微波子宫内膜去除术治疗月经过多2年随访报告

目的探讨微波子宫内膜去除术(microwave endometrial ablation,MEA)治疗月经过多的疗效. 方法选择60例药物治疗无效,无生育要求的月经过多患者行MEA治疗. 结果颈管粘连1例,无子宫穿孔等严重并发症.术后随访2年,闭经12例(20%),月经量减少34例(57%),月经量正常6例(10%),无效8例(13%),总有效率87%(52/60).其中功能失调性子宫出血有效率为100%(35/35),子宫腺肌病70%(14/20),子宫肌瘤60%(3/5). 结论 MEA适合于各种月经过多,具有安全、简便的特点,但应掌握适应证以提高疗效.     

Is balloon ablation as effective as endometrial electroresection in the treatment of menorrhagia?

BACKGROUND: Hot-fluid balloon therapy is a recently introduced, relatively simple endometrial ablation procedure for menorrhagia. Because it is thought to be safer than other ablation procedures, it would be superior to other types of ablation if it is equally effective. The purpose of the present study was therefore to compare the safety and effectiveness of balloon ablation and transcervical resection of the endometrium (TCRE) for the treatment of menorrhagia. PATIENTS AND METHODS: We performed a prospective cohort study comparing TCRE and hot-fluid balloon ablation in consecutive patients suffering from menorrhagia and not responding to medical treatment. Between 1992 and 1994, all patients had TCRE, whereas from 1995 onward, all patients had balloon therapy. Outcome measures were surgical reintervention, menstrual pattern, and patient satisfaction. Assuming a 9% reintervention rate after TCRE, a series of 150 patients was required to show balloon ablation to be equally effective. RESULTS: Of the 152 patients who were included, 75 underwent TCRE and 77 had balloon ablation. The procedure had to be abandoned in 13 patients in the TCRE group (17%) and in 8 patients in the balloon ablation group (10%). In the TCRE group, four patients underwent a second resection, whereas hysterectomy was performed in 15 patients (3-year cumulative reintervention rate 26%). In the balloon-ablation group, there were no reresections, whereas hysterectomy was performed in 9 patients (3-year cumulative reintervention rate 13%) (log-rank test P = 0.11). The relative risk for any reintervention was 0.36 (95% confidence interval 0.05-2.5). At 3 months' follow-up the duration of menstruation was significantly shorter after TCRE than after balloon ablation, but at 6, 12, and 24 months, the duration of menstruation in the two groups appeared to be equal. No difference in patient satisfaction could be detected between the two groups, but there appeared to be a statistically significant decline in patient satisfaction over time for both therapies. This decline was stronger after TCRE than after balloon ablation. CONCLUSIONS: Because endometrial ablation with a hot-fluid balloon seems to be as effective as endometrial resection, with a lower complication rate, balloon ablation might become the procedure of choice for endometrial ablation.     

Endometrial ablation for the treatment of menorrhagia: a comparison of patients with normal, enlarged, and fibroid uteri.

One hundred sixty-one patients underwent endometrial ablation with the Nd:YAG laser for the treatment of refractory menorrhagia. Patients were divided into one of three groups: those with a normal-sized uterus; those with an enlarged uterus (greater than 10 cm); and those with uterine fibroids, which had been documented clinically, ultrasonographically, or by a combination of hysteroscopy and laparoscopy or by one or the other. All patients were considered candidates for hysterectomy. Both preoperatively and postoperatively, patients monitored their menstrual cycles and evaluated their flow according to predetermined categories of amenorrhea, light flow, normal flow, heavy flow, and severe flow. After treatment, 68% of patients with normal-sized uterus and 91% of patients with an enlarged uterus (greater than 10 cm) and 88% of patients with uterine fibroids became amenorrheic or had light flow. None of the patients in this last group have had to undergo hysterectomy. This study indicates that the patient with an enlarged or fibroid uterus may not have contraindications for endometrial ablation. Endometrial ablation may be effective in at least temporarily controlling bleeding in those patients with enlarged or myomatous uterus.     

Long-Term Patient Satisfaction with Thermal Balloon Ablation for Abnormal Uterine Bleeding

Background and Objective:

Thermal balloon ablation is a minimally invasive surgical technique that can be used to treat abnormal uterine bleeding/heavy menstrual bleeding (AUB/HMB). Most published studies to date provide information on short-term patient satisfaction and outcomes. The purpose of this study was to determine long-term patient satisfaction after thermal balloon endometrial ablation 7 to 10 years postoperatively in a population previously surveyed at the Penn State Milton S. Hershey Medical Center at 1 to 5 years postoperatively.

