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。     

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.     

Global endometrial ablation: a modern day solution to an age-old problem.

Menorrhagia remains a significant health issue for women worldwide. Traditionally hysterectomy has been the treatment of choice when excessive menstrual bleeding remains unresolved by hormonal manipulation. In an attempt to provide a less invasive alternative to hysterectomy, traditional techniques such as rollerball endometrial ablation were developed 20 years ago. Although extremely effective, they possessed the potential of significant intra-operative risks and their success depended on high technical proficiency of the surgeon. As surgery and technology evolved, second generation endometrial ablation devices were developed which demonstrated improved safety and efficacy rates that paralleled traditional treatments. Since 1997, the Food and Drug Administration (FDA) has approved five such devices for use in the United States. Each possesses a unique technology profile with supporting level I evidence that allows for the treatment of a wide variety of uterine anatomy.     

青春期子宫出血54例临床分析

目的 探讨青春期子宫出血的病因、诊断和治疗方法。方法 对1990-01-2004-05中山大学附属第二医院54例青春期子宫出血病例进行回顾性分析。结果 54例青春期子宫出血患者，功能失调性子宫出血（功血）共34例占63．0％，血液系统疾病14例占25．9％，生殖道器质性病变3例占5．6％，其他疾病3例占5．6％。54例均经超声检查，9例有异常发现者再接受宫腔镜检查，3例发现器质性病变。功血患者经性激素治疗均达止血效果。结论 青春期子宫出血的病因以功血为多，但需排除其他疾病。超声结合诊断性刮宫和宫腔镜检查，是有力的诊断手段。     

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding.

OBJECTIVE: To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG-IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding. METHOD: Of 50 women with a pictoral blood loss assessment chart (PBAC) score of 100 or greater, 25 had a LNG-IUS inserted (Mirena; Schering, Berlin, Germany) and 25 underwent TCRE. Procedure-related complications, PBAC score, hemoglobin levels, adverse effects, and rates of acceptability and satisfaction were recorded at 3-month intervals for a period of 12 months. RESULTS: At the end of 1 year there were a 97% and a 94% reduction in menstrual blood loss in the LNG-IUS and TCRE groups, respectively, and hemoglobin concentration had increased by 5.5% in the LNG-IUS group and 5.2% in the TCRE group. Adverse effects were similar in both groups except for systemic effects, which were seen only in the LNG-IUS group. Satisfaction rates were about 80% in the 2 groups. CONCLUSION: Both treatments were found to be equally effective but LNG-IUS placement requires less operator skill and entails no operative hazards, and the device provides effective contraception.     

Clinical efficacy of individual cognitive behavior therapy for psychophysiological insomnia in 20 outpatients

Aim: Twenty patients (14 of them women) suffering from psychophysiological insomnia (PPI) were enrolled for cognitive behavior therapy (CBT). The mean age of the patients was 56.9 years, and the mean duration of insomnia morbidity was 8.9 years. Each received individual combined CBT treatments consisting of stimulus control, sleep reduction, cognitive therapy and sleep hygiene education over a period of 1 month. Methods: Just before the CBT and after its completion, sleep measurements were conducted that involved (i) sleep logs, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and the Pittsburgh Sleep Quality Index (PSQI); (ii) actigraphy measurement; (iii) dissociation between subjective and objective evaluation of sleep calculated from sleep logs and actigraphy results; and (iv) correlation between DBAS and the aforementioned sleep parameters. Because the intention was to focus on patients' incorrect cognition about sleep, the definition ‘changes in dissociation between the sleep log and actigraphically measured sleep’ was used as the primary outcome and ‘changes in DBAS score’ as the secondary outcome. Results: After the CBT the following was found: (i) underestimation by PPI patients of the objective evaluation of sleep; (ii) a decrease in the dissociation between the subjective and objective evaluation of sleep; (iii) improvement of the DBAS; and (iv) improvement of sleep logs and actigraphy measurements. Moreover, there was a correlation between the improvement of PSQI, sleep logs and DBAS. Conclusion: CBT for insomnia is able to redress incorrect cognition about sleep, leading to improvement of the disorder.     

对该院妇科96例功能失调性子宫出血的临床诊治分析

目的：分析与探讨该院妇科功能失调性子宫出血患者96例的临床诊治方法及效果。方法选取该院于2012年9月-2013年7月间收治的功能失调性子宫出血患者96例为研究对象,按照用药方法的不同,平均分为对照组和实验组,每组48例。其中,对照组采用米非司酮进行药物治疗,实验组在对照组的基础上加用中药治疗,一般临床多加用中药固崩汤。比较两组患者的临床治疗效果和身体各项指标值变化。结果经治疗后,对照组显效40例(83.33%),有效4例(8.33%),无效4例(8.33%),总有效率为44例(91.66%),且各项指标在治疗后,黄体生成素(9.8±3.1)IU/L、卵泡刺激素(17.2±3.1)IU/L、孕酮(2.4±0.8)pmol/L、雌二酮(118.9±22.9)nmol/L。实验组显效44例(91.67%)、有效3例(6.25%)、无效1例(2.08%),总有效率为47例(97.92%),且各项指标在治疗后,黄体生成素(13.5±3.2)IU/L、卵泡刺激素(19.7±2.6)IU/L、孕酮(1.5±0.9)pmol/L、雌二酮(97.1±14.6)nmol/L。两组比较差异有统计学意义(P<0.05)。结论临床中采用米非司酮加用中药固崩汤可有效改善患者功能失调性子宫出血症状,且疗效显著,值得在临床中广泛推广。     

LNG-IUS辅助子宫内膜去除术治疗功能失调性子宫出血疗效探讨

目的:分析左炔诺孕酮宫内缓释系统(LNG-IUS)辅助子宫内膜去除术治疗功能失调性子宫出血的疗效.方法:回顾性分析近两年来该院妇产科就诊的功能失调性子宫出血患者共90例,随机分为两组,观察组给予LNG-IUS辅助子宫内膜去除术治疗,对照组单纯给予子宫内膜去除术治疗,统计患者术前、术后3、6、12个月月经情况、血红蛋白浓度、子宫内膜厚度及不良反应发生情况.结果:术后两组患者PBAC评分明显降低,闭经率明显提高,血红蛋白浓度明显升高,子宫内膜厚度明显增加,且观察组比对照组改善作用更显著(P＜0.05);总有效率方面,观察组明显高于对照组,差异有统计学意义(P＜0.05).结论:LNG-IUS辅助子宫内膜去除术治疗功能失调性子宫出血不良反应少,能够有效减少月经量,纠正贫血,抑制子宫内膜增生.