宫腔镜子宫内膜切除术对异常子宫出血的近远期疗效及预后影响因素研究

Short-and long-term curative effects of hysteroscopic endometrial ablation in treatment of abnormal uterine bleeding and the influencing factors of prognosis

目的探讨宫腔镜子宫内膜切除术对异常子宫出血的近、远期疗效及预后影响因素。方法将武汉大学人民医院收治的46例异常子宫出血患者随机分为观察者和对照组,每组各23例。对照组采用常规治疗方法 ,观察组采用宫腔镜下子宫内膜切除术。随访患者两年,比较两组患者的近、远期疗效;分析影响患者预后的相关因素。结果观察组总有效率为91.30%,显著高于对照组(78.26%),两组相比差异有统计学意义(χ2=6.589,P<0.05);观察组贫血纠正率及月经改善率均显著高于对照组,两组比较差异有统计学意义(P<0.05)。观察组1年及2年复发率均显著低于对照组,两组比较差异有统计学意义(P<0.05)。单因素分析显示:年龄、病程、宫腔深度及子宫内膜厚度是子宫内膜切除术预后的主要影响因素(P<0.05);多因素分析显示:年龄越大、宫腔深度越浅,患者预后越好。结论宫腔镜子宫内膜切除术对异常子宫出血的疗效显著,对月经和贫血具有明显的改善作用,患者近、远期效果较好,值得临床推广。

Objective To explore the short- and long-term curative effects of hysteroscopic endometrial ablation in treatment of abnormal uterine bleeding and the influencing factors of prognosis. Methods Forty-six patients with abnormal uterine bleeding treated in the hospital were randomly divided into observation group and control group, 23 patients in each group. The patients in control group were treated with routine therapy, while the patients in observation group were treated with hysteroscopic endometrial ablation. All the patients were followed up for two years; the short- and long-term curative effects in the two groups were compared; the related influencing factors of prognosis were analyzed. Results The total effective rate in observation group was 91.30%, which was statistically significantly higher than that in control group （78.26%） （X2 = 6. 589, P〈0. 05 ） ; the correct rate of anemia and menstrual improvement rate in observation group were statistically significantly higher than those in control group （P〈0.05） . The one-year and two-year recurrence rates in observation group were statistically significantly lower than those in control group （P〈0. 05 ） . Univariate analysis showed that age, course of disease, uterine cavity depth, and endometrial thickness were main influencing factors of prognosis of endometrial resection （P〈0. 05 ） ; multivariate analysis showed that the older the patients was, the shallower uterine cavity depth was, the better the prognosis was. Conclusion The curative effect of hysteroscopic endometrial ablation in treatment of abnormal uterine bleeding is significant, which can significantly improve anemia and menstruation, the short- and long-term curative effects are good, the method is worthy of clinical popularization.