C to obtain more comprehensive tissue samples. In special cases such as postmenopausal bleeding, D&C can help exclude malignant lesions.
The procedure is usually performed in an outpatient or day surgery setting, with patients required to fast and undergo anesthesia assessment. The steps include dilating the cervix, gradually enlarging the cervical canal with metal dilators, and then removing tissue with a metal curette or suction device. The entire process takes approximately 15 to 30 minutes, with post-operative observation for bleeding and pain.
While not in drug form, the depth and scope of tissue removal are adjusted based on the physician’s judgment. For example, therapeutic D&C may involve removing more tissue, while diagnostic D&C emphasizes uniform sampling. Anesthesia choice depends on the patient’s health status; local anesthesia is suitable for mild symptoms, whereas general anesthesia is used for extensive tissue removal.
Main advantages include direct removal of causative factors and immediate diagnostic capability. For instance, residual tissue after miscarriage may lead to infection or ongoing bleeding; D&C can promptly remove the lesion, reducing complications. For diagnosis, tissue biopsy results can accurately determine endometrial carcinoma or other lesions, avoiding misdiagnosis.
Potential complications include injury to the cervix or uterine wall, uterine adhesions, increased risk of infection, and rarely uterine perforation, which may require further surgical repair. Postoperative mild abdominal pain, slight bleeding, or brownish discharge within 1-2 weeks are normal recovery phenomena.
Serious risks include uterine damage leading to future infertility, allergic reactions to anesthesia, or chronic cervical stenosis. Older patients or those with uterine deformities may face increased surgical difficulty, requiring cautious operation by the physician.
Contraindications include acute uterine cervicitis, severe uterine retroversion that complicates operation, bleeding disorders, or fever. Pregnancy must be confirmed before the procedure to avoid confusing miscarriage surgery with D&C. Patients with diabetes or cardiopulmonary diseases should have their underlying conditions controlled prior to surgery.
Postoperative care includes avoiding sexual intercourse and vaginal douching for at least 2 weeks, and closely monitoring for fever, severe abdominal pain, or other abnormal symptoms. The physician will tailor the surgical approach based on patient age and medical history; for example, postmenopausal women may require additional endometrial cancer screening.
Drug interactions mainly involve anesthesia medications. Patients on anticoagulants (such as aspirin) should discontinue them beforehand to reduce bleeding risk. Those on hormone therapy (e.g., progestins) should inform the physician to adjust the timing of the procedure.
Regarding interactions with other surgeries, if hysteroscopy is performed simultaneously, the sequence of procedures should be confirmed to avoid tissue confusion. Patients with previous uterine surgeries may have adhesions, requiring special instruments to reduce injury risk.
According to international gynecological guidelines, D&C has an immediate success rate of over 95% in removing uterine contents. Its diagnostic accuracy, combined with histopathological analysis, has a sensitivity of up to 98% for diagnosing endometrial carcinoma. Long-term follow-up shows that 85% of patients experience significant improvement in bleeding issues postoperatively.
Compared to drug therapy, D&C provides more immediate removal of residual tissue, with a recurrence rate below 20%. Studies indicate a complication rate of approximately 3-5%, and modern anesthesia techniques have reduced anesthesia-related risks to below 0.1%.
Diagnostic alternatives include endometrial biopsy (obtaining small tissue samples), hysteroscopic biopsy, or 3D ultrasound assessment. Therapeutic alternatives include pharmacological induction of uterine contractions (e.g., prostaglandins), uterine artery embolization, or targeted hormone therapy.
If patients cannot undergo invasive surgery, options such as ultrasound-guided vacuum aspiration or medical agents like mifepristone to promote natural tissue expulsion may be considered. However, these methods may require multiple treatments or have lower diagnostic accuracy.
Patients should follow the physician’s instructions, such as fasting and abstaining from water, stopping anticoagulants, etc. Blood tests and uterine position assessments are necessary, along with signing informed consent. Patients with drug allergies or chronic illnesses should inform the medical team in advance.
How can postoperative abdominal pain be relieved?Mild abdominal pain is normal and can be managed with prescribed painkillers (e.g., NSAIDs). If pain is severe or persists beyond 48 hours, seek medical attention promptly, as further evaluation for uterine contractions or infection may be needed.
When can daily activities be resumed after surgery?Generally, rest for 1-3 days and gradually resume light activities, avoiding heavy lifting or vigorous exercise for at least 2 weeks. Recovery time varies per individual; follow the physician’s advice to avoid affecting uterine healing.
How long will vaginal bleeding last after surgery?It is normal to experience light bleeding or discharge for about 1-2 weeks. If bleeding exceeds menstrual volume, or if severe abdominal pain or fever occurs, it may indicate infection or tissue residual, requiring immediate medical examination.
How long does it take for the endometrial lining to recover post-surgery?The endometrial recovery typically takes about 4-6 weeks, depending on individual physiological conditions. The physician may schedule ultrasound examinations at 4-6 weeks post-surgery to assess endometrial recovery and check for residual tissue, reducing the risk of subsequent complications.
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