宫腔镜子宫内膜电切术后晚期并发症的分析

Clinical Analysis of Late Complications After Hysteroscopic Transcervical Resection of Endometrium

目的：总结宫腔镜子宫内膜电切术后晚期并发症的临床特点和治疗经验。方法2006年1月～2014年6月13例因功能失调性子宫出血行宫腔镜子宫内膜电切术后（＞9年）出现晚期并发症，再次宫腔镜探查并处理。结果13例宫腔镜二次探查结果：6例宫腔积血，其中4例位于宫角，2例位于宫腔；7例局灶或四壁内膜增生，其中1例出现子宫内膜去除-输卵管绝育术后综合征，1例子宫内膜病理为非典型增生Ⅰ级。7例术后症状好转（53．8％）；3例合并子宫腺肌病继发进行性痛经（23．1％），2例子宫内膜增殖有乳腺癌手术史（15．4％），1例子宫内膜非典型增生Ⅰ级（7．7％）均行腹腔镜下全子宫切除术。结论宫腔镜子宫内膜电切术后残存有功能的子宫内膜或日后再生的内膜可引起晚期并发症，需要临床进一步诊治。

Objective To analyze clinical characteristics and treatment experience for late complications after hysteroscopic transcervical resection of endometrium （ TCRE） . Methods Clinical data of 13 cases of late complications after hysteroscopic TCRE for dysfunctional uterine bleeding from January 2006 to June 2014 were retrospectively analyzed .A re-operation of hysteroscopic exploration and resection were required . Results The re-operation in the 13 patients found 6 cases of hematocele in uterine cavity （4 cases in the uterine horn, 2 cases in the uterine cavity） and 7 cases of focal or whole uterine endometrial hyperplasia （including 1 cases of PASS syndrome and 1 case of endometrial pathology of grade Ⅰatypical hyperplasia ） .Postoperative symptoms were relieved in 7 cases （53.8%）.Laparoscopic total hysterectomy was performed in 3 cases of adenomyosis complicated with secondary progressive dysmenorrhea （23.1%）, 2 cases of endometrial proliferation associated with a breast cancer history （15.4%）, and 1 case of endometrial atypical hyperplasia grade Ⅰ （7.7%）. Conclusion After hysteroscopic TCRE, residual functional endometrium or future regeneration of endometrium may lead to late complications , which need further clinical diagnosis and treatment .