宫腔镜内膜电切术治疗难治性功血81例临床分析

Transcervical resection of endometrium in obstinate dysfunctional uterine bleeding clinical analysis of 81 cases

目的:探讨宫腔镜下内膜电切术治疗难治性功血的疗效。方法:2006年2月～2008年6月对81例难治性功血患者行宫腔镜下内膜电切治疗,将81例患者随机分为机械性处理组和未行处理组,比较术中的情况,术后定期随访。结果:81例患者手术均在B超下监护完成,无1例手术并发症发生,平均手术时间(14.64±4.57)min,平均随访(12.35±1.34)个月,术后闭经率为43.2%,经量减少率为39.5%,正常为12.3%,满意率达95.1%。行机械性预处理组与未行处理组在手术时间及液体吸收量方面相比差异有统计学意义(P<0.05)。经宫颈子宫内膜切除术(TCRE)术前及术后卵巢激素水平比较差异无统计学意义(P>0.05)。结论:宫腔镜下内膜电切术是治疗难治性功血安全有效的方法,值得进一步的推广及临床的广泛应用。子宫腺肌症可能是手术失败的原因之一,术前行机械性预处理可有效的缩短手术时间及液体吸收量,该手术不影响卵巢的功能。

Objective： To evaluate the clinical effectiveness of transcervieal resection of endometrium （TCRE）. Methods： From February 2006 to June 2008 there were 81 cases who suffered from dysfunctional uterine bleeding, all cases were performed by TCRE. The 81 patients were divided into two groups. One was mechanical preparation group, the other was not mechanical preparation group. The comparations were done. The regulary follow-up were carried out after TCRE. Results： 81 cases were performed by ultrasound without serious complications occurred. Mean time of operation was （14.64±4.57） minutes and mean duration of follow-up was （12.35±1.34） months. After TCRE, 35 cases became amenorrhea. 32 cases were proved to be improved in their menorrhea, 10 cases were normal, giving a success rate of 95. 1%. With pretreatment the operation time and absorption of fluid, were significantly shorter and less than unpretreatment group （P〈0. 05）. There were no significant difference between before TCRE and after TCRE in ovarian hormones. Conclusion： TCRE is a safe and effective procedure in treating obstinate dysfunctional uterine bleeding. Adenomyosis is probably the one of failure factors of TCRE. Mechanical pretreatment can effectively shorten time of operation and absorption of fluid. TCRE dose not influence the ovarian function.