發(fā)布時(shí)間：2018-11-27 07:34

【摘要】：異常子宮出血（Abnormal Uterine Bleeding AUB）是臨床常見的婦科癥狀之一，可發(fā)生在月經(jīng)初潮至絕經(jīng)期任何年齡段的女性，包括由調(diào)節(jié)生殖內(nèi)分泌功能失調(diào)引起的功能失調(diào)性子宮出血以及全血或生殖系統(tǒng)器質(zhì)性病變引起的子宮出血兩大類。正常月經(jīng)周期為24-35日，經(jīng)期持續(xù)約2-7日，經(jīng)量多為20-60ml。而異常子宮出血臨床上多表現(xiàn)為月經(jīng)周期紊亂和子宮出血數(shù)量及性質(zhì)的改變，例如：月經(jīng)過多，月經(jīng)頻發(fā)，子宮不規(guī)則出血以及子宮不規(guī)則過多出血等。治療之前需行診斷性檢查，主要有診斷性刮宮、宮腔鏡檢查等。其治療方法臨床上包括藥物治療和手術(shù)治療。藥物治療是功血的一線治療方法，而對(duì)于藥物治療療效不佳或不宜用藥，且無生育要求的患者，尤其是不易隨訪的年齡較大患者，則更側(cè)重于手術(shù)治療，包括傳統(tǒng)子宮切除術(shù)和子宮內(nèi)膜切除術(shù)。 諾舒--阻抗控制子宮內(nèi)膜消融術(shù)，屬于第二代子宮內(nèi)膜切除術(shù)，2001年在美國(guó)最先開展。其作用機(jī)制：以阻抗控制為原理，利用射頻將子宮內(nèi)膜汽化，當(dāng)阻抗控制升高至50，射頻能量加熱并干燥子宮內(nèi)膜組織，當(dāng)干燥程度達(dá)到預(yù)定值且組織切除深度最佳時(shí)，，與設(shè)備接觸的組織阻抗使控制器停止能量傳輸，手術(shù)自動(dòng)停止。切除深度超過淺肌層，設(shè)備即自動(dòng)停止操作，屬于盲操。因此該術(shù)式進(jìn)行操作前必須進(jìn)行診斷性檢查以排除器質(zhì)性病變。結(jié)合國(guó)內(nèi)外文獻(xiàn)報(bào)道及該研究，在術(shù)后腹痛、閉經(jīng)率及患者滿意率來看，均優(yōu)于其它子宮內(nèi)膜切除術(shù)。目的： 探討諾舒(Nova Sure)阻抗控制子宮內(nèi)膜消融術(shù)治療異常子宮出血的療效及臨床意義。資料與方法：研究對(duì)象： 回顧性分析自2011年11月—2013年9月收入吉林大學(xué)第一醫(yī)院并采用諾舒治療異常子宮出血患者50例，其中功能失調(diào)性子宮出血患者26例，貧血16例（輕度貧血9例、中度貧血6例、重度貧血1例）。器質(zhì)性病變所致子宮出血24例，其中貧血18例（輕度貧血3例、中度貧血12例、重度貧血3例），此24例患者中血液系統(tǒng)疾病12例（白血病4例、再障3例、血小板減少2例、MDS1例、SLE1例、全血細(xì)胞減少1例），腎功衰竭（尿毒癥期）6例，高血壓病2例，糖尿病1例，心臟病1例，腦栓塞1例，蛛網(wǎng)膜下腔出血1例。術(shù)后門診隨訪，觀察療效及并發(fā)癥。手術(shù)方法： 采用美國(guó)豪洛捷公司生產(chǎn)的諾舒(Nova-Sure)阻抗控制子宮內(nèi)膜切除系統(tǒng)。入選標(biāo)準(zhǔn)： (1)月經(jīng)過多且無生育要求；(2)藥物治療無效或因自身合并嚴(yán)重內(nèi)科疾病無法耐受手術(shù)的患者；（3）有手術(shù)指證且要求保留子宮的患者；(4)術(shù)前全身系統(tǒng)性檢查以及病理結(jié)果排除生殖系統(tǒng)器質(zhì)性病變；(5)宮腔深度為4-10cm。排除標(biāo)準(zhǔn)： (1)已妊娠或有生育要求的患者；(2)存在子宮下段肌壁薄弱的解剖或病理情況；(3)異常子宮出血合并子宮腺肌癥的患者；（4）宮頸發(fā)育不良；(5)子宮畸形，例如雙角子宮或縱膈子宮；（6）宮腔深度小于4cm、大于10cm、寬度小于2.5cm；(7)子宮內(nèi)膜癌或癌前病變；(8)目前子宮內(nèi)置宮內(nèi)節(jié)育器；(9)急性盆腔炎；(10)急性生殖道或泌尿道感染。結(jié)果： 諾舒（Nova Sure）治療50例異常子宮出血患者，均順利完成手術(shù)（100%），治療時(shí)間為78-108s，術(shù)中出血＜10ml。50例患者中，失訪7人，在隨訪的43例患者中，據(jù)隨訪數(shù)據(jù)統(tǒng)計(jì)，術(shù)后閉經(jīng)率76.7%(33/43)；下腹部墜痛18.6%。術(shù)中未出現(xiàn)并發(fā)癥，1例于術(shù)后1周出現(xiàn)并發(fā)癥。結(jié)論： 1、諾舒（Nova Sure）阻抗控制子宮內(nèi)膜消融術(shù)是臨床上治療嚴(yán)重內(nèi)科疾病所致子宮出血（器質(zhì)性病變引起的異常子宮出血）的有效方法。 2、諾舒（Nova Sure）阻抗控制子宮內(nèi)膜消融術(shù)治療異常子宮出血安全、術(shù)后閉經(jīng)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
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R713.4

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