摘要
目的 评价宫腔镜手术治疗异常子宫出血的中长期随访结果。方法 回顾分析我院2002年1月～2005年11月经宫腔镜诊治异常子宫出血且随访〉12个月的432例临床资料,诊断良性疾患391例[子宫内膜息肉96例（22.2%）,子宫黏膜下肌瘤38例（8.8%）,子宫内膜增生过长257例（59.5%）],行息肉或肌瘤切除、子宫内膜电切术;诊断子宫内膜腺癌41例（9.5%）,均为Ⅰ期,行经腹全子宫双附件切除、选择性盆腔淋巴结清扫术。结果 手术均获成功,未发生子宫穿孔等并发症。391例良性病变中,术后随访12～57个月,平均39个月,闭经占16.1%（63/391）,月经量少（每周期〈10片卫生巾）18.9%（74/391）,月经量正常（每周期10～20片卫生巾）58.3%（228/391）,术后改善不明显占6.6%（26/391）。26例月经量仍多者术后用孕酮治疗,7例有多发子宫肌瘤,术后32～44个月行全子宫切除术,8例复查阴道彩超子宫内膜厚度〉1.5 cm,术后5～19个月第2次行宫腔镜子宫内膜切除术,继续随访18～36个月,月经量少3例,闭经5例。41例子宫内膜癌Ⅰ期术后随访26～41个月,平均38个月,均无瘤存活。结论 异常子宫出血的治疗在结合病理学检查除外恶性病变后首选宫腔镜手术,严格B超监测是提高手术疗效和手术安全的保障。
Objective To evaluate the mid-long term effects of hysteroscopic treatment of abnormal uterine bleeding （AUB）. Methods A total of 432 patients admitted from January 2002 to November 2005 with AUB were treated with hysteroscopy. All the patients were followed for at least 12 months. Among the 432 patients, 391 were diagnosed as having benign lesions, including endometrial polyp in 96 patients （22.2%） , submucous myoma in 38 patients （8.8%） , and endometrial hyperplasia in 257 patients （59.5%） , receiving transcervical myoma resection or transcervical endometrium resection. The other 41 patients were diagnosed as having stage Ⅰ endometrial carcinoma, and a total hysterectomy and bilateral adnexectomy with selective pelvic lymphadenectomy was performed. Results All the operations were successfully completed, without uterine perforation or other complications. During a follow-up of 12- 57 months （mean, 39 months） in the 391 patients with benign lesions, amenorrhea was found in 63 patients （16. 1% , 63/391） , hypomenorrhea （ 〈 10 sanitary napkins per cycle） in 74 patients （ 18.9% , 74/391 ） , normal menstrual flow （ 10 - 20 sanitary napkins per cycle） in 228 patients （58.3 % , 228/391 ） , and no improvement in 26 patients （6.6% , 26/391 ）. The 26 patients without improvement were given progesterone treatment. Seven patients accompanying multiple hysteromyomas underwent a panhysterectomy at 32 - 44 months after operation. Follow-up vaginal uhrasonography showed endometrial thickness 〉 1.5 cm in 8 patients, and a second hysteroscopic endometrial resection was given at 5 - 19 months after first operation. All the 8 patients were further followed for 18 - 36 months, with findings of amenorrhea in 5 of them and hypomenorrhea in 3. All the 41 patients with stage Ⅰ endometrial carcinoma survived without recurrence during a follow-up period for 26 - 41 months （mean, 38 months）. Conclusions Hysteroseopic treatment can he the first choice for treating non-malignant AUB. Pre-operational pathological examination and uhrasonography can enhance the safety and efficacy of the operation.
出处
《中国微创外科杂志》
CSCD
2007年第7期691-692,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
异常子宫出血
子宫腔镜
电外科手术
中长期随访
Abnormal uterine hleeding
Hysteroscopy
Electrosurgery
Mid-long term follow-up
