宫腔镜辅助下射频消融术治疗月经过多的研究

目的　观察在宫腔镜辅助下子宫内膜射频消融术治疗月经过多的效果。方法　 2 0 0 1年 8月至 2 0 0 3年 7月河南省焦作市人民医院选择由子宫良性病变引起的月经过多并自愿接受子宫内膜射频消融术治疗的 5 8例患者作为观察组 ;宫腔镜下子宫内膜电切术治疗 5 8例同类患者作为对照组。结果　观察组在手术时间、术中出血量、术后病率、术后并发症等方面均低于对照组 (P <0 0 5 ) ,总有效率两组相似 (P >0 0 5 )。结论　宫腔镜辅助下子宫内膜射频消融术是治疗月经过多简单、快速、安全、经济、有效的微创手术方法     

宫腔镜下不同方式治疗子宫内膜息肉不孕症患者的临床观察

目的 探讨宫腔镜下不同方式治疗子宫内膜息肉不孕症患者的临床疗效。方法 选取36例子宫内膜息肉不孕症患者,根据随机数字表法将患者分为对照组与试验组,每组18例。对照组行宫腔镜下刮宫术治疗,试验组行宫腔镜下电切术治疗。对比两组患者的手术时间、术中出血量、住院时间、复发率、妊娠率及月经量。结果 试验组手术时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义（P<0.05）。试验组复发率5.56%低于对照组的33.33%,妊娠率83.33%高于对照组的38.89%,差异有统计学意义（P<0.05）。治疗前,两组月经量比较,差异无统计学意义（P>0.05）,试验组治疗后3个月、6个月的月经量均少于对照组,差异有统计学意义（P<0.05）。结论 对子宫内膜息肉不孕症患者行宫腔镜下电切术治疗,效果确切,能够降低复发率,提高妊娠率。     

宫腔镜下冷刀切除术与电切术在子宫内膜息肉中的治疗效果对比

目的 探讨子宫内膜息肉（EP）应用宫腔镜下冷刀切除术与电切术的治疗效果。方法 选取150例子宫内膜息肉患者,根据随机数字表法分为对照组与研究组,每组75例。对照组行宫腔镜下电切术治疗,研究组行宫腔镜下冷刀切除术治疗,对比两组治疗效果。结果 研究组手术时间及住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义（P<0.05）。术前,两组患者月经失血图（RBAC）评分与排卵期子宫内膜厚度比较,差异无统计学意义（P>0.05）;术后3个月,研究组患者PBAC评分低于对照组,排卵期子宫内膜厚度厚于对照组,差异有统计学意义（P<0.05）。术前,两组患者搏动指数（PI）与阻力指数（RI）指标比较,差异无统计学意义（P>0.05）;术后3个月,研究组患者RI、PI指标均显著低于对照组,差异有统计学意义（P<0.05）。随访1年后,研究组复发率6.67%低于对照组的17.33%,差异有统计学意义（P<0.05）。研究组宫内妊娠率高于对照组,异位妊娠率及流产率均低于对照组,差异有统计学意义（P<0.05）。结论 宫腔镜下冷刀切除术手术操作时间短,出血量...     

敬告读者

目的 探讨射频治疗围绝经期功能失调性子宫出血（功血）的临床疗效。方法 对我院2000～2002年40例围绝经期功血患者采用射频治疗仪自凝刀经阴道介入子宫腔行子宫内膜消融术。治疗后随访观察6个月～2年。结果 40例患者中，36例治愈，4例好转，治愈好转率100％。结论 射频治疗围绝经期功血，疗效好，手术操作简单、安全，无明显并发症，治疗费用低，值得临床推广使用。     

