诺舒（Nova Sure）阻抗控制子宫内膜消融术治疗异常子宫出血50例临床分析

发布时间：2018-11-27 07:34

【摘要】：异常子宫出血（Abnormal Uterine Bleeding AUB）是临床常见的妇科症状之一，可发生在月经初潮至绝经期任何年龄段的女性，包括由调节生殖内分泌功能失调引起的功能失调性子宫出血以及全血或生殖系统器质性病变引起的子宫出血两大类。正常月经周期为24-35日，经期持续约2-7日，，经量多为20-60ml。而异常子宫出血临床上多表现为月经周期紊乱和子宫出血数量及性质的改变，例如：月经过多，月经频发，子宫不规则出血以及子宫不规则过多出血等。治疗之前需行诊断性检查，主要有诊断性刮宫、宫腔镜检查等。其治疗方法临床上包括药物治疗和手术治疗。药物治疗是功血的一线治疗方法，而对于药物治疗疗效不佳或不宜用药，且无生育要求的患者，尤其是不易随访的年龄较大患者，则更侧重于手术治疗，包括传统子宫切除术和子宫内膜切除术。诺舒--阻抗控制子宫内膜消融术，属于第二代子宫内膜切除术，2001年在美国最先开展。其作用机制：以阻抗控制为原理，利用射频将子宫内膜汽化，当阻抗控制升高至50，射频能量加热并干燥子宫内膜组织，当干燥程度达到预定值且组织切除深度最佳时，与设备接触的组织阻抗使控制器停止能量传输，手术自动停止。切除深度超过浅肌层，设备即自动停止操作，属于盲操。因此该术式进行操作前必须进行诊断性检查以排除器质性病变。结合国内外文献报道及该研究，在术后腹痛、闭经率及患者满意率来看，均优于其它子宫内膜切除术。目的：探讨诺舒(Nova Sure)阻抗控制子宫内膜消融术治疗异常子宫出血的疗效及临床意义。资料与方法：研究对象：回顾性分析自2011年11月—2013年9月收入吉林大学第一医院并采用诺舒治疗异常子宫出血患者50例，其中功能失调性子宫出血患者26例，贫血16例（轻度贫血9例、中度贫血6例、重度贫血1例）。器质性病变所致子宫出血24例，其中贫血18例（轻度贫血3例、中度贫血12例、重度贫血3例），此24例患者中血液系统疾病12例（白血病4例、再障3例、血小板减少2例、MDS1例、SLE1例、全血细胞减少1例），肾功衰竭（尿毒症期）6例，高血压病2例，糖尿病1例，心脏病1例，脑栓塞1例，蛛网膜下腔出血1例。术后门诊随访，观察疗效及并发症。手术方法：采用美国豪洛捷公司生产的诺舒(Nova-Sure)阻抗控制子宫内膜切除系统。入选标准： (1)月经过多且无生育要求；(2)药物治疗无效或因自身合并严重内科疾病无法耐受手术的患者；（3）有手术指证且要求保留子宫的患者；(4)术前全身系统性检查以及病理结果排除生殖系统器质性病变；(5)宫腔深度为4-10cm。排除标准： (1)已妊娠或有生育要求的患者；(2)存在子宫下段肌壁薄弱的解剖或病理情况；(3)异常子宫出血合并子宫腺肌症的患者；（4）宫颈发育不良；(5)子宫畸形，例如双角子宫或纵膈子宫；（6）宫腔深度小于4cm、大于10cm、宽度小于2.5cm；(7)子宫内膜癌或癌前病变；(8)目前子宫内置宫内节育器；(9)急性盆腔炎；(10)急性生殖道或泌尿道感染。结果：诺舒（Nova Sure）治疗50例异常子宫出血患者，均顺利完成手术（100%），治疗时间为78-108s，术中出血＜10ml。50例患者中，失访7人，在随访的43例患者中，据随访数据统计，术后闭经率76.7%(33/43)；下腹部坠痛18.6%。术中未出现并发症，1例于术后1周出现并发症。结论： 1、诺舒（Nova Sure）阻抗控制子宫内膜消融术是临床上治疗严重内科疾病所致子宫出血（器质性病变引起的异常子宫出血）的有效方法。 2、诺舒（Nova Sure）阻抗控制子宫内膜消融术治疗异常子宫出血安全、术后闭经率高。
[Abstract]:Abnormal uterine bleeding (AUB) is one of the most common gynecological symptoms, and can occur in women of any age at the beginning of menstruation. including dysfunctional uterine bleeding due to dysregulation of reproductive endocrine function, and metrorrhagia due to the organic pathological changes of the whole blood or the reproductive system. The normal menstrual cycle is 24-35 days, and the menstrual period lasts for about 2-7 days, and the menstrual period is 20-60ml. The clinical manifestations of abnormal uterine bleeding are the changes of the menstrual cycle and the number and nature of the uterine bleeding, such as hypermenorrhea, frequent menstruation, irregular uterine bleeding, and excessive bleeding of the uterus. The diagnostic examination should be performed before treatment, mainly including diagnostic curettage, hysteroscopy, etc. The treatment method comprises the following steps of: The treatment of drugs is a first-line method of treatment of the work blood, and for patients with poor curative effect or not suitable for drug treatment, and the patients with no reproductive requirements, especially those who are not easy to follow-up, are more focused on the surgical treatment, including the traditional hysterectomy and the endometrial resection. Nenoch--impedance-controlled endometrial ablation, which is a second-generation endometrial ablation, first opened in the United States in 2001 The mechanism of action: using impedance control as the principle, using radio frequency to vaporize the endometrium, heating and drying the endometrial tissue when the impedance control is raised to 50, heating the radio frequency energy and drying the endometrial tissue, and when the degree of dryness reaches a predetermined value and the tissue cutting depth is optimal, The tissue impedance in contact with the device stops the