自凝刀子宫内膜射频消融术与宫腔镜子宫内膜电切术治疗围绝经期功血的临床疗效比较

目的:比较自凝刀子宫内膜射频消融术（BBT）与宫腔镜子宫内膜电切术（TCRE）治疗围绝经期功血的临床效果。方法:选取2015年5月-2016年12月在河南省许昌市建安区人民医院妇产科接受治疗围绝经期功血的患者96例，采用随机数字法分为对照组和观察组，每组患者各48例。对照组患者运用宫腔镜子宫内膜电切术治疗，观察组患者运用自凝刀子宫内膜射频消融术治疗。比较两组患者的临床疗效、治疗前后性激素水平、子宫内膜厚度、治疗前后血红蛋白水平、术中情况、住院时间及并发症情况。结果:观察组患者的总有效率为98%，对照组患者总有效率为94%，两组患者总有效率比较，差异无统计学意义（P>0.05）。两组患者性激素包括促卵泡激素（FSH）、促黄体素（LH）、睾酮（T）、催乳素（PRL）、孕酮（P）及雌二醇（E2）水平在治疗前、治疗后均无统计学差异（P>0.05）。 观察组患者术中出血量、手术时间及住院天数分别为（10.36±6.03）mL、（12.64±2.64）min、（2.15±1.29）d优于对照组（26.26±8.16）mL、（22.61±3.61）min、（3.64±1.74）d，差异有统计学意义（P<0.05）。观察组患者术后出血、发热等并发症发生率为2.08%低于对照组14.58%，差异有统计学意义（P<0.05）。两组患者治疗前子宫内膜厚度和血红蛋白水平比较无统计学差异（P>0.05）。观察组患者治疗后子宫内膜厚度[（3.49±0.97）mm]薄于对照组[（5.21±1.24）mm]，患者治疗后，血红蛋白[（121.37±8.04）g/L]高于对照组[（101.51±10.28）g/L]（P<0.05）。结论:自凝刀子宫内膜射频消融术对围绝经期功能失调性出血疗效显著，恢复快、安全性高，对患者的内分泌激素水平无明显影响，值得临床推广应用。

Comparison of efficacy between autocoagulative endometrial ablation and transcervical resection of endometrium for perimenopausal dysfunctional uterine bleeding

Objective: To compare the clinical effects of autocoagulant endometrial radiofrequency ablation (BBT) and hysteroscopic endometrial resection(TCRE) in the treatment for peri-menopausal dysfunctional blood. Methods:Selected from May 2015 to December 2016 in henan province sussing out district people’s hospital of obstetrics and gynecology，96 patients were treated with menopausal transition of function by the random number method and the patients were divided into control group and observation group (n = 48).Patients in the control group were treated with hysteroscopic endometrial electrotomy, and patients in the observation group were treated with auto-coagulation knife endometrial radiofrequency ablation. The clinical efficacy, sex hormone levels before and after treatment, endometrial thickness, hemoglobin levels before and after treatment, intraoperative conditions, hospitalization time and complications of the two groups were compared. Results:The total effective rate of patients in the observation group was 98%, and the total effective rate of patients in the control group was 94%. The difference between the two groups was not statistically significant (P>0.05). There was no significant difference in the levels of sex hormones between the two groups, including follicle stimulating hormone (FSH), luteinizing hormone (LHN), testosterone (TX), prolactin (PRL), progesterone (P) and estradiol (E2) before and after treatment (P>0.05). The amount of intraoperative bleeding, operation time and hospital stay in the observation group were （10.36 ±6.03）mL / min, （12.64 ±2.64） / min/d and （2.15 ±1.29）/ d, respectively, which were significantly higher than those in the control group（26.26±8.16）mL，（22.61±3.61）min and（3.64±1.74） d, respectively (P<0.05). The patients in the observation group had postoperative bleeding. The incidence of complications such as fever was 2.08% lower than that of the control group (14.58%, P<0.05). There were no significant differences in endometrial thickness and hemoglobin levels between the two groups before and after treatment (P> 0.05). The endometrial thickness was（3.49±0.97） mm after treatment in the observation group. It was thinner than that in the control group (5.21±1.24) mm after treatment. The hemoglobin level was （121.37±8.04） g/L higher than that in the control group（101.51±10.28）g/L(P<0.05). Conclusion:The curative effect of auto-congealing knife endometrial radiofrequency ablation for perimenopausal dysfunctional tonal hemorrhageis distinct, with rapid recovery, high safety, and hasno obvious effect on the patient’s level of endocrine hormone, which is suitable for clinical popularization and application.