宫腔镜手术治疗子宫内膜息肉的临床疗效及安全性分析

目的 探讨三种不同宫腔镜手术治疗子宫内膜息肉（EPs）的临床疗效及安全性。方法 回顾性分析138例行宫腔镜手术且病理为EPs患者为研究对象,根据息肉个数,最大直径选取息肉个数≤3个且最大直径≤1.5 cm的107例患者进行研究,按手术方式将患者分为宫腔镜息肉单纯刮宫组（A组,28例）、宫腔镜息肉机械性切除联合刮宫组（B组,47例）、宫腔镜息肉电切联合刮宫组（C组,32例）。比较三组手术时间、术中出血量、术中术后并发症情况、术后1年治疗效果（异常子宫出血改善率）,以及三组术后3个月、6个月、1年的复发情况。结果 三组手术时间比较差异有统计学意义（P<0.05）,其中A组手术时间最长,B组和C组手术时间接近。三组术中出血量比较差异无统计学意义（P>0.05）。三组手术均无并发症,差异无统计学意义（P>0.05）。三组异常子宫出血（AUB）率比较差异无统计学意义（P>0.05）。三组术后1年AUB改善率比较差异有统计学意义（P<0.05）。术后3、6个月,三组复发率比较差异无统计学意义（P>0.05）。术后1年,A组复发率25.0%高于B组、C组（10.6...     

育龄期妇女宫腔镜下子宫内膜息肉切除方式探讨

目的 探讨育龄期妇女子宫内膜息肉在宫腔镜下最佳的切除方式。方法 选取62例子宫内膜息肉患者,按照随机数字表法分为研究组与对照组,每组31例。对照组行宫腔镜下电切术治疗,研究组行宫腔镜下冷刀切除术治疗。比较两组手术相关指标、阴道出血时间、阴道总出血量、月经恢复正常情况、术后子宫内膜情况、妊娠率及复发率。结果 研究组手术时间长于对照组,术中出血量多于对照组,差异有统计学意义（P<0.05）。两组术中均无并发症发生。两组术后体温、住院时间比较,差异无统计学意义（P>0.05）。两组患者术后阴道出血时间比较,差异无统计学意义（P>0.05）,研究组患者阴道总出血量、月经恢复正常率分别为19.4%、96.8%,均高于对照组的3.2%、80.6%,差异有统计学意义（P<0.05）。两组患者术后子宫内膜厚度、复发率比较,差异无统计学意义（P>0.05）,但子宫内膜分型中研究组A型内膜高于对照组,差异具有统计学意义（P<0.05）。研究组术后1年内妊娠率51.6%明显高于对照组的25.8%,差异具有统计学意义（P<0.05）。结论 对于有生育要求的育龄期妇女,...     

宫腔镜下手术联合曼月乐治疗多发性子宫内膜息肉的临床体会

目的 分析多发性子宫内膜息肉采用宫腔镜下手术联合曼月乐治疗的临床效果。方法 选取100例子宫内膜息肉患者,根据随机数字表法将其分为对照组与研究组,每组50例。对照组患者采用宫腔镜下子宫内膜息肉电切术治疗,研究组患者采用宫腔镜下子宫内膜息肉电切术联合曼月乐辅助治疗。比较两组术后复发率、子宫内膜厚度及血红蛋白水平。结果 两组患者术后3个月复发率比较,差异无统计学意义（P>0.05）,研究组术后6、12个月复发率分别为4.0%、12.0%,均低于对照组的20.0%、44.0%,差异有统计学意义（P<0.05）。术前,两组子宫内膜厚度比较,差异无统计学意义（P>0.05）;术后第3、6、12个月,两组子宫内膜厚底均薄于术前,且研究组薄于对照组,差异均有统计学意义（P<0.05）。两组术前血红蛋白水平比较,差异无统计学意义（P>0.05）,术后第3、6、12个月血红蛋白水平均高于术前,且研究组高于对照组,差异有统计学意义（P<0.05）。结论 子宫内膜息肉患者行宫腔镜下电切术后放置曼月乐,可有效地降低术后复发率,改善患者临床症状,提高血红蛋白水平,值得临床推广...     