energy transfer by the controller, and the operation stops automatically. Stop. The cut-out depth exceeds the superficial muscle layer, and the device stops the operation automatically, and belongs to the blind. Operation. Therefore, a diagnostic test must be performed before the operation is performed to eliminate organic disease Varied. Combined with the domestic and foreign literature reports and the study, it is superior to other endometrial ablation in terms of postoperative abdominal pain, amenorrhea rate and patient satisfaction rate. operation Objective: To investigate the effect and application of the impedance-controlled endometrial ablation in the treatment of abnormal uterine bleeding. The meaning of the bed, the data and the method: the research Study object: A retrospective analysis of 50 patients with abnormal uterine bleeding from November 2011 to September 2013 in the first hospital of Jilin University, including 26 patients with dysfunctional uterine bleeding and 16 cases of anemia (9 cases of mild anemia). 6 cases of degree of anemia, severe (1 case of anemia). 24 cases of uterine bleeding caused by organic disease, including 18 cases of anemia (3 cases of mild anemia, 12 cases of moderate anemia, 3 cases of severe anemia), 12 cases of blood system diseases (4 cases of leukemia, 3 cases of aplastic anemia, 2 cases of thrombocytopenia, and MDS1) in 24 patients. SILE1 case, total blood cell reduction (1 case), renal failure (uremia stage) 6 cases, hypertension 2 cases, diabetes 1 case, heart disease 1 case, cerebral embolism 1 case, and subarachnoid space One case of cavity hemorrhage. The follow-up of the postoperative clinic and the observation of the treatment effect and complications. Methods of operation: Noval (Nova-Sure) impedance control manufactured by the U.S. Endometrial resection System. Inclusion criteria: (1) too many and no reproductive requirements; (2) patients who are not effective in drug treatment or who are unable to tolerate the procedure due to their own serious medical conditions; (3) have surgical indications and Patients requiring retention of the uterus; (4) systemic systemic and pathological findings prior to the procedure to exclude organic lesions of the reproductive system; (5) uterine cavity The depth is 4-10cm. Exclusion criteria: (1) a patient that is pregnant or having a reproductive requirement; (2) an anatomical or pathological condition where the muscular wall of the lower segment of the uterus is weak; (3) a patient with abnormal uterine bleeding with adenomyosis; and (4) a cervical hair. (6) endometrial carcinoma or pre-cancerous lesions; (8) current intrauterine device; (9) acute pelvic inflammatory disease; (10) acute Results: The operation (100%) was successfully completed in 50 patients with abnormal uterine bleeding (100%), the treatment time was 78-108s, and the bleeding was less than 10ml in the operation. 76. 7% (33/ 4 3). The lower abdominal pain was 18. 6%. No complications were observed in the operation. 1 case Complications were present at 1 week post-operation. Conclusion: 1, Novolo (NovaSure) impedance control endometrial ablation is a clinical treatment for uterine bleeding due to severe internal medical conditions (organic lesions an effective method for abnormal uterine bleeding). Noval (NovaSure) impedance controls endometrial ablation
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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