子宫异常出血合并血液系统出血性疾病的临床处理

Gynecological strategies for menorrhagia accompanied by haematological diseases

目的了解血液系统出血性疾病导致的子宫异常出血的情况,探讨妇科干预和治疗的方法及效果。方法回顾性分析北京协和医院17年间合并血液系统出血性疾病的有月经的妇女,了解子宫异常出血的比例,并进一步对子宫异常出血的患者进行分析,了解妇科治疗的情况,包括药物治疗和手术治疗。结果合并血液系统出血性疾病有月经的妇女,发生子宫异常出血的比例高达63%,其中以血小板减少性紫癜(48%)、再生障碍性贫血(27%)、骨髓异常增生综合征(15%)为多见。48例药物保守治疗,18例有手术指征者接受了妇科手术,其中14例临床表现为子宫大量出血单纯由于血液病造成者7例,采取刮宫手术与子宫内膜切除术各3例,其中各有1例因手术失败,复发而改子宫切除术,1例直接行子宫切除术;另外7例子宫出血者同时合并有妇科手术指征而行子宫切除术;术前、术中与术后纠正凝血功能异常如血小板数量低非常重要,可防止再次发生出血。结论造成育龄妇女异常子宫出血的血液系统疾病常见的是血小板减少性紫癜、再生障碍性贫血、骨髓异常增生综合征等。通常保守药物治疗可达到止血目的(76.2%),但出血多,保守治疗效果差,需及时行手术治疗,包括子宫内膜切除术和子宫切除术。多科合作对围手术期病人的监测至关重要,可有效防止并发症的发生。

Objective To investigate the abnormal menorrhagia accompanied by haematological diseases and its gynecological strategies and consequences. Methods Women with menstrual cycle who combined with haematological diseases in last 17 years were reviewed. The management including medications and surgery were analyzed. Results The percentage of patients who had menorrhagia and also combined with haematological diseases accounted for 63%, 48 of them received gynecological managment. Hormone therapy is primary and effective. Eighteen patients who had operational indication including severe menorrhagia(14) and gynecological diseases received surgery. Seven of the patients were duo to the heavy bleeding induced by the combined haematological disease. Three had curettage, another 3 had endometrial ablation and 3 hysterectomy. Another 7 patients with hemorrhagia who had hysterectomy were because of gynecological indications, such as fibroid or endometrial neoplasia. A good therapy plan made for this kind of disease by the doctors from gynecology and other departments, such as haematology, is essential during peri-operation period. Conclusions Women with haematological diseases often(63%) have menorrhagia and need medical intervention. Hormone therapy(76.2%) is primary and effective. For those with operational indication, surgery is needed and effective, including endometrial ablation and hysterectomy. Cooperation between gynecology and medicine departments is very important for a successful management.