两种射频热凝固术去除内膜治疗功能失调性子宫出血对女性生殖内分泌激素的影响  

Influence of Endometrial Ablation Procedures Using Two Different Ways of Radiofrequency Thermocoagulation for Treatment of Dysfunctional Uterine Bleeding on Female Reproductive Endocrine

作　　者：尹格平[1] 武爱芳[1] 郭秀霞[1] 朱彤宇[1] 

机构地区：[1]济南军区总医院妇产科,济南250031

出　　处：《中华妇幼临床医学杂志（电子版）》2013年第3期255-259,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：卫生部科研基金资助课题(CJN10L084)~~

摘　　要：目的探讨两种射频热凝固术(RFT)去除子宫内膜治疗功能失调性子宫出血(DUB)后,对女性生殖内分泌激素的影响。方法选择2006年1月至2010年1月在本院妇科就诊、经药物治疗无效的DUB患者162例为研究对象,平均年龄为(44.5±7.5)岁(33～53岁)。将其按照年龄分别纳入RFT-A组(n=95):≥45岁(平均为48岁),以闭经为治疗目的,采用RFT去除全部子宫内膜;RFT-B组(n=67):<45岁(平均为38岁),以减少月经量为目的,采用RFT去除部分子宫内膜。术前对两组患者均进行月经量评分(PBAC)、采用诊断性刮宫进行组织病理学诊断。对两组患者术前与术后6～12个月和12～24个月时,进行生殖内分泌6项激素血清学检查[雌激素(E2)、孕酮(P)、睾酮(T)、垂体泌乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)]。随机选择同期在本院体检的健康个体纳入对照组(n=68),按照年龄分别将其纳入对照组-A(n=32),≥45岁[平均为(49.0±3.5)岁];对照组-B(n=36),<45岁[平均为(36.5±3.5)岁]。对4组个体不同时段的内分泌6项激素血清学检测结果进行统计学处理(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。结果①RFT-A组经RFT治疗后6～12月时的闭经止血总有效率为96.8%(92/95),12～24个月时的总有效率为100.0%;RFT后,其PBAC评分结果和血红蛋白(Hb)水平,均较治疗前显著改善,差异有统计学意义(P<0.05)。RFT-A组中,经首次RFT治疗后随访6～12个月时,6例(6.3%,6/95)患者月经仍然过多(PBAC评分>100分),但经再次RFT后均闭经。RFT-B组经RFT治疗后随访6～12个月时,月经改善总有效率为91.0%(61/67),其中2例闭经,4例月经量仍然较多(PBAC评分>100分),但经再次RFT后均闭经。两组RFT治疗后PBAC评分和Hb水平均较治疗前显著改善,差异有统计学意义(P<0.05)。本组无RFT后改行子宫�Objective To investigate the influence of serum menopause hormonal changes by different strategies of radiofrequency thermocoagulation（RFT）procedures to remove the endometria for treatment of dysfunctional uterine bleeding（DUB）.Methods From January 2006to January 2010,a total of 162 patients who were diagnosed as DUB were included into this study.Their ages ranged from 33to 53years old,and the average age was（44.5±7.5） years old.They were divided into RFT-A group（n=95,≥45years old） and RFT-B group（n=67,45years old） according to their ages.RFT-A group received RFT to remove all endometria and their therapeutic purposes were amenorrhoea.Meanwhile,RFT-B group received RFT to remove parts of endometria and their therapeutic purposes were to decrease menstrual blood quantity.All the patients had the results of pictorial blood loss assessment chart（PBAC）,endometrial currettage pathology before the operation.And another six kinds of serum endocrine markers were detected,including estradiol（E 2）,progesterone（P）,testosterone（T）,pituitary prolactin（PRL）,corpus luteum erythropoietin（LH）,follicle-stimulating hormone（FSH） before and after RFT within 6-12and 12-24 months.Meawhile,another 68healthy women were recruited as control group.They were divided into two groups according to their ages,too,control group-A（n=32,≥45years old） and control group-B（n=36,45years old）.The six kinds of serum endocrine markers as the same as RFT groups were detected.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Jinan Millitary General Hospital.Informed consent was obtained from each participant.Results ①Total effective rates of amenorrhoea of RFT-A group within 6-12months after RFT was 96.8%（92 / 95）,and within 12-24months was 100%.②The PBAC scores and hemoglobin（Hb） levels had significant improvement compared with pre-operation,with the significant difference（P〈0.05）.During 6-12 months followed-up,six patients showed po

关 键 词：功能失调性子宫出血 射频热凝固术 雌激素 黄体生成素 卵泡刺激素 

分 类 号：R711.52[医药卫生—妇产科学]