内分泌和月经异常

060436子宫异常出血合并血液系统出血性疾病的临床处理/孙爱军…∥中国医刊.—2004,39(12).—25～27了解血液系统出血性疾病导致的子宫异常出血的情况,探讨妇科干预和治疗的方法及效果。回顾性分析北京协和医院17年间合并血液系统出血性疾病的有月经的妇女,了解子宫出血异常出血的比例,并进一步对子宫异常出血的患者进行分析,了解妇科治疗的情况,包括药物和手术治疗。结果:合并血液系统出血性疾病有月经的妇女,发生子宫异常出血的比例高达63%,其中以血小板减少性紫瘢(48%)、再生障碍性贫血(27%)、骨髓异常增生综合征(15%)为多见。48例药保守…     

妇科：内分泌和月经异常

060436子宫异常出血合并血液系统出血性疾病的临床处理，060437人子宫内膜腺上皮细胞原代培养方法的改进，060438应用子宫内膜切除术治疗月经过多50例临床体会。[编者按]     

子宫内膜切除术治疗功能失调性子宫出血

目的：探讨子宫膜切除术治疗功能失调性子宫出血的疗效，预后及影响因素，方法：选择有手术指征的功能失调性子宫出血患者38例，使用被动式连续灌流电切镜行子宫内膜切除术，术前均子宫颈准备和机械性子宫内膜预处理。结果：手术均顺利完成，术后随访3－20个月，月经改善总有效率为92．1％，结论：子宫内膜切除术可以有效改善月经情况，术前机械性子宫内膜预处理可薄化子宫内膜，保证子宫内膜切除的手术效果。     

宫腔镜电切治疗子宫异常出血42例分析

目的探讨子宫异常出血行宫腔镜电切手术的安全和疗效。方法术前宫腔镜诊断为功血18例,肌瘤15例,内膜息肉6例,胎盘部分粘连机化2例,子宫腺肌症1例,应用连续灌流式宫腔镜下电切手术。结果手术成功率达100%,子宫内膜切除26例(11例同时行单纯粘膜下肌瘤切除术),2例月经恢复正常,11例月经明显减少,7例月经稀发,6例闭经;单纯粘膜下肌瘤及内膜息肉切除者月经恢复正常。结论子宫异常出血者行宫腔镜电切治疗具有创伤小、恢复快,无并发症等优点。     

微波子宫内膜去除术治疗异常子宫出血的临床观察

目的:探讨微波子宫内膜去除术(MEA)治疗异常子宫出血的疗效.适应证和并发症.方法:应用MEA治疗良性病变所致异常子宫出血患者168例,术前行刮宫术薄化子宫内膜,然后"Z"字形烧灼宫腔后再以"W"形烧灼官腔,术后1.3.6.12.24.个月随访患者的月经.贫血症状改善及并发症发生情况.结果:平均手术时间为286S±7S;平均随访时间22个月±6个月.绝经前患者156例中,术后闭经97例(62.2%),月经正常56例(35.9%),少量不规则阴道出血3例(1.9%);治疗满意率为98.1%(153/156).119例随访到术后2年以上,疗效稳定.107例合并贫血,术前血红蛋白为(83±24)g/l,术后3个月升至(117±18)g/l,手术前后比较,差异有统计学意义(P<0.01>.痛经改善率为74.5%(34/47).绝经后患者12例,术后均无出血.168例中47例合并严重内科疾病,全部手术成功,术中无并发症发生.术后发生子宫内膜炎12例,2例宫腔积血,1例因输卵管绝育一子宫内膜去除术综合征行子宫切除术.结论:MEA操作简单.安全.疗效好,适用于多种良性疾病所致的异常子宫出血.尤其适用于有严重内科合并症的患者.充分且完整地破坏子宫内膜全层,是治疗成功的关键.严格掌握适应证可减低并发症的发生.     

微波子宫内膜消除术治疗血液病引起的子宫异常出血的价值

目的探讨微波子宫内膜消除术(MEA)治疗血液病引起的子宫异常出血的疗效及影响因素。方法应用微波子宫内膜消除术治疗经药物治疗失败的23例血液病子宫异常出血患者,其中血小板减少性紫癜12例、再生障碍性贫血11例。结果手术时间180~410s,平均(284±70)s,术后第1、3、6、12、24个月进行随访,闭经率60.8%(14/23),满意率95.6%(22/23)。术中无并发症发生,无子宫切除患者。结论MEA治疗血液病患者的子宫异常出血效果可靠。     