Methods:

Two-hundred fourteen patients were identified who underwent thermal balloon ablation at our institution between January 1, 2001 and December 31, 2004. These patients were mailed a 2-page survey asking for information on demographics, patient satisfaction, postoperative bleeding patterns, and the need for subsequent surgery. Satisfaction rates, amenorrhea rates, and the rates of women who required hysterectomy were calculated as percentages.

Results:

Ninety-seven patients returned completed surveys. The survey response rate was 62%, excluding 57 surveys that were returned as undeliverable. The follow-up interval was 93 to 129 months. Eighty-seven percent of respondents were satisfied with the results of their procedure compared with 88% in the original study. Subsequent hysterectomy was required in 21.6% of women after 7 to 10 years compared with 9% after the 1- to 5-year follow-up period. Of the 76 women who did not undergo hysterectomy, 58% reported amenorrhea and 35.5% reported minimal to light bleeding.

Conclusion:

This study demonstrates a consistently high patient satisfaction rate with thermal balloon ablation at our institution at 7 to 11 years postoperatively compared with 1 to 5 years postoperatively. The hysterectomy rate, however, was 2.4 times greater in the long-term follow-up period.     

Hematometra after thermal balloon endometrial ablation in a patient with cervical incompetence

BACKGROUND: Thermal balloon endometrial ablation is a relatively safe nonsurgical treatment for menorrhagia. Hematometra follows this procedure in <3 % of patients, but risk factors for this complication are unclear. CASE: A woman with a history of cervical incompetence during pregnancy later developed cervical occlusion and hematometra after thermal balloon endometrial ablation. Cervical occlusion did not recur after cervical dilatation and temporary placement of a catheter as a stent. CONCLUSION: The normal resistance of the internal cervical os may be an important factor in avoiding thermal damage to the cervix during thermal balloon endometrial ablation. This case suggests that a history of cervical incompetence may be a clinical indicator of decreased cervical resistance.     

Characteristics of Patients Undergoing Hysterectomy for Failed Endometrial Ablation

Background and Objectives:

Endometrial ablation is a minimally invasive procedure for menorrhagia. High success rates are documented with >90% of patients experiencing satisfaction. However, adequate relief after endometrial ablation is not obtained in a cohort of patients. The purpose of this study is to identify the characteristics of patients for whom endometrial ablation fails due to persistent symptoms, causing them to choose hysterectomy for definitive treatment.

Methods:

We conducted a retrospective chart review of patients who underwent hysterectomy for persistent menorrhagia, pain, or both, who previously had endometrial ablation. We reviewed medical records including pathology reports from hysterectomy. We compared demographics to a group previously studied at our institution that were identified as satisfied 5 years after ablation.

Results:

The number of patients in our study group was 51 (n = 51). Median age of patients was 39 (range 29–50) years. Average body mass index was 31 (range 19–47) kg/m². Average parity was 1.9. Sixty-nine percent underwent tubal ligation. The majority were nonsmokers (75%). Ninety-six percent were Caucasian. Compared with the previously studied satisfied group, the only statistically significant difference was age.Of 51 patients, 11 (22%) noted pelvic pain as their chief concern. Menorrhagia was the chief concern in 22 (43%). Eighteen patients (35%) complained of both. The most common diagnosis was endometriosis, which was identified in 35 patients (68%). Leiomyomata were present in 33 patients (64%). Adenomyosis was identified in 22 patients (43%).

Conclusions:

Patients who present for hysterectomy after endometrial ablation have a high rate of endometriosis, adenomyosis, and leiomyomata, with endometriosis being the most common finding.     

Hysteroscopic endometrial ablation validation among conservative treatment methods of menorrhagia

Hysterectomy begins to fail as an absolute treatment for menorrhagia, as new medical and conservative treatment occurs. The author analyzes literature data of efficiency of hysteroscopic endometrial ablation compared with medical treatment, as well as among different hysteroscopic techniques. In conclusion, considering the expansion of hysteroscopic methods, gynaecologists should consider revising the treatment option in dysfunctional uterine bleeding, and offer to the patients the option of endometrial ablation.     