宫腔镜下子宫内膜电切术治疗功血68例临床分析

目的:探讨宫腔镜下子宫内膜电切术治疗功血的疗效。方法:选择2007年3月至2009年3月本院经保守治疗无效的顽固性功血患者,排除妇科恶性疾病,已无生育要求,不愿切除子宫或有内科疾病不能耐受手术者进行宫腔镜下子宫内膜电切术,分析其月经改善情况、并发症发生及手术操作情况。结果:所有手术均顺利完成,无并发症发生,平均手术时间15～20分钟,平均出血约10～15ml,术后随访3～24月,闭经28例,占41.18%,经量正常36例,占52.94%,经量减少4例,占5.88%,满意率达100%。结论:宫腔镜下子宫内膜电切术治疗顽固性功血安全、有效、创伤小、恢复快,能保留子宫,且不影响卵巢功能,提高妇女生活质量,值得临床推广。     

临床护理路径对子宫内膜息肉宫腔镜手术患者护理满意度及并发症的影响

目的 研究临床护理路径对子宫内膜息肉宫腔镜手术患者护理满意度及并发症的影响。方法 选取726例行宫腔镜手术治疗的子宫内膜息肉患者,依据入院顺序分为对照组与观察组,每组363例。对照组手术期间配合常规护理,观察组手术期间配合临床护理路径护理。比较两组护理效果。结果 观察组术中出血量少于对照组,术后住院时间短于对照组,差异有统计学意义（P<0.05）。观察组术后并发症发生率低于对照组,差异有统计学意义（P<0.05）。观察组护理满意度99.17%高于对照组的95.04%,差异有统计学意义（P<0.05）。结论 子宫内膜息肉患者宫腔镜手术期间配合临床护理路径可缩短术后住院时间,减少并发症发生,提高护理满意度,值得临床推广与应用。     

宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效观察

目的探讨宫腔镜下不同手术方式治疗子宫内膜息肉的疗效。方法对不同年龄和不同生育要求的子宫内膜息肉患者327例,分别行子宫内膜息肉切除+子宫内膜汽化电切术(A组,53例);子宫内膜息肉切除+子宫内膜电切术(B组,175例);子宫内膜息肉切除+息肉旁浅层内膜切除术(C组,54例,要求保留生育功能者);子宫内膜息肉切除+子宫内膜电凝术(D组,45例,绝经后患者)。结果手术时间:A组(15·1±0·8)s,B组(19·7±0·7)s,C组(20·9±0·7)s,D组(22·1±0·8)s,A组平均手术时间与其他3组比较,差异有统计学意义(P<0·01);术后子宫内膜息肉复发率:A、D组为0,B组为1·7%(3/175),C组为7·4%(4/54),C组术后复发率与其他3组分别比较,差异均有统计学意义(P<0·05);C组术后无闭经者,但术后息肉复发率高于其他3组,C组中有14例术后5~23个月妊娠。结论宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效无明显差异,但子宫内膜息肉切除+息肉旁浅层内膜切除术后复发率高;应根据患者年龄、生育要求等选择适宜的宫腔镜下手术方式。     

A randomized comparison of endometrial laser intrauterine thermotherapy and hysteroscopic endometrial resection

OBJECTIVE: To investigate the difference of long-term amenorrhea rate in patients with menorrhagia treated by endometrial laser intrauterine thermal therapy (ELITT), a new nonhysteroscopic endometrial ablation procedure, versus transcervical hysteroscopic endometrial resection (TCRE). DESIGN: Randomized clinical study. Healthy volunteers in an academic research environment. SETTING: Academic teaching hospital. PATIENT(S): Premenopausal women with abnormal uterine bleeding. INTERVENTION(S): Fifty-eight patients were treated with the ELITT procedure and 58 patients with TCRE; both groups were treated with GnRH agonists before the procedure. MAIN OUTCOME MEASURE(S): Bleeding status and patient satisfaction after treatment were evaluated as well as the intraoperative complication rate. RESULT(S): At 12 months, the amenorrhea rate was 56% in the ELITT group and 23% in the TCRE group. At 36 months, the figures were 61% for ELITT and 24% for TCRE. No significant complications were recorded for either procedure. CONCLUSION(S): Results of this randomized study demonstrate that both procedures are equally effective in the treatment of menorrhagia. However, the ELITT procedure has proven to be superior in inducing amenorrhea.     

