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.     

宫腔镜子宫内膜电切术在治疗难治性功能失调性子宫出血中的应用

目的探讨宫腔镜子宫内膜电切术治疗难治性功能失调性子宫出血（功血）的效果。方法 2006年8月-2008年9月,采用宫腔镜子宫内膜电切术（transcervical resection of endometrium,TCRE）治疗反复药物治疗无效的功血36例,术前诊断性刮宫子宫内膜病理为单纯性增生23例,息肉样增生13例。术后第1、3、6、12个月随访。结果 36例TCRE手术均顺利完成。无子宫穿孔、过度水化综合征和盆腔脏器电损伤等并发症。均完成1年随访,闭经29例（80.6%）,点状出血5例（13.9%）,月经少2例（5.6%）。术后6个月FSH与术前差异无显著性（P〉0.05）。结论 TCRE是治疗难治性功血的微创技术,具有安全有效、不影响卵巢内分泌功能等优点。     

宫腔镜辅助射频消融术治疗功能失调性子宫出血患者的护理

对126例功能失调性子宫出血患者在宫腔镜辅助下行射频消融治疗,结果治疗后3个月后复查,治愈79例(62.7%),有效28例(22.2%),好转17例(13.5%),无效2例(1.6%).提出术前做好患者的心理护理及物品和阴道准备工作,术中、术后密切观察病情,保持会阴部清洁,注意阴道流血情况,认真讲解术后复查的时间及注意事项,有利于提高手术疗效,促进术后康复.     

微波子宫内膜消融术治疗功能失调性子宫出血的围术期护理

功能失调性子宫出血（dysfunctional uterinebleeding，DUB）可发生于月经初潮至绝经的任何年龄，多数发生在绝经前期^[1]，部分需手术治疗。微波子宫内膜消融术（microwave endometrial ablation，MEA）作为第3代热子宫内膜去除技术，通过微波热效应能快速、简单、安全地破坏子宫内膜全层，     

B超引导下射频介入治疗更年期功能失调性子宫出血

目的 探讨B超引导下射频治疗更年期功血的疗效。方法 B超引导下射频介入治疗121例术前已排除恶性病变的更年期功血。结果 手术时间6min-12min，平均8．5min，无副反应发生。术后3月治愈率88．4％(107／121)，明显有效率11．6％(14／121)；术后24月治愈率78．3％(36／46)，明显有效率19．6％(9／46)，有效率2．1％(1／46)。结论 B超引导下射频介入治疗更年期功血，操作简单，痛苦小，恢复快，不出血，值得应用推广。     

妈富隆治疗青春期功能失调性子宫出血效果观察

目的观察比较妈富隆和雌激素对青春期功能失调性子宫出血的效果。方法随机将68例青春期功能失调性子宫出血的患者分为2组,每组34例。观察组给予妈富隆治疗,对照组给予雌激素治疗。出血控制后,2组均逐渐减少药物剂量。疗程结束后,对2组的治疗效果进行分析、比较。结果观察组的总有效率优于对照组,差异具有统计学意义(P0.05)。结论妈富隆治疗青春期功能性子宫出血的临床疗效肯定,能够有效控制出血,改善月经状况。     

妈富隆治疗青春期功能失调性子宫出血的临床观察

目的探讨妈富隆治疗青春期功能失调性子宫出血(青春期功血)的临床疗效,总结临床经验以提高治疗水平。方法将2012-2—2015-2间收治的84例青春期功血患者随机分成2组,各42例。对照组给予雌激素治疗,观察组给予妈富隆治疗。比较2组治疗效果。结果观察组的控制出血时间、完全止血时间均小于对照组,差异具有统计学意义(P0.05)。观察组总有效率优于对照组,差异具有统计学意义(P0.05)。结论妈富隆治疗青春期功血的临床疗效肯定,能够有效控制出血,改善月经状况。     

第2代(温控)射频消融子宫内膜切除术

目的探讨第2代（温度控制）射频消融子宫内膜切除术的疗效、安全性和可行性。方法2004年9月-2006年2月由上海市4家医院联合开展一项多中心、前瞻性研究,完成功能性子宫出血温控射频消融子宫内膜切除术81例。在超声监护下,射频治疗以温度控制模式输出功率50 W、温度设定85℃,按照两侧宫角、宫底、宫体、下段部位顺序射频消融子宫内膜。每个治疗点治疗时间为4 min。结果81例术后随访4-17个月。术后6个月随访70例,其中闭经48.6%（34/70）,点滴状月经41.4%（29/70）,少量月经10%（7/70）,总有效率为100%（70/70）。术后12个月随访67例,其中闭经56.7%（38/67）,点滴状月经29.9%（20/67例）,少量月经9.0%（6/67）,正常月经量3.0%（2/67）,月经量过多1.5%（1/67）,总有效率98.5%（66/67）。结论温控射频消融子宫内膜切除术不仅使患者的异常子宫出血在保留子宫的情况下得到有效的治疗,同时具有操作方便、治疗时间短、并发症少、术后恢复快等特点。     

