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目的通过观察微波子宫内膜去除术(MEA)中子宫浆膜面温度和病理变化评价MEA的安全性。方法2003年6月至2004年12月对河北医科大学第二医院妇科收治的14例月经过多患者在月经后早卵泡期,分别行离体及在体子宫MEA。设置MEA的作用时间为4min,MEA过程中测量宫底、宫角、后壁、前壁下段的浆膜面温度;并将作用后的子宫标本进行HE、尼可酰胺腺嘌呤核苷酸-黄递酶(NADH-d)染色,观察组织热损伤改变。结果离体子宫浆膜面的最高温度在后壁为50·9℃,最大损伤深度在宫底为8·1mm,占宫壁厚度的36·9%;在体子宫浆膜面的最高温度在后壁和宫角为37·6℃,最大损伤深度在后壁为5·6mm,占宫壁厚度的30·6%。结论MEA在有效去除子宫内膜的同时具有很高的安全性,精确了解子宫壁各部位的厚度和防止手术时间过长可以提高MEA的安全性。
Objective To evaluate the safety of MEA by observing the uterine serosal surface temperature and pathological changes in microwave endometrial ablation (MEA). Methods From June 2003 to December 2004, 14 cases of menorrhagia who received gynecology in the Second Hospital of Hebei Medical University were treated with MEA in vitro and in vivo respectively. The duration of MEA was set at 4 min. MEA was used to measure the serosal surface temperature of the uterine horn, the cornual horn, the posterior wall and the anterior wall of the anterior wall. The uterus specimens were examined for HE, nicotinamide adenine nucleotide Enzyme (NADH-d) staining, observed changes in tissue damage. Results The highest temperature of isolated uterine serosa in the posterior wall was 50.9 ℃, the maximum depth of injury at the fundus was 8.1 mm, accounting for 36.9% of the thickness of the uterine wall. The highest temperature in the body uterine serosa was The posterior wall and corner angle were 37.6 ℃. The maximum depth of injury was 5.6 mm at the posterior wall, accounting for 30.6% of the posterior wall thickness. Conclusion MEA is effective in removing endometrium and has high safety. Precise understanding of the thickness of uterine wall and preventing prolonged operation can improve the safety of MEA.