Endometrial cancer following endometrial resection

Endometrial ablation has emerged as a viable alternative to hysterectomy in the treatment of medically intractable dysfunctional uterine bleeding. However, this procedure cannot guarantee complete removal of the entire endometrium. Cases of endometrial cancer after endometrial ablation have been reported in the literature. We reviewed the cases of patients who underwent hysteroscopic endometrial ablation by endometrial resection for abnormal uterine bleeding from 1994 to 2005 at the Department of Obstetrics and Gynecology, Polyclinique, Clermont-Ferrand University. Of the 3769 patients having had hysteroresections, four developed endometrial cancer after complete endometrial ablation (1.06 out of 1000). All four of these patients showed histological evidence of endometrial polyps at endometrial resection, and all of them presented risk factors for endometrial carcinoma, such as obesity and/or arterial hypertension. Endometrial cancer after hysteroscopic endometrial ablation is a rare but possible occurrence, even a long time after the operation. Close monitoring of patients who have undergone endometrial ablation for endometrial polyps and who present risk factors, such as obesity or hypertension, even after apparent total ablation of the endometrium is strongly recommended, independently of the presence of abnormal bleeding that can represent a late symptom of advanced endometrial cancer.     

射频热凝固治疗无排卵型功能失调性子宫出血预后差异性的Meta分析

目的:评价射频热凝固(RF)治疗无排卵型功能失调性子宫出血(ADUB)的疗效。方法:检索2002年9月1日至2012年9月1日Cochrane图书馆、MEDLINE、PubMed、Web of Science、万方数据库(CECDB)、维普中文科技期刊全文数据库(CQVIP)、中国学术期刊全文数据库(CNKI),提取纳入文献的资料,并严格评价文献质量。应用Review Manager 5.0软件对符合质量标准的随机对照试验(RCT)进行Meta分析。结果:最终纳入6篇RCT研究,共计313例患者,其中治疗组(使用RF)156例,对照组(使用宫腔镜内膜电切除术、微波内膜去除术)157例。两组患者均进行常规口服孕激素和对症支持治疗。Meta分析结果显示:与对照组比较,治疗组治疗3个月后PBAC(月经量评分)显著下降(WMD为-22.70,95%CI为-24.65～-20.75)、痛经症状显著缓解(RR=0.62,95%CI为0.40～0.95)、Hb含量显著上升(WMD为23.83,95%CI为21.47～26.19),差异均有统计学意义。结论:RF较宫腔镜内膜电切除术和微波内膜去除术,能显著提高ADUB的疗效。     

围绝经期异常子宫出血与子宫内膜病变的危险因素分析

目的 分析围绝经期异常子宫出血与子宫内膜病变的危险因素.方法 回顾性分析100例围绝经期异常子宫出血患者的临床资料,根据临床病理检查结果分为良性组(26例)、病变组(52例)、正常组(22例).采用多因素Logistic回归分析围绝经期异常子宫出血与子宫内膜病变的危险因素.结果 三组患者孕产次数、BMI、子宫内膜厚度、...     

