诺舒阻抗子宫内膜去除术治疗异常子宫出血的临床疗效及评价

发布时间：2018-05-19 12:33

本文选题：异常子宫出血 + 诺舒阻抗子宫内膜去除术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:异常子宫出血(abnormal uterine bleeding,AUB)是严重影响患者精神、心理及生活质量的一种疾病。其治疗方法主要分为药物治疗及手术治疗两种,其中诺舒阻抗子宫内膜去除术(Nova Sure impedance controlled endometrial ablation,Nova Sure)适用于药物治疗无效或合并药物相关禁忌症、拒绝切除子宫且同时无生育要求的以月经量过多为临床表现的患者。本文旨在探讨诺舒阻抗子宫内膜去除术在治疗以月经量过多为临床表现的异常子宫出血中的临床疗效及不良反应,并评价其有效性、安全性。方法:选择2015年1月~2016年3月于河北省人民医院因月经量过多行诺舒阻抗子宫内膜去除术的患者36例,所有患者均排除了妊娠可能,且无生育要求、术前均已行诊断性刮宫术排除了子宫内膜恶性病变。术前对所有患者行月经量PBLAC评分、痛经程度VAS评分以及血红蛋白测定,并于术后1个月、3个月、6个月及12个月定期随访观察并记录上述各指标数值,分别与术前对比来评价治疗的效果。数据采用统计软件SPSS 17.0行统计学分析,计数资料用频数及率表示;计量资料分布如符合正态性,采用“均数±标准差(X_±S)”表示,如不符合正态性,用中位数(M)和上、下四分位数(P25,P75)表示;计量资料的对比采用配对t检验/Wilcoxon配对秩和检验。取α=0.05为检验水准,以P0.05为差异有统计学意义。结果:1术中基本情况:36名患者均顺利完成手术,术中测量宫腔深度、宫腔宽度以及手术时间、所用功率、出血量分别为:5.55±0.67cm、4.17±0.26cm、90.53±13.91s、110.69±16.22w及5.31±2.04ml。2月经量PBLAC评分情况:患者术前PBLAC评分为281.50(195.50,325.50),术后1个月、3个月、6个月及12个月分别为:0(0,14.75)、0(0,8.75)、0(0,9.00)及0(0,7.75),与术前相比均下降,差异具有统计学意义(P0.05)。3痛经程度VAS情况:36名患者术前痛经程度VAS得分为4(0,6.00),其中合并有痛经的人数为21名,术后1个月、3个月、6个月及12个月时人数分别为12名、8名、6名和5名,且VAS评分较术前均降低,差异有统计学意义(P0.05)。4血红蛋白情况:患者术前血红蛋白平均值为89.25±19.33g/L,术后1个月、3个月、6个月及12个月时分别为:104.17±13.45g/L、117.72±11.30g/L、118.92±9.80g/L及120.50±6.70g/L,与术前相比均升高,差异具有统计学意义(P0.05)。5术后1个月、3个月、6个月及12个月时手术有效率均为97.2%;患者闭经率分别为58.3%、66.7%、66.7%及69.4%;性生活满意率为75.00%、80.56%、91.67%及91.67%;手术满意率为97.2%、94.4%、94.4%及91.7%。结论:诺舒阻抗子宫内膜去除术可有效减少月经量、缓解痛经程度、改善贫血以及提高性生活满意率,在异常子宫出血的治疗中疗效确切、安全性高,具有手术时间短、术前无需特殊处理、操作易于掌握以及适用于伴随有多种内科合并症的情况等一系列优点,具有很大临床价值。
[Abstract]:Objective: abnormal uterine bleeding (abnormal uterine bleached AUB) is a disease that seriously affects the mental, psychological and quality of life of patients. There are two kinds of treatment methods: drug therapy and surgical treatment. Nosco Impedance Endometride removal (Nova Sure impedance controlled endometrial ablation Nova Sure) is suitable for drug treatment or combination with drug related contraindication. Women who refuse to remove the uterus and have no fertility requirements are clinically characterized by excessive menstruation. The purpose of this study was to investigate the clinical efficacy and adverse reactions of Noushu Impedance Endometrization in the treatment of abnormal uterine bleeding with excessive menstrual volume, and to evaluate its efficacy and safety. Methods: from January 2015 to March 2016, 36 patients with endometrial removal due to excessive menstrual volume in Hebei Provincial people's Hospital were selected. All the patients excluded the possibility of pregnancy and had no requirement to have children. Preoperative diagnosis curettage has excluded malignant endometrial lesions. Menstrual volume PBLAC score, dysmenorrhea VAS score and hemoglobin measurement were performed on all patients before operation, and the values were observed and recorded 1 month, 3 months, 6 months and 12 months after the operation. The effect of treatment was evaluated by comparing with preoperative. The data were analyzed by statistical software SPSS 17.0, the counting data were expressed by frequency and rate, the distribution of measurement data was expressed by "mean 卤standard deviation X _ 卤S" if the distribution of measurement data was consistent with normality, and if it did not conform to normality, it was expressed by median value. The lower quartile is P25 / P75), and the comparison of the measurement data is made by using the matched t test and Wilcoxon pairing rank sum test. A 0.05 as the test level, with P0.05 as the difference was statistically significant. Results the basic condition of the operation was: 36 patients successfully completed the operation. The depth of the uterine cavity, the width of the uterine cavity, the duration of the operation and the power used during the operation were measured. The blood loss was 5.55 卤0.67 cm / min 4.17 卤0.26 cm / min 90.53 卤13.91 sl / s 110.69 卤16.22 w and 5.31 卤2.04ml.2 / month PBLAC respectively: the preoperative PBLAC score was 281.50 卤195.50325.50%, and 1 month, 3 months, 6 months and 12 months after the operation were respectively: 1: 0 0 0 75 0 0 8. 75 0 0 9 00) and 0 0 0 7 7 0 0 0 7. 75 0, compared with before operation, the PBLAC scores of the patients were all lower than those of the patients before operation, and were significantly lower than those of the patients before operation, and were lower at 1 month, 3 months, 6 months and 12 months after operation, respectively. The VAS scores of 36 patients with dysmenorrhea before operation were 4 0 or 6.00, including 21 patients with dysmenorrhea, 12 patients with dysmenorrhea at 1 month, 3 months, 6 months and 12 months after operation, 6 patients with dysmenorrhea degree, 6 patients with dysmenorrhea degree before operation and 5 patients with dysmenorrhea degree at 12 months after operation. The VAS score was significantly lower than that before operation (P 0.054.The mean hemoglobin before operation was 89.25 卤19.33g / L, and was 104.17 卤13.45g / L 117.72 卤11.30g / L 118.92 卤118.92 卤120.50 卤6.70g / L respectively at 1 month, 3 months, 6 months and 12 months after operation). The difference was statistically significant at 1 month, 3 months, 6 months and 12 months after operation, the effective rate of operation was 97.2, the rate of amenorrhea was 66.7% and 69.4%, the satisfaction rate of sexual life was 91.67% and 91.67%, and the satisfaction rate of operation was 97.24.44% and 91.7%, respectively. Conclusion: Nuoshu impedance endometrial removal can effectively reduce menstrual volume, relieve dysmenorrhea, improve anemia and increase sexual satisfaction rate. It is effective and safe in the treatment of abnormal uterine bleeding. There are a series of advantages, such as no special treatment before operation, easy to grasp and suitable for complicated cases of various internal medicine, which has great clinical value.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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