宫腔镜诊断治疗子宫异常出血120例

目的：探讨宫腔镜对子宫异常出血的诊断价值和治疗效果。方法：对120例异常子宫出血患者行宫腔镜检查和治疗。结果：120例子宫异常出血患者中;宫腔内有异常病变者102例,占85.0%,其中子宫内膜息肉17例,子宫内膜增生58例,子宫黏膜下肌瘤14例,慢性子宫内膜炎8例,子宫内膜癌5例。镜下诊断与病理活检的符合率为95.10%（97/102）,经宫腔镜治疗病例治愈率为96.74%（89/92）。结论：宫腔镜对子宫异常出血诊断的正确率和治疗有效率高。     

宫腔镜电切术治疗子宫异常出血43例临床观察

目的：探讨宫腔镜电切术治疗子宫异常出血的疗效。方法：应用OES4000宫腔镜，对43例子宫异常出血患者进行宫腔镜电切手术治疗，其中功能性子宫出血9例，子宫肌瘤18例，子宫内膜息肉16例。结果：术后随访5～18个月月经改善率97．2％，其中无月经28．5％，月经减少47．4％，月经正常21．3％。结论：宫腔镜电切术治疗子宫异常出血疗效高，并发症少，住院时间短，术后恢复快。     

产后出血223例临床分析

目的:探讨产后出血的原因及有效治疗措施。方法:对本院1997年1月至2003年12月住院分娩的 223例产后出血患者的临床资料进行回顾性分析,探讨其病因及防治措施。结果:223例产后出血原因:宫缩乏 力137例(61.43%),胎盘因素63例(28.25%),软产道损伤因素11例(4.93%),凝血功能障碍12例 (5.38%)。223例中159例经保守治疗后(未行宫腔填塞纱条),138例效果满意;21例效果不佳(包括3例DIC, 4例失血性休克,1例胎盘早剥合并死胎,4例胎盘卒中,3例胎盘植入,1例双胎合并先兆子痫,1例子宫破裂,4 例子宫收缩乏力),行子宫次全切除术。64例常规保守治疗无效后,及时行宫腔填塞纱条治疗,61例效果满意;3 例(1例妊娠合并黏膜下肌瘤,1例妊娠合并乙肝,1例多胎妊娠合并先兆子痫)效果不满意,急行子宫次全切除 术。与产后出血未采用宫腔填塞纱条组相比,采用宫腔填塞纱条组子宫切除率显著下降(4.69%vs11.32%, P<0.05)。223例产后出血中剖宫产子宫切除率明显高于阴道分娩组(P<0.05)。结论:宫缩乏力、胎盘因素是 产后出血的主要原因,宫腔填塞纱条是治疗产后出血、保留子宫的有效措施,对经保守治疗措施(尤其宫腔填塞 纱条)无效者,应果断及时采取子宫切除术。     

子宫内膜气化电切术治疗子宫异常出血22例

子宫异常出血经保守治疗无效时,传统的治疗方法是子宫切除术。近年来,利用宫腔镜施行子宫内膜电切术（ＴＣＲＥ）,治疗子宫异常出血已成为妇科常用技术,但常有子宫穿孔、灌流综合症、大出血等并发症。我科自１９９７年１０月以来应用子宫内膜气化电切术治疗子宫异常出...     

Update on treatment of menstrual disorders

There is evidence from well designed randomised controlled trials that modern medical and conservative surgical therapies (including endometrial ablation) are effective treatments for heavy menstrual bleeding for many women. Submucous fibroids may be resected directly via the hysteroscope, reducing menstrual bleeding, although data are available only from case series. Endometriosis is common, may also occur in young women and may present with atypical or non-cyclical symptoms; conservative laparoscopic surgery increases fecundity and reduces dysmenorrhoea and dyspareunia. Randomised trials of the levonorgestrel intrauterine system in women with menorrhagia have shown that hysterectomy can be avoided in 80% of cases, and that this system is an effective therapy for menorrhagia. The levonorgestrel intrauterine system may also be useful for managing symptoms of endometriosis, adenomyosis and endometrial hyperplasia, based on observational data.     