热球子宫内膜去除术治疗月经过多的远期疗效和安全性分析

目的观察热球子宫内膜去除术（简称热球）治疗月经过多的远期疗效和安全性。方法回顾分析2004年2月～2008年1月105例因月经过多接受热球治疗的临床资料。对病人进行长期随访,包括月经周期和月经量,有无腹痛、感染、出血、粘连等并发症。结果除2例失访、1例术后56d死于泌尿系肿瘤外,共随访102例。完成3、6、12、24和36个月随访分别是102例、101例、99例、66例和51例,对应的有效率／闭经率分别是93．1％（95／102）／38．2％（39／102）、93．1％（94／101）／33．7％（34／101）、91．9％（91／99）／32．3％（32／99）、93．9％（62／66）／34．8％（23／66）和92．2％（47／51）／31．4％（16／51）。热球治疗术中及术后未发生邻近组织热损伤、血尿、肠穿孔、严重感染及大出血等严重并发症。术后11例（10．5％）并发子宫收缩样疼痛,经口服止痛药物后6h内恢复;8例（7．9％）并发宫颈和（或）宫腔粘连,4例经扩宫、3例经宫腔粘连分解治疗后缓解,1例行子宫切除。术后36个月与术后12个月比较,有效率和闭经率均无统计学差异（χ^2=0．000,P=1．000;χ^2=0．014,P=0．906）;术后24个月与术后12个月比较,有效率和闭经率均无统计学差异（χ^2=0．034,P：0．854;χ^2=0．114,P=0．736）。结论热球是治疗月经过多患者的有效、安全的手段,且疗效持久,是子宫切除的良好替代方法之一。     

Thermal effects of intrauterine Nd-YAG laser therapy for endometrial ablation

Intrauterine use of the Nd-YAG laser has been reported for the treatment of menorrhagia. During the procedure, there is a risk that heat may be conducted across the uterine wall, causing damage to adjacent organs. This possibility was investigated, and the temperature rise on the peritoneal surface of the uterus was recorded during laser endometrial ablation. The effects were studied of varying the tissue thickness, the separation between tissue and fibre and the exposure duration. In addition to measurements made on uteri after hysterectomy, a thermal sensor was designed and constructed to enable temperature measurements to be made in vivo during laser application. The maximum temperature rise recorded in vivo was 2°C. Our conclusion from in vitro and in vivo experiments is that, provided reasonable care is exercised to ensure that the fibre does not penetrate the tissue, heat conduction across the uterine wall during endometrial ablation by the Nd-YAG laser is insufficient to cause damage to adjoining organs.     

异常子宫出血NovaSure子宫内膜去除术后再干预的危险因素分析

目的探讨和分析NovaSure子宫内膜去除术后患者再次干预的高危因素。 方法回顾性分析2011年1月至2018年1月就诊于首都医科大学附属北京天坛医院妇产科,行NovaSure子宫内膜去除术的192例异常子宫出血患者的临床资料,包括患者的一般信息及病史相关特征、超声结果及手术记录中的相关资料,通过单因素分析以及Logistic回归分析的方法找出子宫内膜去除术后需再次手术干预的高危因素,分析这类患者的临床特点。 结果本研究192例异常子宫出血患者中,20例(10.42%)术后2年内需再次手术干预,其中13例表现为阴道出血,3例表现为腹痛,4例则两种症状均有。单因素分析提示NovaSure子宫内膜去除术后再次干预与年龄、月经失血图评分、腹痛的视觉模拟评分、子宫腺肌症以及术后是否放置曼月乐有关(P<0.05);而与体质量指数、孕产次、宫腔深度、子宫体积、剖宫产史、合并子宫肌瘤无关(P>0.05)。多因素分析提示年龄、子宫腺肌症、腹痛的视觉模拟评分及术后是否放置曼月乐是再次干预患者的独立影响因素(P<0.05)。 结论年龄、子宫腺肌症、腹痛的视觉模拟评分及术后是否放置曼月乐是异常子宫出血患者NovaSure子宫内膜去除术后需再次干预的独立影响因素,而阴道出血是再次干预患者的主要临床表现。     

