子宫内膜切除术治疗月经过多400例分析

目的：总结子宫内膜切除术治疗月经过多的手术指征、手术方法、预后及体会。方法：应用连续灌流宫腔电切镜，对４００例手术指征为保守治疗无效的月经过多、无生育要求、合并粘膜下肌瘤直径≤５ｃｍ的病人行子宫内膜切除术。４００例行子宫内膜切除术中，７２例同时切除子宫肌瘤，术中子宫穿孔３例。术后随访３个月至４年者３６６例，１３例因异常出血行第二次手术。结果：１６例因手术失败切除子宫，其余３５０例月经均有所改善，手术成功率９５．６％。术后１４６例（４１．７％）无月经，１１９例（３４．０％）月经为点滴状，８５例（２４．３％）经血明显减少，原有痛经者７８．３％痛经消失或减轻。术后远期合并症有异常出血２２例，宫腔积血５例，子宫腺肌病４例。结论：子宫内膜切除术可减少或停止月经，减轻痛经，同时切除肌瘤疗效较满意。

Analysis of the Outcomes of Transcervical Resection of Endometrium in 400 Cases with Meuorrhagia

Objective: To report the efficacy and outcomes of transcervical resection of the endometrium (TCRE) in treatment of menorrhagia. Methods: 400 patients with menorrhagia due to fatique causes who had failed in medical therapy and did not desire pregnancy and surgery underwent TCRE under hysteroresectoscope. Among them, 72 patients with submucous uterine myoma less than 5cm in diameter had their myoma resected simultaneously, 366 cases were followed up postoperatively for 3 months to 4 years. Results: TCRE was performed succesefully except 16 cases, giving a success rate of 95.6%. Three cases sustained uterine perforation. During follow up, 146 cases (41.7%) became amenorrhea, 119 (34.0%) had only spotting. The remaining 85 (24.3%) had normal periods. 78.3% of the cases who pneviously had dysmenorrhea had relieved their pain. Long term complications were recurrent abnormal uterine bleeding (22 cases 13 of them had a second operation), hematometra (5) and adenomyosis (4 cases). Conclusion: TCRE is an effective procedure in treating menorrhagira and small submucous uterine myoma.