本文選題：異常子宮出血 + 諾舒阻抗子宮內(nèi)膜去除術(shù)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:異常子宮出血(abnormal uterine bleeding,AUB)是嚴(yán)重影響患者精神、心理及生活質(zhì)量的一種疾病。其治療方法主要分為藥物治療及手術(shù)治療兩種,其中諾舒阻抗子宮內(nèi)膜去除術(shù)(Nova Sure impedance controlled endometrial ablation,Nova Sure)適用于藥物治療無效或合并藥物相關(guān)禁忌癥、拒絕切除子宮且同時(shí)無生育要求的以月經(jīng)量過多為臨床表現(xiàn)的患者。本文旨在探討諾舒阻抗子宮內(nèi)膜去除術(shù)在治療以月經(jīng)量過多為臨床表現(xiàn)的異常子宮出血中的臨床療效及不良反應(yīng),并評(píng)價(jià)其有效性、安全性。方法:選擇2015年1月~2016年3月于河北省人民醫(yī)院因月經(jīng)量過多行諾舒阻抗子宮內(nèi)膜去除術(shù)的患者36例,所有患者均排除了妊娠可能,且無生育要求、術(shù)前均已行診斷性刮宮術(shù)排除了子宮內(nèi)膜惡性病變。術(shù)前對(duì)所有患者行月經(jīng)量PBLAC評(píng)分、痛經(jīng)程度VAS評(píng)分以及血紅蛋白測(cè)定,并于術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月定期隨訪觀察并記錄上述各指標(biāo)數(shù)值,分別與術(shù)前對(duì)比來評(píng)價(jià)治療的效果。數(shù)據(jù)采用統(tǒng)計(jì)軟件SPSS 17.0行統(tǒng)計(jì)學(xué)分析,計(jì)數(shù)資料用頻數(shù)及率表示;計(jì)量資料分布如符合正態(tài)性,采用“均數(shù)±標(biāo)準(zhǔn)差(X_±S)”表示,如不符合正態(tài)性,用中位數(shù)(M)和上、下四分位數(shù)(P25,P75)表示;計(jì)量資料的對(duì)比采用配對(duì)t檢驗(yàn)/Wilcoxon配對(duì)秩和檢驗(yàn)。取α=0.05為檢驗(yàn)水準(zhǔn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1術(shù)中基本情況:36名患者均順利完成手術(shù),術(shù)中測(cè)量宮腔深度、宮腔寬度以及手術(shù)時(shí)間、所用功率、出血量分別為:5.55±0.67cm、4.17±0.26cm、90.53±13.91s、110.69±16.22w及5.31±2.04ml。2月經(jīng)量PBLAC評(píng)分情況:患者術(shù)前PBLAC評(píng)分為281.50(195.50,325.50),術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月分別為:0(0,14.75)、0(0,8.75)、0(0,9.00)及0(0,7.75),與術(shù)前相比均下降,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3痛經(jīng)程度VAS情況:36名患者術(shù)前痛經(jīng)程度VAS得分為4(0,6.00),其中合并有痛經(jīng)的人數(shù)為21名,術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月時(shí)人數(shù)分別為12名、8名、6名和5名,且VAS評(píng)分較術(shù)前均降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4血紅蛋白情況:患者術(shù)前血紅蛋白平均值為89.25±19.33g/L,術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月時(shí)分別為:104.17±13.45g/L、117.72±11.30g/L、118.92±9.80g/L及120.50±6.70g/L,與術(shù)前相比均升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5術(shù)后1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月時(shí)手術(shù)有效率均為97.2%;患者閉經(jīng)率分別為58.3%、66.7%、66.7%及69.4%;性生活滿意率為75.00%、80.56%、91.67%及91.67%;手術(shù)滿意率為97.2%、94.4%、94.4%及91.7%。結(jié)論:諾舒阻抗子宮內(nèi)膜去除術(shù)可有效減少月經(jīng)量、緩解痛經(jīng)程度、改善貧血以及提高性生活滿意率,在異常子宮出血的治療中療效確切、安全性高,具有手術(shù)時(shí)間短、術(shù)前無需特殊處理、操作易于掌握以及適用于伴隨有多種內(nèi)科合并癥的情況等一系列優(yōu)點(diǎn),具有很大臨床價(jià)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 鹵standard deviation X _ 鹵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 鹵0.67 cm / min 4.17 鹵0.26 cm / min 90.53 鹵13.91 sl / s 110.69 鹵16.22 w and 5.31 鹵2.04ml.2 / month PBLAC respectively: the preoperative PBLAC score was 281.50 鹵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 鹵19.33g / L, and was 104.17 鹵13.45g / L 117.72 鹵11.30g / L 118.92 鹵118.92 鹵120.50 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R713.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 李丹;萬亞軍;慕慶玲;;諾舒治療子宮腺肌病30例臨床療效分析[J];中南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2016年01期

2 陸婕;吳曉杰;朱巍立;;諾舒阻抗控制子宮內(nèi)膜切除系統(tǒng)治療無生育要求的子宮內(nèi)膜息肉的臨床研究[J];中國(guó)現(xiàn)代醫(yī)生;2016年01期

3 邊茜;馮力民;郭蕾;王明;;諾舒阻抗控制子宮內(nèi)膜去除術(shù)臨床觀察研究[J];中國(guó)計(jì)劃生育和婦產(chǎn)科;2015年11期

4 韋利英;趙仁峰;;諾舒子宮內(nèi)膜切除術(shù)系統(tǒng)臨床應(yīng)用的研究進(jìn)展[J];中國(guó)婦幼保健;2015年10期

5 余煒昶;王燕;劉玉蘭;孫冬巖;邢琦;董毅;郎雁;董虹;;諾舒阻抗控制系統(tǒng)治療子宮內(nèi)膜增生癥45例臨床觀察[J];華中科技大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2014年02期

6 韋利英;趙仁峰;李雪;楊月明;黃暉媛;黃偉龍;;諾舒阻抗控制子宮內(nèi)膜切除系統(tǒng)治療月經(jīng)過多66例臨床分析[J];中國(guó)臨床新醫(yī)學(xué);2013年12期

7 王明;馮力民;;宮腔鏡子宮內(nèi)膜去除術(shù)的沿革、現(xiàn)狀及前景[J];國(guó)際婦產(chǎn)科學(xué)雜志;2012年05期

8 吳瑞瑾;江橋英;;月經(jīng)過多的診治分析[J];中華全科醫(yī)師雜志;2011年12期

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