HIFU消融治疗弥漫型和局限型子宫腺肌病的近远期疗效

目的比较HIFU治疗弥漫型和局限型子宫腺肌病的近远期疗效。方法收集308例接受HIFU治疗的子宫腺肌病患者,依据术前MRI将其分为弥漫组和局限组,计算消融率及消融发生率,并评估2组患者术前、术后痛经及月经量情况。结果共297例患者进行了有效随访,随访时间1~50个月,其中弥漫组177例,局限组120例。297例患者消融发生率为99.33%(295/297),弥漫组及局限组消融率分别为(26.00±13.36)%、(44.32±19.93)%。2组患者术后痛经及月经量评分与术前比较均有明显降低(P均0.05)。痛经症状总缓解率在术后3、6、12、24及36个月分别为92.96%(264/284)、86.18%(237/275)、73.51%(197/268)、60.71%(136/224)及46.83%(59/126);各随访时段局限组痛经缓解率均高于弥漫组,且在术后6、24及36个月差异有统计学意义(P0.05)。月经量过多症状总缓解率在术后3、6、12、24及36个月分别为87.38%(187/214)、83.09%(172/207)、68.63%(140/204)、63.64%(105/165)及45.92%(45/98);各随访时段局限组均高于弥漫组,但差异均无统计学意义(P均0.05)。结论 HIFU治疗子宫腺肌病疗效显著,局限型与弥漫型近期疗效相当,远期疗效局限型优于弥漫型。     

The use of transvaginal sonography and vaginoscopic hysteroscopy in women on tamoxifen.

BACKGROUND AND OBJECTIVES: Long-term administration of tamoxifen causes endometrial changes. The aim of this study was to evaluate the role of transvaginal sonography and vaginoscopic hysteroscopy in the screening of patients on tamoxifen. METHODS: Seventy patients with breast cancer treated with tamoxifen 20 mg daily underwent transvaginal sonography and vaginoscopic hysteroscopy, a modified relatively painless approach, at the beginning of the treatment and at a follow-up visit approximately 9 months after its initiation. RESULTS: At the follow-up visit, the mean uterine dimensions and mean endometrial thickness as measured by ultrasound were significantly larger, and pulsatility and resistance indices of the uterine arteries as measured by Doppler were significantly lower. Sonography revealed abnormal endometrial thickness in 73% (51 of 70) of the patients, and 83% (58 of 70) had hysteroscopical changes. Sonography missed 1 case of endometrial adenocarcinoma. CONCLUSIONS: Vaginoscopic hysteroscopy, an approach that causes reduced pain, can add significantly to the sensitivity of transvaginal sonography for the detection of endometrial changes in patients with breast cancer receiving tamoxifen. It is recommended for every patient prior to the initiation of treatment and at the follow-up visits.     

射频与滚球或滚筒电极电凝子宫内膜去除术治疗功能失调性子宫出血的比较

目的 探讨射频子宫内膜去除术治疗功能失调性子宫出血的效果.方法 回顾性分析2011年1月～2012年1月我院异常子宫出血65例,按手术方法不同分为射频组(射频子宫内膜去除术,采用美国HOLOGIC公司子宫内膜去除系统,n=33)和电凝组(滚球或滚筒电极电凝子宫内膜去除术,采用德国诺道夫公司子宫内膜去除系统,n=32),比较2种手术方法的疗效.结果 射频组术后48 h VAS评分明显低于电凝组[(2.1±0.7)分vs.(3.8±1.2)分,t=-7.003,P=0.000].术后6个月射频组月经情况:闭经17例,点滴量月经8例,少量月经6例,正常经量2例,治疗有效率100％;电凝组:闭经16例,点滴量月经8例,少量月经7例,正常经量1例,治疗有效率100％,2组比较无统计学差异(Z=-0.057,P=0.955).术后12个月射频组月经情况:闭经15例,点滴量月经7例,少量月经7例,正常经量4例,治疗有效率100％;电凝组:闭经15例,点滴量月经6例,少量月经8例,正常经量3例,治疗有效率100％,2组比较无统计学差异(Z=-0.105,P=0.916).结论 射频子宫内膜去除术治疗无生育要求的功能失调性子宫出血安全、有效.     