Transcervical Resection of Endometrium — Will it edge out Hysterectomy

The most frequent indication for hysterectomy is menorrhagia, even though the uterus is normal in a large number of patients. Transcervical resection of the endometrium (TCRE) is a less drastic alternative, but success rates have varied and menorrhagia can recur. 60 patients with menorrhagia due to various causes who failed to respond to medical therapy and did not desire pregnancy and hysterectomy underwent TCRE with hysteroscope. 56 cases have been followed up postoperatively for 3 years. The primary endpoints were women''s satisfaction and need for further surgery. The proportion of patients who attained amennorhea 24 months after the procedure was 44.4% and the percentage of patients who attained hypomennorhea was 44.4%. The patients satisfaction rate after 24 months of follow up was 88.8%. Failure of TCRE procedure was encountered in 6.6% of patients. Randomized comparison with hysterectomy has shown short-term benefits in the form of shorter operating time, fewer complications and faster rates of recovery and almost as high satisfaction levels. TCRE is an effective procedure in treating menorrhagia and is an acceptable alternative to medical management and hysterectomy in the treatment of menorrhagia for many women with no other serious disorders.Key Words: Hysterectomy, Menorrhagia, Transcervical resection of endometrium     

子宫腺肌病的手术治疗策略

子宫腺肌病是育龄期女性常见激素依赖性炎症性疾病,以进行性加重的痛经、月经过多、不孕和子宫增大为主要临床表现,发病率逐年增加并呈年轻化趋势。子宫腺肌病的手术治疗往往是在药物治疗、非手术技术(包括子宫动脉栓塞术、高强度聚焦超声和射频消融等)无效或不愿意的基础上而执行的,具体术式需根据患者的年龄、临床症状、生育要求以及病灶的类型与范围等分层制定个体化手术策略。目前手术治疗主要包括子宫切除术、保守性病灶切除术、宫腔镜下囊性腺肌病灶切除术、宫腔镜下子宫内膜去除/射频消融术等术式。通过着重探讨各类术式的适用人群、手术操作要点及后续维持治疗方案等,以期个体化治疗并全程立体化管理,最大化优化疗效和提高生育力。     

应用前列腺等离子汽化电切镜切除子宫内膜治疗月经过多

目的：探讨应用前列腺等离子汽化电切镜（PKVP）电切子宫内膜治疗月经过多的安全性和有效性。方法：72例因功能性子宫出血、子宫内膜息肉、子宫腺肌症等引起月经过多，经药物治疗无效且无生育要求的患者随机分为两组。观察组（42例）应用前列腺等离子汽化电切镜施行子宫内膜电切术治疗；对照组（30例）在官腔镜下行子宫内膜单极电切术治疗。结果：观察组在手术时间、术中出血量等方面均低于对照组（P〈0．05），术后病率、总有效率两组无差别（P〉0．05）。结论：应用前列腺等离子汽化电切镜施行子宫内膜电切术治疗月经过多是快速、安全、有效的方法。     

腹腔镜淋巴结切除治疗妇科恶性肿瘤的价值

目的：探讨腹腔镜下广泛子宫切除和盆腹腔淋巴结切除用于妇科恶性肿瘤的效果及价值。方法：于2000年7月至2001年5月期间,采用腹腔镜下广泛子宫切除和盆腔及腹主动脉周围淋巴结切除治疗了21例经活检证实的早期妇科恶性肿瘤患者,其中子宫内膜癌12例,子宫颈癌9例,所有腹腔镜手术均根据病变部位和淋巴结切除术适应症,行盆腔淋巴结切除术,部分病例行选择性腹主动脉周围内淋巴结切除,再行腹腔镜辅助阴式广泛子宫切除术。结果：腹腔镜下平均手术时间为3．7h。术中出血平均216ml。／切除的淋巴结数平均19个,术后 住院5．6d,所有病例术中未发生肠道,膀胱和输尿管损伤,1例于术后1月出现双侧输尿管轻度狭窄外,其余病例无明显并发症发生。结论：腹腔镜下施行恶性肿瘤广泛子宫切除和盆腹腔淋巴结切除术是安全可行的,其分期可靠,准确,且手术创伤小,术后恢复快。     

热球子宫内膜去除术治疗严重内科疾病所致月经过多12例临床观察

目的探讨热球子宫内膜去除术在严重内科疾病导致月经过多中的应用价值。方法对2010年4月。2011年10月因严重内科疾病致月经过多的12例患者在我院施行异丙酚静脉麻醉下的热球内膜去除术。结果手术时间10～40min,平均（19．5±4．5）min;术中出血5～10mL。术后7例患者有轻度腹痛,4例患者有少量的阴道流血,1例患者阴道流血与月经量相当。在患者原有内科疾病没有加重的情况下,无术后并发症现象发生。术后随访3～20个月,4例患者恢复月经,其余患者闭经。结论热球子宫内膜去除术是治疗严重内科疾病所致月经过多病症的安伞有效方法．     

