射频治疗功能失调性子宫出血的临床疗效和不良反应分析  

Therapeutic effects of radio frequency ablation on dysfunctional uterine bleeding and analysis of its adverse reactions

作　　者：戴良图[1] 张华[1] 吴蕾[1] 

机构地区：[1]解放军第四一一医院妇产科,上海200081

出　　处：《海军医学杂志》2015年第3期224-226,232,共4页Journal of Navy Medicine

摘　　要：目的探讨射频消融术治疗功能失调性子宫出血（DUB）的疗效和不良反应。方法将2 017例经诊断性刮宫后病理确诊为DUB的患者按治疗方法分成3组。射频治疗组（射频组,1 937例）用功率30~35 W消融治疗;米非司酮治疗组（米非司酮组,40例）给予连续口服小剂量米非司酮和输液及止血;常规治疗组（常规组,40例）给予输液止血等治疗,必要时给予高效孕激素。定期检测3组患者血红蛋白、子宫大小、卵巢性激素水平,随访观察疗效及不良反应。结果射频组和米非司酮组治疗后对月经改善、纠正贫血均有效,且2组差异无统计学意义（P〉0.05）。米非司酮组治疗后血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）和孕酮（P）的平均水平较治疗前均有不同程度的下降;尤以E2、P下降更为明显,与治疗前比较差异有统计学意义（P〈0.01）。射频组治疗前后血清FSH、LH、E2、P平均水平差异无统计学意义（P〉0.05）。射频组主要不良反应为人工流产综合征212例,阴道排液115例,低热83例（〈38℃）。米非司酮组主要不良反应是：4例患者在停药3个月内出现不规则阴道流血,呈点滴状,2例月经量无明显变化;6个月后12例病情反复,治疗失败,改用其他治疗方法。结论射频组能克服米非司酮治疗的不足,是治疗DUB的一种更为简便、安全、有效、微创的方法。Objective To investigate therapeutic effects of radio frequency ablation （RFCA） on dysfunctional uterine bleeding （DUB） and analysis of its adverse reactions. Methods In accordance with different methods of treatment, 2 017 cases of dysfunctional uterine bleeding patients confirmed and diagnosed by dilatation and curettage were randomly divided into 3 groups： the RFCA group, the mifepristone group and the control group. The RFCA group （1 937 cases） received radio frequency ablation at a power rate of 30 -55 W, the mifepristone group （40 cases） was continually given small doses of mifepristone orally, intravenous infusion and hemostasis, and the control group （40 cases） received intravenous infusion, hemostasis and highly effective progestogen, as deemed necessary. The levels of hemoglobin （ Hgb）, the sizes of wombs and the levels of ovary hormone in the patients of the 3 groups were detected periodically, and they all had medical follow-ups for observation of adverse reactions. Results After treatment, improvement could be seen in meuorrhagia and anemia for the RFCA group and mifepristone group, but without statistical differences （P 〉 0.05 ）. In the mifepristone group, the mean levels of follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, 17-esradiol （E2）, progesterone （P） were decreased in varying degrees following treatment, with Ez and P decreased more prominently, as compared with those before medication （ P 〈 0. O1 ）, while the mean levels of FSH, LH, E2 and P did not fluctuate markedly for the RFCA group, and no statistical significance could be seen, when comparisons were made between pre-treatment and post-treatment （P 〉 0.05 ） . Main adverse reactions after treatment in the RFCA group were artificial abortion syndromes （212 cases） , vaginal discharge （115 cases） and low fever （83 cases） （ 〈 38 ℃ ）. Main adverse reactions in the mifepristone group 3 months after drug withdrawal were irregular colporrhagia （4 cases

关 键 词：射频消融 月经失调 子宫内膜 米非司酮 不良反应 

分 类 号：R711.52[医药卫生—妇产科学]