Photodynamic endometrial ablation: morphological study

BACKGROUND AND OBJECTIVES: Endometriumablation provides an alternative treatment modality to hysterectomy for dysfunctional uterine bleeding (DUB). Its feasibility was demonstrated in animal studies. The purpose of this study was the evaluation of histological changes following photodynamic endometrial ablation in patients. STUDY DESIGN/MATERIALS AND METHODS: 5-Aminolevulinic acid (ALA) was topically applied in three premenopausal and one postmenopausal patient 4-6 hours before laser-illumination. ALA-concentration: 100-400 g/ml, NaOH-titration (pH 5.5). Volume applied, 1.5-2.0 ml; intrauterine balloon-lightdiffuser; wavelength, 635 nm; lightdose, 160 J/cm(2). Hysterectomy was performed 3-152 days after photodynamic ablation. Histological examination was carried out on endometrium sections stained with hematoxylin and eosin (H&E). RESULTS: Necrosis including the full thickness of the endometrium was found 3 days after photodynamic endometrial ablation. Specimens collected after 35 and 152 days did not exhibit fibrosis or adhesions. Foci of preserved endometrium were detected in all patients. CONCLUSIONS: Photodynamic endometrial ablation is selective and does not cause endometrial fibrosis or adhesions.     

Tranexamic Acid: A Potential Adjunct to Resectoscopic Endometrial Ablation

Abnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. In this study, our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB. Sixty patients were enrolled in this study. All patients underwent resectoscopic surgery. Patients were randomly divided into two groups. Group 1 (n = 30) received 500 mg of tranexamic acid. Group 2 (n = 30) served as the control group and underwent surgery without the administration of tranexamic acid. Total pictorial blood loss assessment chart (PBAC) scores were significantly lower postoperatively (152.14 ± 9.65 versus 6.6 ± 0.90; P < 0.001). When stratified by the administration of tranexamic acid, the number of patients with a postoperative day 1 PBAC score ≤15 was higher in the tranexamic group (19 versus 13), whereas the number of patients with a post operative day 1 PBAC score >15 was lower in the tranexamic group (11 versus 17), but the differences were not statistically significant (P > 0.05). AUB is a complex disease that may need repeated treatments. In expert hands, the treatment rate of resectoscopic surgery seems acceptable. However, some patients may require additional interventions, like repeated surgery, hysterectomy, or a drug therapy in the long run. Introduction of tranexamic acid as a potential adjunct to rollerball endometrial ablation may present an interesting option that requires additional well-designed studies before firm conclusions can be made.Key words: Abnormal uterine bleeding, Endometrial ablation, Resectoscopic surgeryAbnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. AUB accounts for up to 20% of visits to the gynecologist.¹Studies have shown that as many as 79% of such women will have no identifiable source of such bleeding, such as polyps, myomas, hyperplasia, or carcinomas, and subsequently leave the clinician with a “diagnosis of exclusion” of dysfunctional or anovulatory bleeding.² Reasons for such dysfunction and the actual mechanisms of bleeding are still unclear.Once a proper diagnosis is established, there is again no consensus on the best treatment, including surgical approaches versus nonsurgical approaches with hormonal and nonhormonal drug therapies.One common factor in patients is abnormal blood loss from the endometrial lining. Hence, if one could remove the entire endometrial lining by selective destruction of the endometrium, also known as endometrial ablation, in theory, bleeding should stop. Such a procedure can be performed without an incision and have little impact on ovarian hormone production or ovarian reserve. Therefore, it may be an attractive approach. Endometrial ablation may be indicated for the treatment of women who have either menorrhagia or menometrorrhagia due to a benign condition, have completed their childbearing, and have failed medical therapy or cannot receive medical therapy because of a health condition.There are a number of surgical approaches that attempt treatment of AUB by endometrial ablation. Currently, there are four main techniques: endometrial desiccation with an electrosurgical rollerball or vaporizing electrode, laser endometrial desiccation, and endomyometrial resection using a wire loop. Rollerball endometrial ablation (REA) is the most commonly used resectoscopic method and can be performed with either a monopolar or bipolar resectoscope.Tranexamic acid, a competitive inhibitor of plasminogen activation, has been used to treat AUB for decades. It is particularly useful in women who either desire immediate pregnancy or for whom hormonal treatment is inappropriate. Tranexamic acid is a well-tolerated treatment that reduces menstrual blood loss in the range of 34% to 59%.³In this study,4 our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB.     

Evaluation of novel nonlaser light source for endometrial ablation using 5-aminolevulinic acid.

