摘要
目的 探讨功能失调性子宫出血(DUB)患者行宫腔镜子宫内膜切除术(TCRE)的疗效与影响预后的因素。方法 选择行TCRE资料完整的220例DUB患者,随访手术疗效,并对术中切除的子宫肌条及术后症状复发患者切除的子宫标本,通过HE和免疫组织化学染色等方法,观察内膜肌层的破坏深度及切除子宫组织的病理学改变。结果术后随访时间24—114个月,月经改善总有效率为94.5％(208/220),其中闭经为25.9％(57/220),月经量减少为68.6％(151/220);术后贫血纠正率为97.3％(145/149);患者对手术效果满意率为92.3％(2003/220);术后症状复发进行再次干预治疗38例(17.3％,38/220),其中行二次TCRE 3例,子宫切除10例,药物治疗25例。术中切除内膜下平滑肌组织30例,组织厚度为2.12～3.26 mm;10例切除的子宫腔内仍有功能完好的内膜存在,其中发现肌层子宫内膜异位病灶5例。结论 TCRE是治疗DUB安全有效的方法;术中对内膜破坏不彻底,或合并子宫腺肌症,是影响手术疗效的主要因素;规范手术操作和加强术后管理是提高疗效的必要措施。
Objective To investigate the efficiency and factors related to the recurrence of transcervical resection of endometrium ( TCRE) in treating women with dysfunctional uterine bleeding (DUB). Methods Two hundred and twenty women with DUB were selected for TCRE. Specimens from removed endometrium were obtained during the procedures and their menstruation and menorrhagia after the operations were followed up. We also studied the uterine specimens obtained from the recurrent cases undergoing hysterectomies. The specimens were stained by hematoxylin-eosin and immuno-histochemistry respectively to evaluate the depth of removed myometrium and the histopathologic changes in relapsed cases. Results The follow up period after operation was 24 to 114 months. (1) Overall effective rate was 94. 5% , in which amenorrhea rate was 25. 9% , menstruation reduction rate was 68. 6% . (2)The effective rate of corrective anemia was 97. 3% and the satisfaction rate for the operation was 92. 3%. (3) Thirty-eight cases required subsequent treatment as a result of recurrence, of which 10 cases underwent hysterectomy and 3 cases underwent repeat TCRE and 25 cases were given medicine treatment (4) The average depth of myometrium in removed endometrium strip was 2. 12 - 3. 26 mm. (5)Endometrium regrowth was seen in the resected uterine specimens from relapsed cases and adenomyosis was also found in the intra-uterine wall in some cases. Conclusions (1)TCRE is a safe and effective alternative treatment for DUB. (2)The main factor reducing the efficiency is either incomplete removal of endometrium or adenomyosis. (3) Standardizing the procedures and strengthening postoperative management are essential requirements for improving the efficiency of TCRE.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2004年第5期301-304,共4页
Chinese Journal of Obstetrics and Gynecology