妇科微创手术理念及经阴道手术未来

微创外科的发展经历了近百年的历史，涉及临床所有专业，在手术治疗中尤为突出。妇科微创技术主要通过经阴道手术、内镜技术及介入治疗实现。内镜技术从最初的宫腔镜、腹腔镜检查，发展到如今在宫腔镜、腹腔镜下几乎可以完成各种妇科疾病的治疗。放射及超声等介入治疗也是微创手术不可或缺的措施。然而各种术式均有其利弊，随着微创理念的深入，经阴道手术的价值越来越被临床医师及患者肯定。经阴道手术在全子宫切除术、子宫肌瘤剔除、盆底重建方面优势明显。经阴道手术的适应证也随着手术技能的提高而不断扩展，势必会在未来手术中得到更广泛的应用。临床医师应该掌握各种手术方式，又要彰显自己的特长，针对具体疾病选择最适宜的手术方案，在保证手术效果及安全性的前提下，尽量选择微创手术，使患者受益。     

Uterine Balloon Therapy : An Alternative Therapy for Menorrhagia

Background

Menorrhagia is a common problem in women of reproductive age. Its aetiology in the absence of organic pathology, hormonal or haematological disorders remains largely unknown. Traditional medical therapy may not be beneficial in the long run. Hysterectomy for this condition is an invasive over treatment. First generation endometrium ablation techniques aimed at destroying the endometrium, were associated with life threatening complications. The second generation endometrial ablation techniques like uterine thermal balloon therapy have reduced these problems.

Methods

Fifty patients were selected for the procedure between 2002 and 2005. The patients qualified for the procedure if they had completed their family, had normal pelvic ultrasound findings, benign endometrial histology, normal PAP smear and clinically a normal size or bulky uterus.

Results

50% patients were in the age group of 35-45 years. 28(56%) procedures were done under local anaesthesia and 22(44%) under general anaesthesia. The patients were followed up for a period of 3 to 29 months (median 16 months). Seven(14%) had amenorrhoea and 40(80%) had normal periods or hypomenorrhoea. Three(6%) patients continued to have menorrhagia and were considered failures. 94% patients were satisfied with the procedure and there were no complications in this series. Conclusions : Uterine balloon therapy is a simple, safe and effective method for the treatment of menorrhagia in selected patients.Key Words: Uterine balloon therapy, Menorrhagia     

The neodymium:YAG laser and the resectoscope for the treatment of menorrhagia

OBJECTIVE: To assess the efficacy of destruction of the endometrium by ablation with a neodymium:YAG laser or resection with electrocautery in the management of menorrhagia. DESIGN: The efficacy of the treatment was assessed subjectively by each patient comparing the duration and amount of her menstrual bleeding before and after the operative procedure. Randomisation of treatments or patients was not undertaken. SETTING: The study was carried out in tertiary centres. Most of the procedures were undertaken in the Day Surgery Units of those centres. PATIENTS: A total of 64 patients underwent one or more procedures. One had continuous bleeding per vagina on hormone replacement therapy, all others had menorrhagia which they considered incapacitating. INTERVENTIONS: Of the patients 40 had removal of endometrium via a resectoscope and 24 had endometrial vaporisation with the neodymium:YAG laser. MAIN OUTCOME MEASURE: The outcome was assessed by each patient as amenorrhoea, hypomenorrhoea, attainment of normal menstrual amount or no change in menstrual loss. RESULTS: Both operative procedures were satisfactory in that amenorrhoea, hypomenorrhoea or normal menstruation was achieved in 87% of cases. Uterine perforation occurred on two occasions with thermal bowel injury in one patient. CONCLUSION: Destruction of the endometrium by the neodymium:YAG laser or the resectoscope is a successful way of managing menorrhagia in the absence of demonstrable pathological cause in nearly 90% of cases. The performance of the procedures as day cases with minimal discomfort makes them attractive alternatives to hysterectomy in the management of menorrhagia.     

Increased incidence of menstrual abnormalities and hysterectomy preceding primary biliary cirrhosis

A study was performed to assess the incidence of previous hysterectomy and dilatation and curettage among women with primary biliary cirrhosis. In 87 patients with primary biliary cirrhosis hysterectomy or dilatation and curettage had been performed significantly more often than among 100 age matched normal controls and 80 age matched patients with chronic active hepatitis or alcoholic liver disease. Among the 47 patients with primary biliary cirrhosis who had undergone hysterectomy or dilatation and curettage operations had been performed at a mean of 10.7 years and 13.2 years, respectively, before the onset of disease. The main indication for hysterectomy among patients with primary biliary cirrhosis and controls was menorrhagia. These menstrual disorders may be a consequence of high concentrations of oestrogens in patients with primary biliary cirrhosis.