BACKGROUND AND OBJECTIVE: This research evaluated the effectiveness of a new nonlaser prototype short-arc lamp to achieve photodynamic ablation of endometrium in a rat. STUDY DESIGN/MATERIALS AND METHODS: Thirty female Sprague-Dawley rats were divided into two groups. 5-Aminolevulinic acid (ALA), the precursor to the photosensitizer protoporphyrin IX, was injected into the left uterine horn and vehicle alone (Hyskon) was injected into the right horn of 23 rats (group 1). An additional seven rats received vehicle only into both uterine horns (group 2). Three hours later, a cylindrical diffusing optical fiber was inserted into the lumen of the uterine horns, and light treatment was delivered from either a laser or a nonlaser light source. Rats in group 1 received either 1 hour (n = 15) or 10 minutes (n = 8) of light treatment into both uterine horns. In rats in group 2, the left horn was exposed to 1 hour of light treatment. Uterine tissues were examined histologically 4 days after light treatment. RESULTS: One hour of light exposure to the uterine horns injected with ALA produced extensive necrosis of the rat uterine wall. No difference in the magnitude of destruction was seen between the groups treated with the laser and nonlaser light sources. Ten minutes of light exposure resulted in endometrial ablation that was comparable in both the laser- and the prototype-treated groups, but the destruction of the deepest layers of the uterine wall was more consistent in the group treated with the nonlaser prototype. One hour of light treatment from either light source did not result in any histological changes in the uterine horns not exposed to ALA. CONCLUSION: The extent of endometrial ablation in the rat uterine horn achieved with the nonlaser prototype was comparable to that achieved with the laser. Thus, the nonlaser prototype may provide a less expensive approach to photodynamic endometrial ablation.     

Novasure as a Mechanical Endometrial Preparation Agent in Large Uteri

Objective:

We evaluated Novasure ablation as a mechanical endometrial preparation agent before Roller Ball endometrial ablation in lieu of GnRH agonists in large uteri.

Methods:

A retrospective chart review of 20 consecutive patients undergoing Novasure ablation for mechanical endometrial preparation before Roller Ball ablation (RB-Novasure group) was conducted and the results compared to that of 23 consecutive patients who received GnRH agonist (Leuprolide acetate) as a medical endometrial preparation before Roller Ball ablation (RB-Lupron group). The postoperative follow-up time frame was divided into immediate (3 mo), intermediate (3 to 12 mo) and long-term (12 to 32 mo). Rates of amenorrhea, heavy bleeding, cramping, and failure (repeat ablation or hysterectomy for heavy bleeding or persistent pain) were compared between the 2 groups.

Results:

The mean rates of amenorrhea for the patients not lost to follow-up at 3 mo, 3 to 12 mo, and 12 to 32 mo visits were 45.5%, 58.8%, and 44.4% for the RB-Lupron group, and 80%, 86.7%, and 100% for the RB-Novasure group (P = .02, P = .08, and P = .02). Failure rates were 4.8%, 6.2%, and 55.6% for the RB-Lupron group; and 0 (0/20), 12.5% (2/16) and 0 (0/8) for the RB-Novasure group (P = .51, P = .50, and P = .02). The RB-Novasure group had a significantly lower rate of heavy bleeding and cramping. 86.4%, 58.8%, and 33.3% patients reported satisfaction with their treatment in the RB-Lupron group and 100%, 87.5%, and 75% in RB-Novasure group (P = .13, P = .07, and P = .11).

Conclusion:

Novasure ablation, for mechanical endometrial preparation before Roller Ball ablation, appears to be a superior alternative to medical preparation with GnRH agonists in patients with large uteri.     

Hydrothermal Endometrial Ablation Can Reduce the Need for Hysterectomy and Transfusion

Women seeking emergency care for severe uterine hemorrhage with profound anemia often undergo transfusion dilatation curettage and ultimately hysterectomy. The purpose of this article is to describe a modern conservative approach to treating persistent uterine hemorrhage unresponsive to medical therapy, avoiding transfusion and allowing for nonemergent future therapy without the potential complications of transfusion. Six patients with unremitting uterine bleeding were included in the study performed in the Department of Gynecology at an academically affiliated general hospital. Patients underwent successful hydrothermal endometrial ablation after failed medical therapy. This procedure is effective in controlling severe uterine bleeding in patients with large intrauterine fibroids; thus, the number of women being transfused can be significantly reduced.     

微泡造影剂用于高强度聚焦超声治疗子宫肌瘤研究进展

作为一种无创热消融技术,高强度聚焦超声(HIFU)越来越广泛地用于治疗子宫肌瘤,疗效肯定。微泡造影剂在病灶识别、HIFU消融后疗效评估及增效方面均具有重要临床价值。本文就微泡造影剂在HIFU治疗子宫肌瘤中的研究进展进行综述。