射频消融治疗子宫良性病变的临床疗效和近、远期疗效分析

Evaluation of clinical therapeutic effect and short-and long-term outcomes of radiofrequency ablation for benign lesion of uterine.

目的探讨子宫内膜射频消融术(RFAE)治疗功能性子宫出血的近、远期效果及其预后影响因素。方法采用RFAE治疗功能性子宫出血患者152例。治疗后1、3、6个月行经阴道彩色多普勒超声检查,观察子宫内膜厚度及卵巢血流动力学的变化,同时行血清六项性激素检查。结果术后随访6个月,无月经103例(67.76%),经量明显减少42例(27.63%),复发7例(4.61%),有效率95.39%。子宫大小、子宫修复层厚径在术后呈现变小、变薄规律性变化。卵巢动脉血流阻力指数和搏动指数及血清六项性激素术前与术后1、3及6个月相比,差异无显著性(P>0.05)。结论对子宫内膜基底层的不完全破坏或对子宫内膜的不完全消融,是术后复发的重要原因。感染是影响手术近期疗效主要因素。合并子宫腺肌症是影响手术远期疗效的主要因素。RFAE对卵巢功能无明显影响。

Objective To evaluate the clinical therapeutic effect and short- and long-term outcomes of radiofrcqucncy ablation （ RFAE ） for functional uterine bleeding （ UB ）. Methods There were 152 cases of UB treated by RFAE. The thickness of endometrium and ovarian hemodynamics wee observed by transvaginal color Doppler at 1, 3 ,and 6 months after treatment. Meanwhile serum levels of six steroid sex hormones were measured. Results 152 patients were followed up for 6 months. Of them, 103 cases had amenorrhea （67.76%） ,42 cases had decreased volume（27.63% ） and 7 cases experienccd rccurrence（4.61% ） ,with the effective rate of 95.39%. The size of uterus and the repairing layer thickness showed marked decrcase following RFAE. The blood flow impedance of ovarian arteries and pulse index as well as six steroid sex hormones were not changed after at 1,2,3 months after treatment. With showed no significant diffcrcncc （ P 〉 0.05 ）. Conclusion Incomplete destroy to the endometrium base floor or incomplete RFAE to the endometrium is important reason of postoperative recurrence. Infection is the main factor affecting the short-term therapeutic effcct and the complication of adenomyosis is the main factor affecting the long-term therapeutic effect. RFAE does not influence the ovarin function obviously.