宫腔镜下子宫内膜射频消融术与子宫内膜电切术治疗围绝经期难治性功能失调性子宫出血临床观察  

Clinical observation of radiofrequency ablation of endometrium and transcervical resection of endometrium in treatment of refractory dysfunctional uterine bleeding during perimenopause

作　　者：王倩 侯家宁 王凤雏 WANG Qian;HOU Jianing;WANG Fengchu(Department of Obstetrics and Gynecology,Tongbai Third Hospital,Tongbai 474750,China)

机构地区：[1]桐柏第三医院妇产科,河南桐柏474750

出　　处：《社区医学杂志》2023年第18期940-944,共5页Journal Of Community Medicine

摘　　要：目的 探讨宫腔镜下子宫内膜射频消融术(RFAE)与子宫内膜电切术(TCRE)治疗围绝经期难治性功能失调性子宫出血(DUB)患者的临床疗效。方法 选取2019-06-01-2022-01-31桐柏第三医院收治的94例围绝经期难治性DUB患者为研究对象,根据组间基本资料均衡可比的原则分为TCRE组和RFAE组,各47例。TCRE组给予宫腔镜下TCRE治疗,RFAE组给予宫腔镜下RFAE治疗。对比2组临床疗效、围术期指标、性激素[促卵泡激素(FSH)、促黄体激素(LH)、孕酮(P)、雌二醇(E2)]、子宫内膜厚度、血红蛋白、并发症情况。结果 RFAE组总有效率为95.74%,与TCRE组的91.49%比较,差异无统计学意义,P=0.677。RFAE组手术用时、住院天数分别为(14.27±2.36) min、(2.73±0.86) d,均短于TCRE组的(24.53±3.21) min、(3.39±1.13) d,t值分别为17.654和3.186,P值分别为<0.001和0.001;术中总出血量为(12.39±2.59) mL,低于TCRE组的(26.73±2.87) mL,t=25.430,P<0.001。术后3个月,RFAE组FSH、LH、P、E2水平分别为(5.86±1.83) mU/L、(7.96±2.24) mU/L、(0.88±0.19) ng/mL、(70.59±17.31) pg/mL,与TCRE组的(6.22±1.53) mU/L、(8.23±2.87) mU/L、(0.93±0.23) ng/mL、(71.24±15.97) pg/mL比较,差异无统计学意义,F值分别为1.339、0.128、0.938和0.107,均P>0.05;子宫内膜厚度为(3.64±0.85) mm,小于TCRE组的(5.40±1.08) mm,F=39.010,P<0.001;血红蛋白水平为(126.33±8.43) g/L,高于TCRE组的(103.42±7.96) g/L,F=94.053,P<0.001。RFAE组并发症发生率为4.26%,低于TCRE组的19.15%,χ^(2)=5.045,P=0.025。结论 宫腔镜下RFAE与TCRE治疗围绝经期难治性DUB均有较好的疗效,对性激素水平基本无影响。但与TCRE比较,RFAE能有效缩短手术用时和住院天数,减少术中总出血量、子宫内膜厚度,提高血红蛋白水平,促进患者术后快速康复且并发症较少,具有更高的安全性。Objective To compare the clinical efficacy of radiofrequency ablation of endometrium(RFAE)and transcervical resection of endometrium(TCRE)in the treatment of refractory dysfunctional uterine bleeding(DUB)patients during perimenopause.Methods Totally 94 patients with refractory menopausal DUB admitted to Tongbai Third Hospital from June 1,2019 to January 31,2022 were selected and divided into TCRE group(n=47)and RFAE group(n=47)based on the principle of balanced and comparable basic data.The TCRE group was treated with hysteroscopic TCRE surgery,while the RFAE group was treated with hysteroscopic RFAE surgery.The clinical efficacy,perioperative indicators,sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),progesterone(P),estradiol(E_(1))],endome-trial thickness,hemoglobin,and complications were compared between the two groups.Results The total effective rate of the RFAE group was 95.74%,and there was no statistically significant difference compared with the TCRE group(91.49%),P=0.677.The surgical time and hospitalization days in the RFAE group were(14.27±2.36)minutes and(2.73±0.86)days,respectively,which were shorter than those in the TCRE group(24.53±3.21)minutes and(3.39±1.13)days,t values were 17.654 and 3.186,P values were<0.001 and 0.001,respectively;The total intraoperative bleeding volume was(12.39±2.59)ml,which was lower than that in the TCRE group(26.73±2.87)ml,t=25.430 and P<0.001.After 3 months of surgery,the levels of FSH,LH,P,and E,in the RFAE group were(5.86±1.83)mU/L,(7.96±2.24)mU/L,(0.88±0.19)ng/ml,and(70.59±17.31)pg/ml,respectively,there was no statistically significant difference compared with the TCRE group(6.22±1.53)mU/L,(8.23±2.87)mU/L,(0.93±0.23)ng/ml,and(71.24±15.97)pg/ml,Fvalues were1.339,0.128,0.938,0.107,respectively,all P>0.05;The endometrial thickness in the RFAE group was(3.64±0.85)mm,which was thinner than that in the TCRE group(5.40±1.08)mm,the hemoglobin level was(126.33±8.43)g/L,which was higher than that in the TCRE group(103.42±7.96)g/L,F val

关 键 词：子宫内膜射频消融术 子宫内膜电切术 功能失调性子宫出血 激素水平 

分 类 号：R711.52[医药卫生—妇产科学]