术前子宫内膜薄化在宫腔镜治疗功能失调性子宫出血的价值

摘要

Objective: To explore the clinical value of pre-operative endometrial thinning in dysfunctional uterine bleeding (DUB) patients trated by hysteroscopic transcervical resection of endometrium (TCRE). Methods: 52 cases diagnosed as DUB were randomly divided into endometrial thinning group and non-endometrial thinning group, 26 cases in each group,which were given pre-operative endometrial thinning or not given pre-operative endometrial thinning. The two groups were given the same TCRE operation, and they were all reviewed 3 months later. Results: There were none case of uterine perforation occurred. The mean operative time, intraoperative fluid absorption and blood loss of endometrial thinning group were lower than those of non-endometrial thinning group, and there were significant differences between the two groups (t=4.444, P=0.000; t=5.074, P=0.000; t=5.546, P=0.000), but there was no significant difference in the postoperative hospital stay time between the two group (t=0.284, P=0.567). After TURE, the endometrial thickness of endometrial thinning group was thinner than that of non-endometrial thinning group, and there was a significant difference between the two groups (t=3.798, P=0.000); but there was no significant difference of the muscle thickness under endometrial between the two groups (t=0.901, P=0.372). After three months, there were no postoperative bleeding, no intrauterine infection and no intrauterine adhesions in all patients. There was no significant difference of menstruation between the two groups (t=0.754, P=0.686).Conclusion: Pre-operative endometrial thinning in dysfunctional uterine bleeding by hysteroscopy can shorten the operation time, less blood loss, but does not increase postoperative complications.%目的:探讨子宫内膜薄化预处理在宫腔镜子宫内膜电切术(TCRE)治疗功能失调性子宫出血(DUB)中的价值.方法:将52例诊断明确的DUB患者随机分为内膜薄化组和非内膜薄化组,每组各26例.分别给予和不给予薄化预处理.TCRE手术的方法相同.3个月后复查.结果:两组患者术中无一例发生子宫穿孔并发症.内膜薄化预组平均手术时间、术中液体吸收量及术中出血量与非内膜薄化组比较,差异有统计学意义(t=4.444,P=0.000;t=5.074,P=0.000;t=5.546,P=0.000);而术后住院天数比较,差异无统计学意义(t=0.284,P=0.567).电切后,内膜薄化组的内膜厚度较非内膜薄化组薄,差异有统计学意义(t=3.798,P=0.000);而内膜下肌层厚度两组比较,差异无统计学意义(t=0.901,P=0.372).术后3个月内,两组均无术后出血、宫腔内感染、宫腔粘连发生,DUB月经情况比较,差异无统计学意义(t=0.754,P=0.686).结论:宫腔镜子宫内膜电切术治疗功能失调性子宫出血前行薄化预处理,可缩短手术时间、减少术中出血,但并不增加术后并发症.