青春期功能失调性子宫出血患者的护理

目的进一步探讨青春期功能失调性子宫出血患者的护理方法及护理效果。方法以笔者所在医院2009年12月～2011年2月收治的32例青春期功血患者为研究对象，对其临床资料进行回顾性分析。结果所有患者经过周密的治疗和护理，均治愈并顺利出院。结论周密的临床治疗和护理可以有效改善青春期功血患者的症状，改善贫血。     

妈富隆片联合米非司酮口服治疗围绝经期功能失调性子宫出血效果观察

目的比较口服妈富隆片与妈富隆片联合米非司酮治疗围绝经期功能失调性子宫出血的效果。方法随机将68例围绝经期功能失调性子宫出血患者分为2组,每组34例。对照组口服妈富隆片,观察组使用妈富隆片联合米非司酮口服治疗。治疗结束后对全部患者随访6个月,对2组患者的治疗效果进行比较。结果 2组患者治疗期间不良反应比较,差异无统计学意义(P0.05);观察组的治疗总有效率高于对照组,2组差异有统计学意义(P0.05)。结论与单纯口服妈富隆片比较,妈富隆片联合米非司酮口服治疗围绝经期功能失调性子宫出血,有效率高,且未增加不良反应的发生率。     

Photodynamic endometrial ablation for the treatment of dysfunctional uterine bleeding: a preliminary report

BACKGROUND AND OBJECTIVES: To evaluate feasibility and functional effects of photodynamic endometrial ablation (PEA) in patients. STUDY DESIGN/PATIENTS AND METHODS: A total of 15 PEAs has been performed in 11 patients using topically applied 5-aminolevulinic acid (ALA) solutions and a balloon-light diffuser (160 J/cm(2), 635 nm). Uterine bleeding intensity has been determined on a daily basis 3 months prior to and up to 6 months after endometrial ablation using an analogous scale scoring from 1 (spotting) to 6 U (severe bleeding). Statistical analysis by unpaired Student's t-test. RESULTS: The mean number of bleeding units per cycle (n = 44) was 35.7 prior to PEA. The decrease in bleeding units was significant for the months 1-3 (24.4 U per cycle; P = 0.03), but not for the months 4-6 (25.9 U; P = 0.11) following PEA. CONCLUSIONS: PEA is feasible and provides a significant short-term reduction of uterine bleeding.     

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。     

A retrospective study on estrogen or contraceptives in the treatment of dysfunctional uterine bleeding in adolescent patients

Objective: To investigate the clinical efficacy of estrogen or contraceptives in the treatment of acute bleeding of dysfunctional uterine bleeding (DUB) in adolescent patients and the optimal starting dosage of drugs.Methods: The clinical records of 106 girls who with DUB and moderate or severe anemia from February 1990 to July 2005 were analyzed retrospectively.Results: All 106 patients received hormonal therapy. 56 patients were treated with estradiol benzoate(E2), 30 patients with conjugated equine estrogen(CEE) and 20 patients with combined oral contraceptives (COCs). The rates for rapidly controlling bleeding and for rapidly stopping bleeding in E2 group were higher than those in CEE group ,but similar to those in COCs group. The days for controlling and completely stopping bleeding were not significantly different between the starting dosages (≤8 mg/d and >8 mg/d) of E2 groups, and also there were no statistical difference between the starting dosages (<7.5 mg/d and ≥7.5 mg/d) of CEE groups, but during the treatment the rate of increasing the dosage in <7.5 mg/d group was higher than that of ≥7.5 mg/d group(40% vs. 5%),while there were no statistical difference between the starting dosages (≤3 pills/d and >3 pills/d) of COCs groups. Conclusions: The clinical efficiency of E2 treatment on DUB in adolescent patients is similar to that of COCs. And the efficacies of treatment of DUB with E2, CEE and COCs in the different dosages are similar.     

雌激素或避孕药治疗青春期功能性子宫出血的效果分析

目的探讨雌激素及避孕药治疗青春期功能性子宫出血(功血)的止血效果和适宜的起始剂量。方法对我院1990年2月至2005年7月治疗的106例的临床资料进行回顾性分析。结果本组106例中采用苯甲酸雌二醇(E2)组56例,口服结合雌激素(CEE)组30例,口服避孕药(COCs)组20例。快速控制出血率和快速止血率CEE组与E2组相比有显著延长,COCs与E2组效果相似。控制出血时间和完全止血时间E2起始剂量≤8 mg/d组和>8 mg/d组相比无显著差异;CEE起始剂量<7.5 mg/d与≥7.5 mg/d组相比也无显著差异,但需加量治疗率明显增加;COCs(妈富隆)≤3片/d与>3片/d组相比也无显著差异。结论用COCs治疗青春期功血在控制出血方面效果与E2的效果类似。增加上述各药的剂量,并不增强其止血效果。     

超声、宫腔镜与病理学联合诊断异常子宫出血的价值

目的探讨阴道超声(transvaginal sonography,TVS)、宫腔镜及子宫内膜病理检查在异常子宫出血中的诊断价值. 方法 181例异常子宫出血患者,经腹部超声及盆腔检查除外卵巢囊肿、子宫肌瘤及与妊娠有关疾病后,依次行TVS、宫腔镜和子宫内膜病理检查,比较其诊断的敏感性、特异性和准确率. 结果 TVS、宫腔镜和病理学检查对诊断上述异常子宫出血的敏感性、特异性和准确率分别为52.3%、46.7%、51.4%,70.9%、70.0%、70.7%,59.5%、100%、64.7%.宫腔镜诊断的敏感性和准确率高于TVS(z=3.205,3.657;P＜0.05);而病理学诊断特异性高于宫腔镜(z=2.454,P=0.014). 结论宫腔镜对鉴别子宫异常出血宫腔内因素的敏感性和准确性均优于TVS,而对于子宫内膜的病变,病理学检查具有确诊作用.     

