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目的探讨微波子宫内膜去除术(MEA)治疗异常子宫出血的疗效、适应证和并发症。方法应用MEA治疗良性病变所致异常子宫出血患者168例,术前行刮宫术薄化子宫内膜,然后“Z”字形烧灼宫腔后再以“W”形烧灼宫腔,术后1、3、6、12、24个月随访患者的月经、贫血症状改善及并发症发生情况。结果平均手术时间为(286±75)s;平均随访时间(22±6)个月。绝经前患者156例中,术后闭经97例(62.2%),月经正常56例(35.9%),少量不规则阴道出血3例(1.9%);治疗满意率为98.1%(153/156)。119例随访到术后2年以上,疗效稳定。107例合并贫血,术前血红蛋白为(83±24)g/L,术后3个月升至(117±18)g/L,手术前后比较,差异有统计学意义(P<0.01)。痛经改善率为74.5%(35/47)。绝经后患者12例,术后均无出血。168例中47例合并严重内科疾病,全部手术成功,术中无并发症发生。术后发生子宫内膜炎12例,2例宫腔积血,1例因输卵管绝育子宫内膜去除术后综合征行子宫切除术。结论MEA操作简单、安全、疗效好,适用于多种良性疾病所致的异常子宫出血。尤其适用于有严重内科合并症的患者。充分且完整地破坏子宫内膜全层,是治疗成功的关键。严格掌握适应证可减低并发症的发生。
Objective To investigate the curative effect, indications and complications of microwave endometrial ablation (MEA) in the treatment of abnormal uterine bleeding. Methods A total of 168 patients with abnormal uterine bleeding caused by benign lesions were treated with MEA. Thinning of the endometrium was performed by curettage before surgery, then “Z” shape was used to burn the uterine cavity and then “W” , 6,12,24 months follow-up of patients with menstruation, anemia and improve the incidence of complications. Results The average operation time was (286 ± 75) s; mean follow-up time was (22 ± 6) months. Among the 156 premenopausal patients, 97 (62.2%) had amenorrhea, 56 (35.9%) had normal menstruation and 3 (1.9%) had a small amount of irregular vaginal bleeding. The satisfaction rate was 98.1% (153/156). 119 cases were followed up more than 2 years after operation, the effect was stable. There were 107 cases of anemia with preoperative hemoglobin of (83 ± 24) g / L and an increase of 117 ± 18 g / L at 3 months after operation. The difference was statistically significant before and after operation (P <0.01). Dysmenorrhea improvement rate was 74.5% (35/47). Postmenopausal patients in 12 cases, no bleeding after surgery. Of the 168 cases, 47 cases were complicated with medical diseases, all the operations were successful and no intraoperative complications occurred. Postoperative endometritis occurred in 12 cases, 2 cases of uterine hemorrhage, 1 case of tubal sterilization due to tubal sterilization after hysterectomy hysterectomy. Conclusion MEA is simple, safe and effective. It is suitable for abnormal uterine bleeding caused by many benign diseases. Especially for patients with severe medical comorbidities. Full and complete destruction of the endometrial full-thickness, the key to the success of the treatment. Strict control of indications can reduce the incidence of complications.