双极射频子宫内膜去除术治疗异常子宫出血的前瞻性、多中心临床对照研究  

A Multicenter-Prospective Study about the Application of Bipolar Radiofrequency Endometrial Ablation in Abnormal Uterine Bleeding

作　　者：陈丽梅[1] 郭罗培 张宏伟[1] 汪清[1] 高蜀君[1] 谢锋[1] 杜明[1] 谢康云[1] 徐军 曹云桂 徐灵 唐江萍 隋龙[1] CHEN Limei;GUO Luopei;ZHANG Hongwei(OB ＆ GY Hospital of Fudan University,Shanghai Female Key Endocrine Laboratory,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院上海市女性重点内分泌实验室,上海200011 [2]上海市闵行区中心医院,上海201199 [3]嘉定区妇幼保健院,上海201899

出　　处：《实用妇产科杂志》2018年第10期750-754,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:81701398);上海市市级医院适宜技术项目(编号:SHDC12014238)

摘　　要：目的:明确双极射频子宫内膜去除术(BREA)治疗异常子宫出血(AUB)的安全性、有效性和术后生存质量,评价该技术作为治疗无生育需求AUB患者的临床价值。方法:2014年6月至2016年12月,在上海三家医院开展前瞻性临床研究,选择AUB患者102例进行BREA,分析手术安全性、有效性,并与同期因AUB行腹腔镜辅助下阴式全子宫切除术(LAVH)的患者50例进行对照,比较围手术期各项指标,随访患者术后12～24个月月经情况和生活质量评分。结果:(1)102例行BREA患者,平均年龄46. 2±5. 4岁,其中全身麻醉60例,局部麻醉14例,无麻醉镇痛28例。所有BREA手术顺利完成,无术中严重并发症发生。(2)与LAVH相比,BREA手术时间明显较短,术中出血量较少,术后恢复活动时间、在院时间缩短、手术费用降低,差异均有统计学意义(P <0. 05)。(3)102例BREA术后平均随访时间16. 4±5. 6月(12～24月),术后3、6、12、18、24个月AUB有效率分别为97. 1%、96. 1%、95. 0%、92. 9%、88. 4%,闭经率分别为46. 1%、47. 1%、48. 5%、47. 6%、50. 7%。61例子宫腺肌病患者中,术后3、6、12、18、24个月月经量有效率分别是98. 4%、95. 1%、95. 1%、88. 5%、85. 1%,痛经改善率分别为90. 2%、82. 0%、75. 4%、71. 2%、68. 1%。(4)术后1个月BREA患者生活质量评分与LAVH比较,差异无统计学意义(P> 0. 05),术后6、12个月BREA患者生活质量评分较LAVH高(P<0. 05)。结论:BREA治疗AUB安全、有效、微创,操作简便,可门诊无麻醉镇痛进行,有效改善患者术后生存质量,可推荐作为无生育需求的AUB的治疗。BREA对子宫腺肌病患者不仅可有效减少月经量,也可缓解痛经,但有效率随术后随访时间延长略有下降趋势。Objective： The aim of this study was to investigate the safety,effectiveness and post-operative life quality of the bipolar radiofrequency endometrial ablation（ BREA） and to evaluate its clinical value in the treatment of abnormal uterine bleeding（ AUB） in women without fertility requirements.Methods： This prospective clinical study was carried out in three hospitals in Shanghai from June 2014 to December 2016. 102 patients who underwent BREA were enrolled to analyze the safety and effectiveness,while 50 patients who underwent laparoscopic assisted vaginal hysterectomy（ LAVH） because of AUB were also enrolled for comparison.All patients were followed up with perioperation data,as well as menstruation,satisfaction and quality of life scores after 12-24 months.Results：（1）102 cases were treated by BREA with an average age of 46. 2±5. 4.In these cases,60 were performed with general anesthesia,14 with local anesthesia and 28 cases with analgesia.All BREA procedures were successfully carried out without any serious complications.（2）Compared with LAVH,BREA significantly reduced the operation time,the intraoperative blood loss,the postoperative recovery time and the hospital stay period（ P〈0. 05）.The overall cost of BREA was less than that of LAVH（ P〈0. 05）.（3） With the average follow-up period of 16. 4 ± 5. 6（ 12-24） months,the effective rate of BREA was 97. 1%,96. 1%,95. 0%,92. 9% and 88. 4%,while the amenorrhea rate was 46. 1%,47. 1%,48. 5%,47. 6% and 50. 7%.after 3,6,12,18 and 24 months respectively.For the cases with AUB-A,the effective rate of hypermenorrhea was 98. 4%,95. 1%,95. 1%,88. 5% and 85. 1%after 3,6,12,18 and 24 months respectively.The effective rate of dysmenorrhea was 90. 2%,82. 0%,75. 4%,71. 2% and68. 1%after 3,6,12,18 and 24 months respectively.（4） There was no significant difference between BREA and LAVH in the evaluation of life quality after one month（ P〉0. 05）.Post-BREA group showed a higher satisfaction than LAVH groupafter 6 and 12 months

关 键 词：子宫内膜去除术 异常子宫出血 全子宫切除术 双极射频 

分 类 号：R711.51[医药卫生—妇产科学]