射频热凝固治疗特殊类型子宫异常出血效果观察

Radio Frequency Heat Coagulation Treantment for Patients with Special Abnormal Uterine Bleeding

目的探讨射频热凝固治疗特殊类型子宫异常出血的效果。方法对我院收治的存在异常子宫出血的56例进行子宫内膜射频热凝固治疗,其中肾移植术后30例,血液病20例,心脏瓣膜置换术后6例。治疗前均行诊断性刮宫送病理检查排除子宫内膜不典型增生和子宫内膜癌。治疗时间3～5 min,治疗后在院观察48～72 h。治疗后1、3、6、12个月门诊随访。结果与治疗前比较,本组治疗后血红蛋白水平显著升高(P<0.05),阴道出血量评分(PBAC)显著降低(P<0.05),肾移植术后患者血肌酐、尿素显著降低(P<0.05)。治疗后3个月,有6例复发,其中3例单纯功能失调性子宫出血和1例子宫腺肌病治疗无效,经再次射频热凝固治疗后有效;1例多发性子宫肌瘤和1例子宫腺肌病治疗无效后行子宫次全切除术。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工闭经。结论射频热凝固治疗能迅速控制子宫出血,创伤小,预后好,不易复发,对原发病无不良影响,而且操作简单、安全,费用低,可以作为某些特殊类型子宫异常出血的首选治疗方法。

Objective To investigate the method to treat abnormal uterine bleeding in patients following renal transplantation,Cardiac valve replacement and some blood diseases.Methods 56 special abnormal uterine bleeding（AUB） patients were treated using RFHC,inclouding 30 cases after renal transplantation,6 cases after Cardiac valve replacement,and 20 cases with blood disease.Dilation curettage were given to exclude possible atypical hyperplasia and endometrium carcinoma before treatmen,and other necessary examinations were also given.These patients were treated by RFHC for 3-5 minutes,observed in hospital for 48-72 hours,with prevention of infection at the same time,and followed up at month 1,3,6,12 after treatment.Results Compared to prior treatment,RFHC significantly improved Hb（P0.05）,decreased PBAC（P0.05）.Also,it significantly dreased BUM in patents with kidney translplattioin（P0.05）.3 mnths after the treatment,6 patient relapsed.Among them,3 simple DUB patients and 1 adenomyosis patient benefited from the second treatment.1 patient with multiple uterine myoma and 1 adenomyosis patient who had no better clinical outcome were given subtotal hysterectomy.Other patients showed better clinical outcome.Conclusion Radiofrequency treatment can control AUB quickly,and has no side effects on the primary disease.This treatment is acceptable,fast,effective,easy-to-operate,mini-invasive,and low-cost.It may be the first choice to treat some special AUB,such as patients after renal transplantation,cardiac valve replacement and other blood diseases.