围绝经期无排卵型功能失调性子宫出血射频热凝固治疗后生殖激素水平变化

The Changes in Serum Endocrine Hormone Level in Menopausal Patients with Dysfunctional Uterine Bleeding following the Treatment of Radio Frequency Heat Coagulation

目的探讨射频热凝固(RFHC)子宫内膜去除术治疗围绝经期无排卵型功能失调性子宫出血(功血)后生殖激素水平的变化。方法随机收集2009年1月～2011年1月在济南军区总医院妇科就诊、经药物治疗无效的围绝经期无排卵型功血156例为研究组,以闭经为治疗目的采用RFHC子宫内膜去除术治疗。选择同期予药物治疗的围绝经期无排卵型功血38例为对照组。所有患者具备阴道出血量评分(PBAC)、术前诊断性刮宫病理诊断等临床资料。RFHC治疗前和治疗后12、24个月时观察疗效,并检测血清生殖激素六项[雌二醇(E2)、孕酮(P)、睾酮(T)、垂体泌乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)]。结果①研究组治疗后12、24个月总有效率为96.2%、100.0%,PBAC和血红蛋白水平均较治疗前及对照组显著改善(P<0.05)。本组有6例(3.8%)首次RFHC治疗后12个月仍月经过多(PBAC>100),再次RFHC后达到闭经。②研究组治疗后12、24个月时血清E2、P、T、PRL、LH、FSH与术前比较差异均无统计学意义(P>0.05)。③研究组RFHC治疗后24个月时33例(21.2%)血清E2、LH、FSH检测值达到绝经水平,与对照组(18.3%,7/38)比较差异无统计学意义(P>0.05)。结论 RFHC治疗无排卵型功血微创、有效、安全,且治疗后患者生殖激素水平无显著变化。

Objective To investigate the changes in the level of endocrine hormone in plasma in menopausal patients following radio frequency heat coaglulation（RFHC） which was used to abolish emdometrium for the treatment of dysfunctional uterine bleeding（DUB）.Methods One hundred and fifty five patients 43-53（44.5±3.5） years old,who failed to respond to some medicine and resulted in amenorrhea,were recuirted randomly in Jan.2009 to Jan.2011 in the Department of Gynecology of Jinan Miltary General Hospital.They were included in the study group and treated with RFHC.Menstrual score（pictorial blood loss assessment chart,PBAC）,hemoglobin（Hb） data,and endometrial currettage pathology were collected.In addition,six serum endocrine markers were tested before and after RFHC between 12 months with 24 months,including estradiol（E2）,progesterone（P）,testosterone（T）,pituitary prolactin（PRL）,corpus luteum erythropoietin（LH）,and follicle stimulating hormone（FSH） examination.The control group（44-51,45.5±4.5 years old） was 38 cases with DUB who were treated with drugs.Results ①The efficacy of RFHC in the study group for bleeding cessation was 96.2%（150/156） and 100% after 12 and 24 months,respectively.Statistically,PBAC and Hb in the study group within follow-up months were obviously improved（P0.05）,compared to the treatment group prior treatement and the control group.The rate of irregularly minor bleeding in 6 to 12 months was 3.8%（6/156）.Those patients with irregularly minor bleeding received another RFHC treatment.None underwent hysterectomy in this group.②The serum E2 P,T,PRL,LH,FSH of the study group within 12 and 24 months after RFHC treatment showed no statistical difference（P0.05）.③In thirty three patients in the study group（21.2%,33/156）,with an average age of 48.0±3.7 years old,the level of serum E2,LH,FSH reached the level during menopause in 24 months after RFHC in the study group.And in the control group it was 18.3%（7/38）,there was no significant difference between the study and the control groups（P0.05）.Conclusion RFHC is a safe,effective and minimally invasive method in the treatment for DUB without postoperative gynecological endocrine hormone change.