[目的]探讨宫腔镜下月经过多型排卵性功血患者子宫内膜的形态学改变和选择性子宫内膜切除术对其的治疗效果.[方法]选取2013年1月至2015年1月本院收治的月经过多型排卵性DUB患者120例为观察组,选取同期80例月经正常志愿者为对照组,分别运用宫腔镜观察两组对象子宫内膜性状.检查结束后,按照随机数字表法将观察组分成治疗1组和治疗2组,各60例,治疗1组行宫腔镜下选择性子宫内膜切除术,治疗2组行传统子宫内膜切除术,观察两组治疗效果和并发症发生率.[结果]观察组患者内膜多呈局灶性改变,内膜不规则区腺体面积平均为(14567.7±3029.1)μm2,明显高于对照组(9983.6±3145.5)μm2,比较差异有统计学意义(P＜0.05);观察组不规则内膜区腺体密度平均为(1.41±0.79),明显低于对照组(1.89士0.64),比较差异有统计学意义(P＜0.05);观察组不规则内膜区螺旋小动脉的截面积为398.7±84.μm2,明显大于对照组(321.8±102.8μm2),比较差异有统计学意义(P＜0.05).观察组内膜不规则区雌激素受体(ER)表达计分为(1.68±0.37)分,明显高于对照组(1.36±0.40)分,比较差异有统计学意义(P＜0.05);孕激素受体(PR)表达计分为(1.91±0.32)分,和对照组(1.82士0.41)分比较,差异无统计学意义(P＞0.05).两组均经宫腔镜下手术治疗,治疗1组(选择性内膜切除术)有效率为78.33％,治疗2组(传统手术)有效率为90.00％,治疗1组有效率略低于治疗2组(x2=3.0641,P=0.0800)但无统计学意义;治疗1组平均手术时间、术后月经过少和闭经例数、术后6个月复查宫腔粘连情况,均明显优于治疗Ⅱ组,比较差异有统计学意义(P＜0.05).[结论]月经过多型排卵性功血患者子宫内膜于宫腔镜下呈局灶性改变,内膜不规则增厚区是引发月经过多的主要病理改变区.宫腔镜下选择性子宫内膜切除术具有和传统术式同样的治疗效果,且术后并发症较低,是对传统子宫内膜切除术的有效改良术式.%[Objective]To investigate the morphology changes of menorrhagia ovulatory dysfunctional uterine patients in hysteroscopy and therapeutic effect of selective endometrial resection.[Methods]From January 2013 to January 2015,120 cases of menorrhagia DUB patients in our hospital were selected as the observation group,and 80 normal menstrual volunteers were selected as the control group,hysteroscopy was used to observe the endometrial characteristics of the two groups.After the examination,according to the random number table method,the observation group was divided into treatment group 1 and treatment group 2,60 cases in each group.The groups 1 was treated with selective endometrial resection under hysteroscopy.And the group 2 was treated with traditional endometrial resection.The therapeutic effect and complication rate of the two groups were observed.[Results] In the observation group,the endometrium showed focal changes,and the average glandular area in irregular zone of endometrium was (l4567.7 ± 3029.1) μm2,which was significantly higher than that of the control group (9983.6±3145.5) μm2,and the difference was statistically significant (P ＜0.05);The average density of glandular cells in the irregular endometrium of the observation group was (1.41±0.79),which was significantly lower than that of the control group (1.89±0.64),and the difference was statistically significant (P ＜0.05);The cross-sectional area of spiral arterioles in the irregular endometrium was 398.7 ± 84.μm2 in the observation group,which was significantly higher than that in the control group (321.8± 102.8μm2),and the difference was statistically significant (P ＜0.05).The expression of estrogen receptor (ER) in the irregular endometrium of the observation group was (1.68 ±0.37) points,which was significantly higher than that of the control group (1.36± 0.40),and the difference was statistically significant(P ＜0.05).Progesterone receptor (PR) expression score was (1.91±0.32) points,and compared with the control group (1.82 ±0.41) points,the difference was not statistically significant (P ＞0.05).The two groups were treated by hysteroscopy,and the effective rate of the group 1 (selective endarterectomy) was 78.33％,the effective rate of the group 2 (traditional surgery) was 90％,and the effective rate of the group 1 was slightly lower than that of the treatment group 2 (x2 =3.0641,P =0.0800),but there was no statistical significance.The average operation time,the number of postoperative amenorrhea,and the intrauterine adhesions after 6 months of treatment in the 1 groups were significantly better than those in the treatment group 2,the difference was statistically significant (P ＜0.05).[Conclusion] Patients of menorrhagia ovulatory dys functional uterine show focal change in hysteroscopy,irregular thickening of endometrium is the main pathological change area causing menorrhagia.Hysteroscopic selective endometrial resection has the same therapeutic effect as traditional surgery,and the postoperative complications are low,which is an effective way to improve the traditional endometrial resection.
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