宫腔镜子宫内膜去除术的沿革、现状及前景

The History,Situation and Future of Hysteroscopic Endometrial Ablation

子宫异常出血(abnormal uterine bleeding,AUB)是女性的常见病,子宫内膜去除术(endometrial ablation,EA)是其治疗手段之一。EA通过物理或化学方法破坏或切除子宫内膜全层及其下方的浅肌层组织,防止子宫内膜再生,使月经量减少甚至闭经,从而控制过量的子宫出血。EA发展至今,经历了第一代和第二代;每一代EA有许多种通过破坏子宫内膜治疗月经过多的方法。尽管EA越来越安全、有效,但仍有不足之处,如术后再次出血、感染、妊娠;月经相关的疼痛,如宫腔积血、子宫内膜去除-输卵管绝育综合征(post-ablation-tubal sterilization syndrome,PATSS);EA后仍存在子宫内膜恶性疾病的风险。关于EA的许多问题尚需进一步的研究和循证医学的总结。

Abnormal uterine bleeding（AUB） is a femal common disease.Endometrial ablation（EA） is one of the treatments of AUB.EA could destroy the endometrium and the superficial layer of myometrium by physical or chemical methods.When the endometrium destroyed,it will lose the potential to regenerate,then the menstruation quantity become little,even amenorrhoea and excessive uterine bleeding is avoided.Up to now,there are two generations of EA.Each generation various ways destroy the endometrium to treat menorrhagia.Though endometrial ablation is more and more safe and effective,but it still has many deficiencies,such as postoperative bleeding,infection,even pregnancy.Also,menstrual related abdominal pain,such as hematometra,post-ablation-tubal sterilization syndrome（PATSS） and still exists the risk of endometrial malignant disease.There are EA related problems need further research and the summary of evidence-based medicine.