第二代子宫内膜去除术诺舒临床应用70例分析

目的：评估第二代子宫内膜去除术诺舒（NovaSure）的安全性和有效性，对术后随访结果进行疗效分析。方法：对2011年1月—2013年12月，在首都医科大学附属复兴医院宫腔镜中心使用诺舒治疗的70例异常子宫出血（AUB）患者，记录病情、手术前后血红蛋白、子宫内膜厚度、手术情况和术后随访症状改善情况。结果：①患者年龄28～54岁，平均（43.5±5.5）岁，有严重内科合并症者占27.1%（19/70），子宫长度（9.17±1.12）cm，诺舒主机工作时间55～179 s，平均（122.00±19.73）s，术时出血均小于10 mL；所有患者均未发生并发症。②随访闭经率54.3%（38/70），有效率97.1%（68/70），再次手术率2.9%（2/70），宫腔积液率28.6%（20/70）。③术前与术后3个月血红蛋白（98.56 g/L vs. 115.27 g/L）及子宫内膜厚度（9.2 mm vs. 3.4 mm）差异有统计学意义（均P=0.000）。④子宫腺肌病与非子宫腺肌病患者诺舒治疗后闭经率差异有统计学意义（χ2=6.860，P=0.013）。结论：诺舒子宫内膜去除术治疗异常子宫出血安全、有效、疗效显著；子宫腺肌病可能是影响疗效的因素。

A Clinical Study of the Second-generation Endometrial Ablation Treatment NovaSure on 70 Cases

Objective：A 3-year follow-up evaluation of the safety, efficacy and outcome analysis of the second generation of endometrial ablation using the NovaSure system. Methods：A study of 70 women with menorrhagia secondary to abnormal uterine bleeding （AUB） who underwent endometrial ablation using the NovaSure system at hysteroscopic center, Fuxing Hospital, Capital Medical University, from January 2011 to December 2013. General condition of these patients, treatment time, complications, hemoglobin and endometrial thickness before and after the operation and rate of surgical re-interventions were recorded. Results：①Patient: The patient age in this cohort ranged from 28-54 years with a median age of （43.5±5.5） years. 27.1%（19/70） had serious medical complications. The mean sounding length was （9.17±1.12） cm. The time of energy delivery was （122.00±19.73） s, range from 55-179 s. All patients reported small amount of bleeding, less than 10 mL. No complications occurred. ②At 3-year follow-up, 97.1%（68/70） experienced a successful reduction in bleeding, 54.3%（38/70） of patients reported amenorrhea. Two of 70 had additional surgery during the follow-up period. 28.6%（20/70） of patients reported fluid accumulation in the uterine cavity. ③Hemoglobin and endometrial thickness before and after the operation has a very significant difference （P=0.000）, 98.56 g/L vs. 115.27 g/L, 9.2 mm vs. 3.4 mm, respectively. ④Menorrhagia with and without adenomyosis group, amenorhea rate has a very significant difference （χ2=6.860，P=0.013）. Conclusions：Clinical result indicate that the NovaSure system is safe and effective method for treatment of women with menorrhagia. Adenomyosis may be one of factors influencing curative effects.