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。

Long-Term Efficacy and Safety of Thermal Balloon Endometrial Ablation for Patients with Menorrhagia

Objective To evaluate the long-term efficacy and safety of thermal balloon endometrial ablation （TBEA） for patients with menorrhagia. Methods From February 2004 to January 2008, 105 women with menorrhagia was admitted to our hospital and treated by TBEA. The clinical data, including menstrual cycle and blood volume, as well as TBEA complications such as abdominal pain, infection, bleeding and conglutination, were followed up for a long period in the patients. Results Among the 105 patients, two were lost for follow-up, and one died of malignant tumor of the urinary system in 56 days after the TBEA, the other 102 （97.1%） patients achieved an follow-up for 3 （102 patients）, 6 （101 patients）, 12 （99 patients）, 24 （66 patients）, or 36 months （51 patients） succesively. At each of the time point, the success/amenorrhea rates were 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）, and 92.2% （47/51）/31.4% （16/51） , respectively. No severe perioperative complications such as perforation of the uterus and adjacent organs, massive bleeding or infection due to mechanical or thermal injuries occurred. After the operation, 11 （ 10.5% ） patients had uterus contraction-like pain, which was relieved by analgesic drugs within 6 hours; 8 （7.9%） patients had adhesion of the tissues around the cervix uteri and/or uterine cavity, 4 of them were cured by dilation of the uterus, 3 received surgical separation, and 1 underwent resection of the uterus. No significant difference in the effective rate and rate of amenorrhea was found between the 36- and 12-month follow-up results （χ^2 = 0.000, P = 1. 000 and χ^2 = 0. 014, P = 0. 906, respectively） , or between 24- and 12-month follow-up results （χ^2 = 0. 034, P = 0. 854 ;χ^2 = 0. 114, P = 0. 736）. Conclusion TBEA shows good long-term efficacy and safety, as an applicable alternative in the treatment of menorrhagia.