摘要
目的探讨宫腔镜检查在射频热凝固(RF)子宫内膜去除两种术式中治疗功能失调性子宫出血(功血)中的意义。方法收集2001年1月至2011年1月就诊、经先前药物治疗无效的功血患者2100例为研究组,以45岁为界分为两组:A组(≥45岁,平均48岁,共927例)是以闭经为治疗目的,采用全部子宫内膜凝固(A-RF术式);B组(<45岁,平均37岁,共1173例)是以月经减量为目的,根据术前宫腔镜检查提供的信息,采用选择性部分内膜凝固(B-RF术式)。所有患者具备术前宫腔镜检查和诊断性刮宫病理诊断等临床资料。除对所有患者术后即时宫腔镜检查了解内膜去除情况外,还对部分患者RF后6～7个月再次进行宫腔镜检查,以明确宫腔表面远期变化。结果本组术前宫腔镜检查发现功血合并不完全子宫纵膈79例,占3.8%(79/2100)、黏膜下子宫肌瘤56例,占2.7%(56/2100)。有效率:RF治疗功血3个月内(近期)总有效率为96.7%(2031/2100),其中A组为97.0%(899/927),B组为96.5%(1132/1173)。术后即时宫腔镜检查和内膜病理显示:A组内膜全部全层凝固性坏死,B组见部分正常内膜遗存。术后3月后不同时间段随访宫腔镜显示受热凝固的内膜被纤维结缔组织替代。主要并发症是术后1～2个月阴道少量不规则流血,占8.0%(168/2100)和3个月后月经量仍多,占5.2%(109/2100)。经宫腔镜检查分别显示为机化内膜组织脱落不全和内膜遗留过多,分别行清宫和再次RF后达到目的疗效。本组患者无经RF后又改子宫切除者。结论辅以宫腔镜检测使RF治疗功血更加直观、安全、有效和微创化,既可以达到闭经,也可以控制减少月经量,受RF作用的子宫内膜热凝固坏死使子宫出血停止,内膜组织纤维化改变是RF治疗功血远期有效和防止复发的重要机制。
Objective procedures using radiofrequency To investigate the significance of hysteroscopy during endometrial ablation （RF） for the treatment of dysfunctional uterine bleeding （DUB）. Methods Twenty-one hundred patients with DUB who had been failure by some drugs hospitalized from Jan. 2001 to Jan. 2011, treated in the department of gynecology of Jinan Military Hospital were selected in this study. The patients were devided into two groups according to age of 45 year： The A-group was comprised of 927 patients who were 45 years of age or older （average age 48 years） , who were comptetedly endometrium ablitoon with RF procedure for amenorrhea （A-RF）;The B-group was comprised of 1173 patients,who were less than 45 years of age （average 37 years） , were sectional endometrium ablitoon to control excessive menstrual bleeding and remain little menorrhea（B-RF）： All the patients had the results of endometrial currettage pathology and hyseteroscopy examination before and immediately after RF procedure;In order to investigate the long-term change after RF procedure of the endomitrim, some patients still had another hysteroscopy results after RF since 6 months later. Results Seventy-nlne patients with incomplete uterine diaphragm （3.8% ,79/2100）and fifty-six with submucose myoma （2.7% ,56/2100） were discovered before RF procedure by the examination of hysteroscopy.Effectiverate： The efficacy of RF treatment for DUB within 3 months （short-term） was 96.7%（2031/2100）, in which it was 97.0% （899/927）in A-group and 96.5% （1132/1173） in B-group.The immediately hysteroscopy and endometrial curettage pathological exam showed that there was completely coagulated necrosis of the whole endometrium of RF-A patients, and island-interstitial endometrium tissue remained of RF-B patients. In different periods of long-term 3 months later after RF, the hysteroscopy exam showed the coagulated endometrium was replaced of fibrosis tissue. Complications ：The main complication was irregularly minor bleeding in 1 to 2 months ,the rate was 8.0%, （168/2100）.The second one was menorrhea in 3 months later after RF, the rate was 5.2% （109/2100）.This condition was organization-endometrium tissue or relatively more endometrial tissue remained in uterine cavity, which verified by hysteroscopy, needed another RF treatment. None underwent hysterectomy in this group. Conclusions The RF procedures by the help of hysteroscopy in the treatment for DUB patients were not only safe, effective and minimally invasive, but also more direct. The procedures could not only achieve amenorrhea, but also increased patient satisfaction in menstruation after treatment. The coagulated necrosis of the endometrium by RF lead to stop bleeding of DUB at once, and the fibrosis change of endometrial cavity after RF treatment was the important mechanism for the long-term effective and preventive recurrence of DUB.
出处
《中华腔镜外科杂志（电子版）》
2011年第6期41-45,共5页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词
宫腔镜
功能失调性子宫出血
射频子宫内膜去除术
微创技术
Hysteroscopy
Dysfunctional uterine bleeding
Radiofrequency endometrial ablation
Minimally invasive techniques
