电视宫腔镜电切术治疗子宫内膜病变640例疗效观察

Observation of the curative effect on endometrial diseases in hysteroscopic electrosurgery

目的：探讨电视宫腔镜电切术治疗子宫内膜病变的临床疗效.方法：640例子宫内膜病变患者,其中子宫内膜息肉326例,功能性子宫出血188例,子宫肌瘤126例,对640例患者采用宫腔镜进行治疗.根据患者生育要求及对月经的要求不同,116例采用子宫内膜病变切除＋子宫内膜汽化电切术,368例采用子宫内膜病变电切＋子宫内膜切除术,81例采用子宫内膜病变电切＋子宫内膜浅层电切术,绝经妇女75例单纯行病灶切除.结果： 随访3个月,640例电切术后597例（93.3%）月经改善;随访5～66个月,平均（38±5）个月,月经改善达81.4%～93.3%.不同手术方式与月经改善情况无明显关系（P＞0.05）.565例子宫内膜病变育龄期患者中, 无生育要求者484例用汽化电切手术时间平均（11.24±0.26）min,子宫内膜电切手术时间平均（20.12±0.46）min,2种术式手术时间差异有统计学意义（P〈0.05）;26例不孕患者中有19例术后妊娠;282例子宫内膜息肉育龄期妇女,对要求保留生育功能患者,切除息肉及息肉旁组织和功能层内膜,术后无闭经者,但术后息肉复发高于汽化电切及子宫内膜电切. 结论： 宫腔镜电切术治疗子宫内膜病变具有极高的临床价值,是子宫内膜病变首选的治疗方法,根据患者生育要求及对月经的要求不同采用的手术方式.

Objective： To assess the effieacy and influences of hysteroscopic electrosurgery in treating endometrial diseases, netheods： Six hundred and torty women with eudometrial diseases received tlysteroseopic transeeervical resection of the endometrium or intrauterine lesion with a resectoseope. Among them ,326 cases endometrial polyps, 188 cases dysfunctional uterining bleeding, 126 cases had submucous myomas. Aeording to the desire of fertility or nlenses we chose different ways of hysteroscopic electrosurgery, Amoug 368 endometrial diseases did endometrial lesion ablation and endometrial resection, patients in sexual maturity without desire of fertility, 116 cases underwent with endometrial lesion ablation and electrosurgical vaporization, and 81 cases who desired future childbearing, did endometrial lesion ablation and endometrial resection of superficial layer near the endometrial lesions. Results ： Followed-up for 3 months. 597 cases （93.3%） of the patients menses was improved （ P 〈 0.05 ） in 640 cases. The mean followed-up for 5 - 66 months, the mean time was （38 ± 5 ） months. 81.4% - 93.3% of the pa- tients menses was improved （ P 〈 0.05 ）. There was no different of menses between dirt〉rent way of electrosurgery （P 〉0.05 ）. Among 565 cases in sexual maturity without desire of tertility, Compared with endometrial resection, the time of electrosurgieal vaporization was shorter 5 - 15 min （ 11.24 ± 0.26） rain （P 〈 0.05 ）. And the effects was better （P 〈 0.05） to the patients with desire of fertility. The patients who had desire of chihlbearing or menses should undergo superficial layer endometrial resection had no amenorrhea after the surgery. 26 cases of infertility, 19 cases got pregnancy after the surgery. Among 282 cases of who desired future childbearing, did polypectomy with endometrial resection of superficial layer near the polyps. There were no amenorrhea after the surgery. But the recurring of the the polyps were greater than other two ways （P 〈 0. 05 ）. Conclusions： Hysteroscopic electric resection is an effeetive and the first proeedure in treating endometrial diseases according to the desiratoin of childbearing or menses used different ways of surgery. The curative effects of endometrial lesion ablation with electrosurgical vaporization was better than it of endometrial lesion ablation with endometrial resection to the polyps patients in sexual maturity without desire of fertility.