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目的观察诺舒阻抗子宫内膜切除术治疗肾衰竭合并异常子宫出血的效果。方法选择2014年4月—2015年12月肾衰竭合并异常子宫出血患者17例,均给予连续性血液透析治疗,采用诺舒阻抗控制子宫内膜切除系统和宫腔镜进行治疗,贫血患者术后给予铁剂纠正贫血。统计手术并发症发生情况、宫腔深度、宫腔宽度、手术时间、术中出血量、住院时间;术后采用月经失血图(pictorial blood loss assessment count,PBLAC)评分评价月经失血,统计治疗有效率、患者满意度;术前及术后3、12个月检测患者血尿素氮、血肌酐及血红蛋白。计量资料比较采用t检验,P<0.05为差异有统计学意义。结果 17例患者均顺利手术,均未发生子宫穿孔、肠穿孔、热损伤、感染、血尿等并发症?宫腔深度4.2~8.7cm,平均(5.21±1.07)cm;宫腔宽度3.2~5.9 cm,平均(4.49±0.82)cm;手术时间35~120 s,平均(70.34±20.37)s;术中出血量8.4~20.3 ml,平均(14.37±5.19)ml。术后住院2~6 d。术后3个月有效率100%,闭经率58.82%;术后12个月有效率100%,闭经率82.35%。术后患者满意度为94.12%。术后3个月贫血纠正率57.14%,术后12个月贫血纠正率85.71%。与术前[(45.03±10.81)mmol/l、(764.8±130.4)μmol/l、(83.09±22.50)g/l]比较,术后3[(29.76±8.53)mmol/l、(482.4±70.0)μmol/l]、12个月[(21.97±7.64)mmol/l、(352.6±60.9)μmol/l]患者血尿素氮、血肌酐水平逐渐降低(均P<0.05),血红蛋白水平[(100.37±20.43)、(108.30±19.24)g/l]逐渐升高(P<0.05)。结论诺舒阻抗控制子宫内膜切除术治疗肾衰竭合并异常子宫出血效果好,可有效纠正贫血,且未影响肾功能。
Objective To observe the effect of nosok resistance endometrial ablation in treating renal failure with abnormal uterine bleeding. Methods From April 2014 to December 2015, 17 patients with renal failure and abnormal uterine bleeding were treated with continuous hemodialysis. Patients were treated with nosocomial resistance endometrial ablation system and hysteroscopy. After aneurysm surgery, Give iron to correct anemia. The incidence of intra-uterine cavity, intra-uterine width, operative time, intraoperative blood loss and hospital stay were calculated. The postoperative menstrual blood loss assessment (PBLAC) score was used to evaluate the menstrual blood loss and the statistical treatment efficiency , Patient satisfaction; blood urea nitrogen, serum creatinine and hemoglobin were measured before and 3 and 12 months after operation. Measurement data were compared using t test, P <0.05 for the difference was statistically significant. Results All the 17 patients underwent surgery successfully. No complications such as uterine perforation, intestinal perforation, thermal injury, infection and hematuria were observed. The depth of uterine cavity was 4.2 ~ 8.7cm (mean 5.21 ± 1.07cm) and the width of uterine cavity was 3.2 ~ 5.9cm , Mean (4.49 ± 0.82) cm. The operation time was 35 to 120 s, with an average of (70.34 ± 20.37) s. The intraoperative blood loss was 8.4-20.3 ml (mean, 14.37 ± 5.19) ml. Postoperative hospital 2 ~ 6 d. Three months after operation, the effective rate was 100% and the rate of amenorrhea was 58.82%. The effective rate was 100% at 12 months and the rate of amenorrhea was 82.35%. Postoperative patient satisfaction was 94.12%. The anemia correction rate was 57.14% 3 months after operation and 85.71% after 12 months. Compared with preoperative [(45.03 ± 10.81) mmol / l, (764.8 ± 130.4) μmol / l, (83.09 ± 22.50) g / l], postoperative 3 [(29.76 ± 8.53) mmol / l, (482.4 ± 70.0 (P <0.05). The levels of hemoglobin [(100.37 ± 7.6) mmol / l, (352.6 ± 60.9) μmol / l) ± 20.43), (108.30 ± 19.24) g / l] (P <0.05). Conclusions Nocex resistance-controlled endometrial resection is effective in treating renal failure with abnormal uterine bleeding, which can effectively correct anemia without affecting renal function.