[Evaluation on clinical application and long term outcomes of transcervical resection of endometrium].
Ключавыя словы
Рэферат
OBJECTIVE
To evaluate the short term and long term outcomes of abnormal uterine bleeding (AUB) treated by transcervical resection of endometrium (TCRE) as well as the factors which influence the outcomes.
METHODS
From May 1990 to September 2002 there were 1431 cases who suffered from menorrhagia. A total of 1468 times of TCRE were performed. Hysteroscopic diagnosis and endometrium biopsy was performed to rule out malignant diseases in 1203 cases. One stage TCRE was performed in 265 cases. Resistance index (RI) and pulse index (PI) of every level uterine artery were measured by ultrasound and serum levels of were 6 steroid sex hormones were measured by laboratory in 32 cases. The mean duration of follow-up was 68.5 months (3 - 148 months).
RESULTS
Three cases of uterine perforation were encountered. Smog like echo in the anterior uterine wall was found in 714 cases (49.9%) by B ultrasonography, among them 21 cases (63.6%) were proved adenomyosis by pathological examination. One hundred and fifty nine cases (10.8%) had been treated by drugs, such as homeostasis, analgesic agent, antibiotics, progesterone and endometrium inhibiting agents, etc. Repeat TCRE was performed in 37 cases. Owing to recurrent bleeding, dysmenorrhea or uterine myoma 87 cases (6.1%) were finally received hysterectomy.
CONCLUSIONS
(1) The main cause of recurrence was incomplete destruction of or leak from basal layer of endometrium. Shift wire loop with the sheath together to resect endometrium from the fundus to cervix smoothly can solve the problem of incomplete resection. Upon completion of operations, "blind area" and "blind point" should be examined and resected again if there is some endometrium left behind which could solve leak from basal layer of endometrium. (2) The duration of follow-up and adenomyosis are the main factors, which influence the long-term successful rate. (3) TCRE dose not influence the ovarian function obviously.
