摘要
目的 探讨宫腔镜子宫内膜切除术(TCRE)治疗异常子宫出血的近、远期效果及预后影响因素。方法1990年5月至2002年9月,在我院共行TCRE术1431例,1468例次。1203例于术前先经宫腔镜检查和子宫内膜活检,排除恶性疾患。265例为一期子宫内膜;32例超声测量子宫各级动脉及卵巢动脉阻力指数(RI)、搏动指数(PI),并测定血清6项性激素水平。术后平均随访时间68.5个月(3—148个月)。结果TCRE治疗异常子宫出血的治愈率为93.9％,发生子宫穿孔3例。术中B超监护714例,均见子宫前壁呈现云雾状强回声,其中33例取肌壁组织送病理检查,证实21例有子宫腺肌症。TCRE术后因症状改善不明显,159例行药物治疗,包括止血药、止痛药、抗生素、孕酮类药物及子宫内膜抑制剂等,其中37例行再次TCRE(2.6％)。1431例中,因术后出血症状复发、痛经或子宫肌瘤最终行子宫切除者87例。TCER术前、术后,患者RI,PI及6项激素水平比较,差异均无显著性(P>0.05)。结论(1)对子宫内膜基底层的不完全破坏和漏切,是术后复发的重要原因。(2)合并子宫腺肌症,是影响手术远期成功率的主要因素。(3)TCRE手术对卵巢功能无明显影响。
Objective To evaluate the short term and long term outcomes of abnormal uterine bleeding (AUB) treated by transcervical resection of endometrium (TCRE) as well as the factors which influence the outcomes. Methods From May 1990 to September 2002 there were 1431 cases who suffered from menorrhagia, A total of 1468 times of TCRE were performed. Hysteroscopic diagnosis and endometrium biopsy was performed to rule out malignant diseases in 1203 cases. One stage TCRE was performed in 265 cases. Resistance index ( RI) and pulse index ( PI) of every level uterine artery were measured by ultrasound and serum levels of were 6 steroid sex hormones were measured by laboratory in 32 cases. The mean duration of follow-up was 68. Smonths (3-148 months). Results Three cases of uterine perforation were encountered. Smog like echo in the anterior uterine wall was found in 714 cases (49.9%) by B ultrasonography, among them 21cases (63.6% ) were proved adenomyosis by pathological examination. One hundred and fifty nine cases (10. 8% ) had been treated by drugs, such as homeostasis, analgesic agent, antibiotics, progesterone and endometrium inhibiting agents, etc. Repeat TCRE was performed in 37 cases. Owing to recurrent bleeding, dysmenorrhea or uterine myoma 87 cases (6.1%) were finally received hysterectomy. Conclusions (1) The main cause of recurrence was incomplete destruction of or leak from basal layer of endometrium. Shift wire loop with the sheath together to resect endometrium from the fundus to cervix smoothly can solve the problem of incomplete resection. Upon completion of operations,'blind area' and 'blind point' should be examined and resected again if there is some endometrium left behind which could solve leak from basal layer of endometrium. (2) The duration of follow-up and adenomyosis are the main factors, which influence the long-term successful rate. (3) TCRE dose not influence the ovarian function obviously.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2004年第5期296-300,共5页
Chinese Journal of Obstetrics and Gynecology
