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目的 :探讨宫腔镜电切除术前负压吸宫及术后电熨联合治疗异常子宫出血的疗效及预后。方法 :选择有手术指征的异常子宫出血患者 87例 ,采用被动式连续灌流宫腔电切镜行子宫内膜切除 40例 ,肌瘤切除 33例 ,肌瘤及内膜切除 3例 ,息肉切除 5例 ,息肉及内膜切除 6例。结果 :手术均顺利完成。术后随访 3～ 11个月 ,总有效率 96 .6 % ,其中单纯子宫肌瘤及息肉切除术者 ,术后月经均减少或恢复正常 ;49例子宫内膜切除术同时切除肌瘤、息肉者 ,5 7.1%无月经 ,32 .7%月经减少 ,4.1%月经正常 ,对痛经治愈率为 10 0 % ,5 9例术前贫血者术后 5 8例恢复正常 ,纠正贫血有效率为 98.3%。术后并发症为 3.4% ,宫腔粘连并积血 1例 ,月经无改善 2例。结论 :宫腔镜电切术前负压吸宫可薄化子宫内薄 ,电切术后滚球电极电熨切面可灭活由于电切深度不够或宫角处遗漏的内膜 ,与宫腔镜电切术联合应用可提高手术成功率 ,减少术后复发率 ,长期疗效尚待观察
Objective :To investigate the efficacy and prognosis of hysteroscopic electroresection combined with negative pressure evacuation and postoperative electrosurgery for treatment of abnormal uterine bleeding. Methods: Eighty-seven patients with abnormal uterine bleeding who underwent surgical indications were selected. Forty patients underwent endometrial ablation with passive continuous percutaneous transcervical resection. 33 patients underwent myomectomy, 3 patients underwent fibroids and endarterectomy, and 5 underwent polypectomy. For example, polyps and endarterectomy were performed in 6 cases. Result : The operation was completed successfully. After 3 to 11 months of follow-up, the total effective rate was 96.6%, of which uterine fibroids and polypectomy were performed. Postoperative menstruation decreased or returned to normal. 49 cases of endometrial resection also removed fibroids and polyps. Among them, 5 7.1% had no menses, 32.7% menstruation decreased, 4.1% menstruation was normal, the cure rate for dysmenorrhea was 10%, and 59 cases of postoperative anemia were normal after surgery. The effective rate of correcting anemia was 98.3. %. Postoperative complications were 3.4%, intrauterine adhesions and hemorrhage in 1 case, menstruation did not improve in 2 cases. Conclusion: Before hysteroscopic electroresection, negative pressure suction can thin the uterus. After electrocution, the electric surface of the ball electrode can be inactivated due to the insufficient depth of the transect or the occlusion of the endometrium at the angle of the uterus. Combined use of microsurgical resection can improve the success rate of surgery and reduce the postoperative recurrence rate. The long-term efficacy needs to be observed.