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目的观察选择性宫腔镜下子宫内膜切除术(TCRE)治疗月经过多型排卵性功能失调性子宫出血(简称月经过多)的临床疗效及不良反应情况。方法选取2009年3月-2010年9月该院妇科门诊收治的43例月经过多患者为研究对象,随机分为治疗组(TCRE,22例)和对照组(传统子宫内膜切除术,21例)。治疗组仅对有病理意义的不规则增厚内膜行切除术,观察并比较其与传统子宫内膜切除术的疗效、手术时间、术后出血量、月经过少及闭经、经期腹痛和术后宫腔粘连的发生情况。结果治疗组治疗有效率为77.3%,与对照组的90.5%相比差异无统计学意义(χ~2=0.611 1,P>0.05)。治疗组平均手术时间为(25.4±9.8)min,显著低于对照组的(43.6±11.7)min,差异有统计学意义(t=5.516 1,P<0.01)。不良反应方面,治疗组术后出血过多、经期腹痛发生率与对照组相比差异无统计学意义(P>0.05),但月经过少及闭经发生率为4.5%,明显低于对照组的42.9%,差异有统计学意义(χ~2=8.836 1,P<0.05)。治疗组术后宫腔粘连发生率为4.5%,显著低于对照组的28.5%,差异有统计学意义(χ~2=4.550 6,P<0.05)。结论 TCRE与传统术式同样有效,但术后不良反应发生率明显低于传统术式,是对传统子宫内膜切除术的有效改良术式。
Objective To observe the clinical efficacy and adverse reactions of selective hysteroscopic endometrial ablation (TCRE) in the treatment of multivariate ovarian dysfunctional uterine bleeding (referred to as menorrhagia). Methods From March 2009 to September 2010, 43 cases of menorrhagia admitted to gynecology outpatient department in our hospital were selected and randomly divided into treatment group (TCRE, 22 cases) and control group (conventional endometrial ablation, 21 example). The treatment group only for pathological significance of irregular thickening of the endometrium resection, observation and comparison with the traditional endometrial resection efficacy, operative time, postoperative bleeding, menorrhagia and menopause, menstrual abdominal pain and surgery Posterior uterine adhesions occurred. Results The effective rate of treatment in the treatment group was 77.3%, which was not significantly different from that in the control group (χ ~ 2 = 0.611 1, P> 0.05). The average operation time of the treatment group was (25.4 ± 9.8) min, which was significantly lower than that of the control group (43.6 ± 11.7) min, the difference was statistically significant (t = 5.516 1, P <0.01). Adverse reactions, the treatment group had excessive bleeding, the incidence of abdominal pain during menstruation compared with the control group was no significant difference (P> 0.05), but the incidence of menorrhagia and amenorrhea was 4.5%, significantly lower than the control group 42.9%, the difference was statistically significant (χ ~ 2 = 8.836 1, P <0.05). The incidence of intrauterine adhesions in the treatment group was 4.5%, which was significantly lower than that in the control group (28.5%) (χ ~ 2 = 4.5506, P <0.05). Conclusion TCRE is as effective as traditional surgical procedures, but the incidence of postoperative adverse reactions is significantly lower than that of traditional surgical procedures. It is an effective modality for traditional endometrial ablation.