射频热凝固治疗肾移植术后子宫异常出血

Radiofrequency treatment of 30 patients with abnormal uterine bleeding following renal transplantation

目的探讨肾移植术后子宫异常出血的治疗方法。方法对肾移植术后异常子宫出血患者30例,包括子宫腺肌症3例,子宫肌瘤7例(子宫黏膜下肌瘤3例),功能性子宫出血20例,采用射频热凝固技术进行治疗,治疗前均行必要的检验,并诊刮送病理排除子宫内膜不典型增生和子宫内膜癌。其中,子宫肌瘤患者肌瘤直径<5 cm,多发肌瘤和腺肌症患者子宫<孕2.5个月。治疗时间3～5 min,治疗后在院观察48～72 h,并预防感染。治疗后1、3、6和12个月门诊随访。结果 1例单纯功能性子宫出血患者和1例子宫腺肌症患者治疗无效,经再次射频治疗后治愈;1例多发性子宫肌瘤患者和1例子宫腺肌症患者治疗无效后行次全子宫切除术。其他患者,保留部分子宫内膜者月经量较前明显减少,子宫内膜全部凝固者达到人为绝经,患者不再有月经来潮。结论射频热凝固治疗能迅速控制肾移植术后患者的异常子宫出血,对移植肾脏无不良影响,创伤小,患者恢复快、预后好、不易复发,而且操作简单、安全,费用低,可以作为肾移植术后子宫异常出血患者的首选治疗方法。

Objective To investigate the treatment method of abnormal uterine bleeding following renal transplantation.Methods Thirty abnormal uterine bleeding（AUB） patients after renal transplantation were treated by radiofrequency,including 3 cases with adenomyosis,7 cases with myoma of uterus（among them 3 cases with subserous myoma）,and 20 cases with dysfunctional uterine bleeding（DUB）.Dilation curettage were given to avoid atypical hyperplasia and carcinoma of endometrium before treatment,and other necessary examination were given too.Results One simple DUB patient and 1 adenomyosis patient reached cure after the second treatment,1 patient with multiple uterine myoma and 1 adenomyosis patient had no response and were given subtotal hysterectomy at the last,others were reached cure.Conclusion Radiofrequency treatment can control AUB after renal transplantation quickly,and has no adverse reaction on transplanted renal.This treatment is acceptable,fast,effective,easy to operate,mini-invasive,and of low cost.It may be the first choice of treatment of AUB after renal transplantation.