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目的随访第二代子宫内膜去除术(热球子宫内膜去除术)治疗异常子宫出血的效果,评估第二代子宫内膜去除术的远期疗效及安全性。方法回顾性分析2006年12月—2008年9月在湖北省妇幼保健院接受治疗的异常子宫出血并符合纳入标准的患者96例。患者均行热球子宫内膜去除术,于术后3、6、12、24、36、48、60个月随访,内容包括月经周期和月经量,有无腹痛、感染、出血;部分患者进行宫腔镜检查。结果术前患者宫腔深度为7~10 cm,平均(8.4±1.0)cm;手术时间为10~35 min,平均(18.1±6.3)min;热球子宫内膜治疗仪治疗次数为2~5次,平均(2.9±0.9)次;术中出血量1~10 ml,平均(5.7±2.8)ml。96例患者均完成3、6、12个月随访,78例完成24个月随访,56例完成36个月随访,44例完成48个月随访,35例完成60个月随访。术后随访3、6、12、24、36、48、60个月的有效率及闭经率分别为:92.7%(89/96)和33.3%(32/96)、92.7%(89/96)和36.5%(35/96)、92.7%(89/96)和37.5%(36/96)、93.6%(73/78)和35.9%(28/78)、92.9%(52/56)和35.7%(20/56)、90.9%(40/44)和43.2%(19/44)、91.4%(32/35)和57.1%(20/35),治疗满意率为89.5%(86/96)。术后随访3、6、12、24、36、48、60个月有效率比较,差异无统计学意义(χ2=0.47,P>0.05);术后随访3、6、12、24、36、48个月的闭经率,差异无统计学意义(χ2=0.466,P>0.05);术后60个月闭经率高于术后3、6、12、24、36个月(χ2=6.07、4.50、4.04、8.28、11.37,P<0.05),与术后48个月相比,差异无统计学意义(χ2=1.52,P>0.05)。术中及术后均未出现子宫穿孔、破裂,无临近脏器膀胱、直肠等热损伤,术后无血尿、便血。结论热球子宫内膜去除术为治疗异常子宫出血的一种简单、安全、有效、损伤小的方法,且远期效果好,值得临床推广应用。
Objective To evaluate the efficacy and safety of second-generation endometrial ablation (hot-ball endometrial ablation) for the treatment of abnormal uterine bleeding and to evaluate the long-term efficacy and safety of second-generation endometrial ablation. Methods A retrospective analysis of 96 patients with abnormal uterine bleeding treated in Hubei MCH in December 2006-September 2008 was performed and met the inclusion criteria. All patients underwent thermal ball endometrial ablation and were followed up 3, 6, 12, 24, 36, 48 and 60 months postoperatively, including menstrual cycle and menstrual flow, abdominal pain, infection and bleeding; some patients Hysteroscopy. Results The preoperative uterine cavity depth was 7 ~ 10 cm (mean, 8.4 ± 1.0 cm). The operation time was 10 ~ 35 min (mean, 18.1 ± 6.3) min. The treatment rate of hot ball endometrial therapeutic apparatus was 2 ~ 5 (Mean 2.9 ± 0.9). The intraoperative blood loss was 1 ~ 10 ml (average 5.7 ± 2.8) ml. All 96 patients were followed up for 3, 6 and 12 months. 78 patients completed 24 months follow-up, 56 patients completed 36 months follow-up, 44 patients completed 48 months follow-up and 35 patients completed 60 months follow-up. The effective rate and the rate of amenorrhea at 3, 6, 12, 24, 36, 48 and 60 months after operation were 92.7% (89/96) and 33.3% (32/96), respectively, and 92.7% (89/96) 92.7% (89/96) and 37.5% (36/96), 93.6% (73/78) and 35.9% (28/78), 92.9% (52/56) and 35.7% The rates of treatment satisfaction were 89.5% (86/96), 90.9% (40/44) and 43.2% (19/44), 91.4% (32/35) and 57.1% (20/35) . There were no significant differences in the effective rates at 3, 6, 12, 24, 36, 48 and 60 months after operation (χ2 = 0.47, P> 0.05) The amenorrhea rate at 48 months was not significantly different between two groups (χ2 = 0.466, P> 0.05). The rate of amenorrhea at 60 months after operation was higher than that at 3,6,12,24 and 36 months after operation (χ2 = 6.07 and 4.50 , 4.04,8.28,11.37, P <0.05). There was no significant difference between the two groups (χ2 = 1.52, P> 0.05) after 48 months. Uterine perforation and rupture did not occur during and after operation, and no thermal injury such as bladder and rectum was found in the adjacent organs. No hematuria and blood in the stool were found after operation. Conclusion Hot ball endometrial ablation is a simple, safe, effective and less invasive method for the treatment of abnormal uterine bleeding. The long-term effect is worthy of clinical application.