Five-year follow-up of endometrial ablation: endometrial coagulation versus endometrial resection

OBJECTIVE: A randomized, controlled trial was performed to compare the patient complication rate, effectiveness, and satisfaction rate of transcervical hysteroscopic endometrial coagulation versus endometrial resection in the treatment for heavy dysfunctional bleeding. METHODS: One hundred and twenty women requiring endometrial ablation for the treatment of heavy bleeding disorders entered the study. All patients were offered a clinical examination 24 months postoperatively and had a questionnaire by mail 5 years after the initial treatment. The number of complications during and after the operation, re-ablations, and hysterectomies were registered. A bleeding index and the patient satisfaction rate were stated. RESULTS: Sixty-one patients were treated by endometrial coagulation, and 59 were treated by endometrial resection. No differences between the two groups were observed concerning fluid absorption, bleeding, perforation, and infection. At the 5-year follow-up, 64% of the patients had only one ablation, 15% were treated twice, 15% had a hysterectomy, and 6% were lost to follow-up. After 5 years, the bleeding index was halved in patients with menses. Seventy-nine percent of the women would recommend the treatment to their best female friend. CONCLUSION: We found no significant differences in the frequency of complications. Only 15% of the women had a hysterectomy after 5 years. No significant difference was observed with respect to bleeding reduction and patient satisfaction in the two groups.     

Small bowel perforation after thermoregulated radiofrequency endometrial ablation: a case report

During the past decades, numerous hysteroscopic ablation techniques have been developed for the treatment of menorrhagia, all conferring relatively comparable success rates and low complication incidences. We here report an unusual, adverse, post-operative, complication of the Vesta thermoregulated radiofrequency endometrial ablation system in a 34-year-old nulliparous woman with dysfunctional uterine bleeding. Fourteen days after the procedure she presented with acute abdominal pain. At laparotomy, a small bowel perforation was identified, and the entire uterus was found to be necrotic, necessitating a total hysterectomy. This is the first report of a severe complication of this endometrial ablation system in the absence of uterine perforation. We propose that minimal myometrial thickness should be taken into consideration to improve the safety of thermoregulated radiofrequency endometrial ablation.     

Efficacy and satisfaction rate comparing endometrial ablation by rollerball electrocoagulation to uterine balloon thermal ablation in a randomised controlled trial

OBJECTIVE: To compare two methods of endometrial ablation, hysteroscopic rollerball electrocoagulation (RBE) and non-hysteroscopic uterine balloon thermal ablation (Thermachoice trade mark ), regarding efficacy for reducing dysfunctional uterine bleeding and patients satisfaction rate. METHODS: A randomised controlled study was performed in a teaching hospital at the department of gynaecology. One hundred and thirty-seven premenopausal women with dysfunctional uterine bleeding proved by validated menstrual score list were included. Endometrial ablation by a hysteroscopic or non-hysteroscopic method was performed by one gynaecologist. RESULTS: Reduction of menstrual blood loss was significantly more successful at 24 months for thermal ablation with uterine balloon. Success rate measured by menstrual score < 185 for rollerball and thermal balloon ablation are equivalent at 12 and 24 months post-operatively. Satisfaction of the patients for both methods at 24 months post-operatively is not significantly different (respective 75% for rollerball and 80% for uterine balloon). CONCLUSIONS: Endometrial ablation by uterine balloon thermal ablation (Thermachoice trade mark ) is equally effective as hysteroscopic RBE of the endometrium.     

Bipolar radio frequency endometrial ablation compared with balloon endometrial ablation in dysfunctional uterine bleeding: impact on patients' health-related quality of life

OBJECTIVE: To compare health-related quality of life (HRQoL) after bipolar radio frequency ablation and thermal balloon ablation in women with dysfunctional uterine bleeding. DESIGN: Randomized clinical trial. SETTING: Teaching hospital. PATIENT(S): Women suffering from dysfunctional uterine bleeding. INTERVENTION(S): Bipolar radio frequency ablation and thermal balloon ablation. MAIN OUTCOME MEASURE(S): Patients were asked to complete HRQoL questionnaires at baseline, and at 2 days, 2 weeks, 3 months, 6 months, and 12 months after surgery. The questionnaires contained the medical outcomes study Short-Form 36 (SF-36), the Self-rating Depression Scale, the Rotterdam Symptom Checklist, State-Trait Anxiety Inventory, and a structured clinical history questionnaire. RESULT(S): Data on HRQoL were available on at least two different time points in 115 of 126 randomized patients. HRQoL improved significantly over time in both groups, except for the domain of general health in the SF-36. None of the dimensions showed a significant difference between both groups, neither was there a significant interaction between time and treatment effect. CONCLUSION(S): Both methods significantly improved HRQoL in women with dysfunctional uterine bleeding. However, despite better amenorrhea and satisfaction rates after bipolar radio frequency ablation, there was no difference in HRQoL between the two groups.     