Minimally-invasive treatment of early stage breast cancer: A feasibility study using radiofrequency ablation under local anesthesia

The objective of this study was to assess efficacy and safety of percutaneous ultrasound (US) guided preferential radiofrequency ablation (PRFA) in early breast carcinoma under local anesthesia and to evaluate a new assessment protocol. Eighteen breast cancer patients were enrolled in order to receive PRFA treatment three weeks prior to resection. Pain assessment was performed using the visual analoge scale. Analysis of treatment success was performed using magnetic resonance imaging (MRI) as well as histological assays for hematoxylin & eosin (H&E) and cytokeratine 8 (CK8). In a subset of patients contrast enhanced ultrasound (CEUS) was performed before and after treatment. MRI showed no residual tumor growth in 100% (18/18) of cases. Complete tumor devitalization was indicated in 83% (15/18) of patients as judged by H&E staining and in 89% (16/18) as judged by immunostaining for CK8. In 100% (18/18) at least one histologic method showed devitalization in the entire tumor. Treatment was well tolerated. Pain experienced during the procedure was mild. US-guided PRFA of small breast carcinoma is feasible under local anesthesia. MRI and CK8 have proven valuable additions to the RF breast tumor ablation protocol. CEUS shows potential as a modality for radiological follow-up.     

宫腔镜对异常子宫出血的诊断与治疗

目的 探讨宫腔镜在诊断及治疗异常子宫出血中的作用.方法 对120例异常子宫出血患者行官腔镜检查,发现98例宫腔异常病变,根据病变的不同,采取不同的治疗措施.结果 应用宫腔镜能够对各种宫腔异常情况做出明确诊断,同时亦可对多种疾病进行直接治疗.结论 宫腔镜诊断异常子宫出血是一种可靠的方法.     

Percutaneous core excision and radiofrequency thermo-coagulation for the ablation of osteoid osteoma of the spine

Percutaneous radiofrequency ablation is the treatment of choice for osteoid osteoma of the appendicular skeleton. However, difficulties in localizing the lesion in the spine and its proximity to neural elements have yet to make it the prevalent treatment for spine. This study assesses the safety and effectiveness of two percutaneous techniques for ablating osteoid osteoma of the spine. Seven patients were treated between 1998 and 2005. Four patients underwent percutaneous radiofrequency coagulation. The lesions were located at the articular processes of L3 and L4, the lamina of L3 and in the head of the 11th rib. Three patients with lesions in close proximity to neural structures (pedicle of T9, the posterolateral inferior aspect of L3 vertebral body and the inferior articular process of C5) were subjected to percutaneous core excision. Mean follow-up was 4.2 ± 1.6 years. Three out of four patients who underwent radiofrequency ablation had an immediate and sustained response. One patient with a lesion in the head of the rib failed to respond. The three patients in the group of pecutaneous core excisional biopsy demonstrated immediate relief of pain. However, one patient experienced relapse of symptoms 6 months after transpedicular core excision. CT scan suggested partial targeting of the lesion that corroborated with histologic examination revealing only reactive tissue. Subsequent percutaneous core excision was successful. Therefore, the overall success rate was 85.7%. Mean VAS improved dramatically from 9 ± 1 to 2 ± 1 after surgery (P < 0.05). No neurological or other complications were encountered. This study indicates that radiofrequency ablation of spinal osteoid osteomas is safe and reasonably effective when an intact cortical shell separates the nidus from the neural elements. Percutaneous core excision can obviate the risk of thermal damage for lesions located in close proximity to the neural elements. Effectiveness of treatment can also be evaluated by CT scan and histological examination. Difficulties in targeting the nidus can lead to treatment failure. The minimal morbidity and the effectiveness of these minimally invasive procedures make them a valid alternative in the treatment of spinal osteoid osteoma.     

New endometrial ablation techniques in the treatment of dysfunctional uterine bleeding

Endometrial resection is a well-examined alternative therapy to hysterectomy in the treatment of abnormal uterine bleeding not associated with malignancy, that preserves the uterus at long term in at least 70% of patients. The new devices have been designed over the last decade, in response to demands from patients and practitioners. This review demonstrated that the second generation endometrial ablation techniques provide efficient and apparently safe endometrial ablation, are quicker to perform, and some may be more suitable for office treatment without the need for anesthesia, are simple to use and less skill dependent, and can, in properly selected cases, provide good results. Preprocedure counseling of patients, including the expected postoperative course and the known procedural risks, is important for adequate informed consent.