微波子宫内膜去除术治疗月经过多的远期疗效分析

Clinical analysis on long term effect of microwave endometrial ablation in treatment of menorrhagia

目的探讨微波子宫内膜去除术（MEA）治疗月经过多的远期疗效及影响因素。方法选择因月经过多药物治疗无效而行MEA治疗且资料完整的患者共334例为观察对象，患者年龄29～59岁，其中合并子宫腺肌病59例。术后随访患者的月经、贫血症状的改善情况；53例患者术后进行宫腔镜检查及子宫内膜活检，观察子宫内膜组织的病理改变。术后平均随访时间64．7个月（3～96个月）。结果MEA治疗月经过多总有效率为91．3％（305／334），其中闭经率为49．7％（166／334），月经量减少或正常为41．6％（139／334）；术后痛经改善的有效率为71．1％（140／197）；患者对手术的满意率为91．9％（307／334）；其中年龄〉40岁者，手术有效率为92．9％（196／211）、满意率为93．8％（198／211）、闭经率为64．9％（137／211），年龄≤40岁者手术有效率为88．6％（109／123）、满意率为88．6％（109／123）、闭经率为23．6％（29／123），不同年龄的患者MEA有效率、满意率、闭经率比较，差异均有统计学意义（P〈0．05）。术后因症状复发（由于子宫内膜的破坏不完全导致宫角部子宫内膜岛状残留）等行再次治疗42例（12．6％，42／334），其中行二次MEA9例，因月经过多症状复发、子宫腺肌病或子宫肌瘤最终行子宫切除术33例，子宫切除率9．9％（33／334）。术后即时宫腔镜检查见宫腔内子宫内膜全部破坏，光镜下病理学改变表现为由表及里的凝固性坏死和部分平滑肌坏死层构成的热损伤带。结论MEA治疗月经过多安全、有效；子宫内膜的不完全破坏导致宫角子宫内膜岛状残留是术后复发的重要原因。年龄、合并子宫腺肌病是影响MEA手术远期疗效的主要因素。

Objective To evaluate long term effect and related factors in patients with menorrhagia treated by microwave endometrial ablation （MEA）. Methods Total of 334 women with menorrhagia were treated by MEA, the range of age was from 29 to 59 years old. Among them, 59 cases were complicated by adenomyosis. All the patients were followed up on the change of menstrual cycle, the amount of flow, improvement of anaemia and complication. Fifty-three women underwent outpatient diagnostic hysteroscopy, the biopsy tissue was taken from the endometrium for bistopathological examination. The mean duration of follow-up was 64. 7 months （3 -96 months）. Results The overall curative rate was 91.3% （305/334）, of which amenorrhea rate was 49. 7% （166/334）, menstruation reduction rate was 41.6% （139/334） ; 71.1% （140/197） of the cases who previously had dysmenorrhea had relieved their pelvic pain and the satisfactory rate was 91.9% （307/334）. Among patients 〉 40 years, 92. 9% （ 196/211 ） of operation effective rate, 93.8% （ 198/211 ） of satisfactory rate and 64. 9% （ 137/211 ） of amcnorrhca rate were obtained, while patients ≤40 years, 88. 6% （109/123） of operation effective rate, 88.6% （ 109/123 ） of satisfactory rate and 23.6% （59/123） of amenorrhea rate were obtained. There was significant difference in rate of operation effectiveness, satisfaction and amenorrhea （P 〈 0. 05 ）. Forty-two cases required subsequent treatment due to recurrence, of which 9 cases were given by secondary MEA and 33 cases （9. 9%, 33/334） underwent hysterectomy indicated by frequent menorrhagia, adenomyosis or leiomyoma＇s A completely destroyed endometrium was observed by hysteroscopy after MEA, pathologic characteristics of MEA showed two zones of necrotic tissue： the inner zone was coagulation necrosis and the outer zone of necrosis was hypocellular hyalinized myometrium. Conclusions MEA is the safe and efficacious management to treat menorrhagia. Incomplete removal of endometrium was the major reason resulting in postoperative recurrence. Young age and complicated with adenomyosis were the main factors influencing long term clinical effect of MEA.