Endometrial ablation by rollerball electrocoagulation compared to uterine balloon thermal ablation. Technical and safety aspects

Objective: To compare two methods of endometrial ablation, hysteroscopic rollerball electrocoagulation (RBE) and non-hysteroscopic uterine balloon thermal (UBT) ablation (Thermachoice™), regarding intra- and post-operative technical complications and safety aspects. Study design: A randomised controlled study in a teaching hospital, 139 pre-menopausal women with dysfunctional uterine bleeding proved by a validated menstrual score list were enclosed. Endometrial ablation by a hysteroscopic or non-hysteroscopic method was performed. Results: Rollerball electrocoagulation carries a significantly higher risk of intra-operative complications compared to uterine balloon thermal ablation and is a significantly more time consuming procedure. Post-operative complication rates in both groups were low, but post-operative analgesics were prescribed significantly more in the uterine balloon group. Conclusion: Endometrial ablation by uterine balloon thermal ablation (Thermachoice™) is a safe and simple non-hysteroscopic procedure.     

Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy

OBJECTIVE: To investigate patient preferences for endometrial ablation and a levonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectomy in the treatment of dysfunctional uterine bleeding. DESIGN: Comparative study based on structured interviews. SETTING: A large teaching hospital with 500 beds in the Netherlands. PATIENT(S): Ninety-six patients who were scheduled for endometrial ablation, 25 patients who were scheduled for hysterectomy, and 23 patients who were scheduled for a levonorgestrel-releasing IUD were interviewed. All of the women had dysfunctional uterine bleeding. INTERVENTION(S): Patients were asked to state their most significant complaints and their reasons for choosing a particular treatment. Subsequently, the preference for endometrial ablation and a levonorgestrel-releasing IUD as alternatives to hysterectomy was assessed during a structured interview. Women were informed about the advantages and disadvantages of all three treatment options. Patients rated their preferences according to different hypothetical success rates. The success rates after endometrial ablation and levonorgestrel-releasing IUD were varied until patients found an acceptable treatment outcome. MAIN OUTCOME MEASURE(S): Patient preference of endometrial ablation and the levonorgestrel-releasing IUD over hysterectomy. RESULT(S): The main reason for the treatment of choice differed between the three groups. Most of the patients in the hysterectomy group wanted a definite solution to their problems, whereas patients in the levonorgestrel-releasing IUD group and in the ablation group put greater emphasis on a minimally invasive intervention with or without a short hospital stay. In women undergoing ablation, 70% of the patients preferred this treatment and the levonorgestrel-releasing IUD to hysterectomy in cases in which the success rate of noninvasive treatment was presumed to be 50%. In women having a levonorgestrel-releasing IUD inserted, 95% of the patients preferred this approach over hysterectomy in cases in which the success rate of this device was presumed to be 50%, whereas 35% of patients preferred ablation over hysterectomy in cases in which the success rate of ablation was presumed to be 50%. In women undergoing hysterectomy, 30% would have opted for ablation and 45% would have opted for a levonorgestrel-releasing IUD in cases in which success rates were 50%. Of patients who opted for hysterectomy, however, 60% stated that they would have preferred a noninvasive treatment if the success rate of this type of treatment were >80%. CONCLUSION(S): A majority of the patients who had dysfunctional uterine bleeding and who were scheduled for an endometrial ablation or a levonorgestrel-releasing IUD were inclined to take a risk of 50% likelihood of treatment failure to avoid a hysterectomy. As a consequence, research of treatment for dysfunctional uterine bleeding should focus on this 50% success level.