微波子宫内膜去除术治疗异常子宫出血的临床观察  

Clinical observation of microwave endometrial ablation for treatment of abnormal uterine bleeding

作　　者：王惠兰[1] 张霞[2] 陈素芹[1] 杨玉凤[1] 孙秀芝[1] 王振海[1] 

机构地区：[1]河北医科大学第二医院妇产科 [2]河北医科大学第一医院妇产科

出　　处：《中华妇产科杂志》2005年第7期445-448,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：河北省卫生局2002年重点科研基金资助项目(320.316)

摘　　要：目的探讨微波子宫内膜去除术(MEA)治疗异常子宫出血的疗效、适应证和并发症。方法应用MEA治疗良性病变所致异常子宫出血患者168例,术前行刮宫术薄化子宫内膜,然后“Z”字形烧灼宫腔后再以“W”形烧灼宫腔,术后1、3、6、12、24个月随访患者的月经、贫血症状改善及并发症发生情况。结果平均手术时间为(286±75)s;平均随访时间(22±6)个月。绝经前患者156例中,术后闭经97例(62.2%),月经正常56例(35.9%),少量不规则阴道出血3例(1.9%);治疗满意率为98.1%(153/156)。119例随访到术后2年以上,疗效稳定。107例合并贫血,术前血红蛋白为(83±24)g/L,术后3个月升至(117±18)g/L,手术前后比较,差异有统计学意义(P<0.01)。痛经改善率为74.5%(35/47)。绝经后患者12例,术后均无出血。168例中47例合并严重内科疾病,全部手术成功,术中无并发症发生。术后发生子宫内膜炎12例,2例宫腔积血,1例因输卵管绝育子宫内膜去除术后综合征行子宫切除术。结论MEA操作简单、安全、疗效好,适用于多种良性疾病所致的异常子宫出血。尤其适用于有严重内科合并症的患者。充分且完整地破坏子宫内膜全层,是治疗成功的关键。严格掌握适应证可减低并发症的发生。Objective To evaluate the efficacy, indication, and complication of microwave endometrial ablation(MEA) in treating abnormal uterine bleeding(AUB). Methods One hundred and sixty-eight women with AUB due to benign causes received MEA treatment. Pre-operative endometrial thinning was carried out using uterine curettage. Then, the applicator radiating microwaves was moved by progressive withdrawal as well as “W” shape motion inside uterine cavity. All the patients were followed-up. The change of menstrual cycle, the amount of flow, dysmenorrhoea, anemia after treatment at 1, 3, 6, 12 and 24 months was recorded. Results The mean operating time was (286±75) seconds. Average follow-up time was (22±6 ,range 6-36)months. Of these patients, 156 women (92.9%) were premenopausal, 97 cases (62.2%) were amenorrhea, 56 cases (35.9%) were hypomenorrhoea or eumenorroea, and 3 cases (1.9%) had irregular bleeding. The overall satisfaction of this treatment reached 98.1%(153/156). The follow-up of 119 cases was up to 24 months after operation. The concentration of hemoglobin in 107 women with anemia increased significantly from (83±24) g/L to (117±18) g/L 3 months after operation (P<0.01). Dysmenorrhoea was relieved in 74.5 %( 35/47) patients. No bleeding occurred in any one of 12 postmenopausal patients after MEA. There was no intraoperative complication in any case. The procedure was successful in all of 47 patients with severe medical disorders. After operation, 12 cases were complicated with endometritis, 2 with hematometra, and one case was performed with hysterectomy due to postablation tubal sterilization syndrome. Conclusions MEA is a simple, safe and effective treatment of patients with abnormal uterine bleeding, especially suitable for those women associated with severe medical complications. Complete endometrial ablation is one of the most important determinants of treatment success. Stringent selection of patients may reduce the rate of complications.

关 键 词：微波子宫内膜去除术 异常子宫出血 治疗 临床观察 不规则阴道出血 平均手术时间 子宫内膜炎 子宫切除术 术后综合征 输卵管绝育 内科合并症 出血患者 良性病变 发生情况 症状改善 随访时间 月经正常 血红蛋白 手术前后 

分 类 号：R713[医药卫生—妇产科学]