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

【摘要】：目的:異常子宮出血(abnormal uterine bleeding,AUB)是嚴重影響患者精神、心理及生活質量的一種疾病。其治療方法主要分為藥物治療及手術治療兩種,其中諾舒阻抗子宮內膜去除術(Nova Sure impedance controlled endometrial ablation,Nova Sure)適用于藥物治療無效或合并藥物相關禁忌癥、拒絕切除子宮且同時無生育要求的以月經量過多為臨床表現(xiàn)的患者。本文旨在探討諾舒阻抗子宮內膜去除術在治療以月經量過多為臨床表現(xiàn)的異常子宮出血中的臨床療效及不良反應,并評價其有效性、安全性。方法:選擇2015年1月~2016年3月于河北省人民醫(yī)院因月經量過多行諾舒阻抗子宮內膜去除術的患者36例,所有患者均排除了妊娠可能,且無生育要求、術前均已行診斷性刮宮術排除了子宮內膜惡性病變。術前對所有患者行月經量PBLAC評分、痛經程度VAS評分以及血紅蛋白測定,并于術后1個月、3個月、6個月及12個月定期隨訪觀察并記錄上述各指標數(shù)值,分別與術前對比來評價治療的效果。數(shù)據采用統(tǒng)計軟件SPSS 17.0行統(tǒng)計學分析,計數(shù)資料用頻數(shù)及率表示;計量資料分布如符合正態(tài)性,采用“均數(shù)±標準差(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;計量資料的對比采用配對t檢驗/Wilcoxon配對秩和檢驗。取α=0.05為檢驗水準,以P0.05為差異有統(tǒng)計學意義。結果:1術中基本情況:36名患者均順利完成手術,術中測量宮腔深度、宮腔寬度以及手術時間、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月經量PBLAC評分情況:患者術前PBLAC評分為281.50(195.50,325.50),術后1個月、3個月、6個月及12個月分別為:0(0,14.75)、0(0,8.75)、0(0,9.00)及0(0,7.75),與術前相比均下降,差異具有統(tǒng)計學意義(P0.05)。3痛經程度VAS情況:36名患者術前痛經程度VAS得分為4(0,6.00),其中合并有痛經的人數(shù)為21名,術后1個月、3個月、6個月及12個月時人數(shù)分別為12名、8名、6名和5名,且VAS評分較術前均降低,差異有統(tǒng)計學意義(P0.05)。4血紅蛋白情況:患者術前血紅蛋白平均值為89.25±19.33g/L,術后1個月、3個月、6個月及12個月時分別為:104.17±13.45g/L、117.72±11.30g/L、118.92±9.80g/L及120.50±6.70g/L,與術前相比均升高,差異具有統(tǒng)計學意義(P0.05)。5術后1個月、3個月、6個月及12個月時手術有效率均為97.2%;患者閉經率分別為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%;手術滿意率為97.2%、94.4%、94.4%及91.7%。結論:諾舒阻抗子宮內膜去除術可有效減少月經量、緩解痛經程度、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,具有手術時間短、術前無需特殊處理、操作易于掌握以及適用于伴隨有多種內科合并癥的情況等一系列優(yōu)點,具有很大臨床價值。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R713.4

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