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目的:探讨米非司酮预防功能失调性子宫出血(dysfunctional uterine bleeding,DUB)宫腔镜子宫内膜电切术(transcervical resection of endometrium,TCRE)后复发的临床疗效。方法:选择诊断为DUB、具有宫腔镜手术指征的患者60例。所有患者术前3个月内行诊断性刮宫术,并经子宫内膜病理检查排除恶性病变。将研究对象随机分为研究组和对照组,各30例,给予TCRE治疗。研究组在术后第1日起,口服米非司酮,剂量为12.5 mg/d,持续3个月,对照组不给予药物处理。于术后1个月、3个月、6个月观察患者的月经情况、血红蛋白(Hb)、子宫内膜厚度及手术疗效。结果:研究组患者术后3个月内均闭经,停药后3例患者出现月经复潮,经量较术前明显减少;对照组术后22例闭经,8例月经复潮,其中3例月经量与术前相当;研究组和对照组术后的平均Hb量均较术前上升,组间相比差异无统计学意义(P>0.05);研究组术后子宫内膜平均厚度低于术前和对照组,差异有统计学意义(P<0.05)。结论:DUB患者TCRE后辅助口服米非司酮可减少患者月经量,甚至导致闭经,预防DUB复发,提高宫腔镜手术治疗的效果。
Objective: To investigate the clinical efficacy of mifepristone in preventing relapse after dysfunctional uterine bleeding (DUB) transcervical resection of endometrium (TCRE). Methods: Sixty patients with indications for hysteroscopic surgery were selected for diagnosis as DUB. All patients underwent diagnostic curettage within 3 months before operation and pathological examination of the endometrium ruled out malignant lesions. Subjects were randomly divided into study group and control group, 30 cases each, given TCRE treatment. The study group on the 1st postoperative day, oral mifepristone, a dose of 12.5 mg / d for 3 months, the control group was not given drug treatment. The patients’ menstrual status, hemoglobin (Hb), endometrial thickness and the curative effect were observed at 1 month, 3 months and 6 months after operation. Results: All the patients in the study group were amenorrhea within 3 months after operation. Three patients recovered after menstruation after stopping the operation, and the volume of the menstrual flow was significantly decreased compared with that before operation. In the control group, 22 cases were amenorrhea and 8 cases were menstruated, The mean amount of Hb in the study group and the control group was significantly higher than that before the operation (P> 0.05). The mean thickness of the endometrium in the study group was lower than that in the study group Preoperative and control groups, the difference was statistically significant (P <0.05). Conclusion: The adjunctive oral administration of mifepristone after TCRE in DUB patients can reduce menstrual flow and even cause amenorrhea, prevent recurrence of DUB and improve the effect of hysteroscopic surgery.