Litta Pietro, Merlin Federica, Pozzan Chiara, Nardelli Giovanni Battista, Capobianco Giampiero, Dessole Salvatore, Ambrosini Antonio
Department of Gynecological Science and Human Reproduction, University of Padua, Padua, Italy.
Eur J Obstet Gynecol Reprod Biol. 2006 Mar 1;125(1):99-102. doi: 10.1016/j.ejogrb.2005.07.017. Epub 2005 Sep 1.
Hysteroscopic endometrial resection is an innovative and conservative surgical technique considered, very often, as an alternative to hysterectomy. The aim of the study was to evaluate long-term efficacy of endometrial resection performed in women with menorrhagia.
Retrospective study of 111 premenopausal women with menorrhagia, unresponsive to medical treatment, who underwent endometrial resection by resectohysteroscope (electrocautery technique supplied with a fundus rollerball electrode, with corneal areas, and with a 90 degrees loop for intrauterine walls and used with glycine 1% as distending fluid) between 1994 and 1999.
Long-term follow-up questionnaires were completed in 106 cases, while 5 cases dropped-out (4.5%). The mean-age at menopause in our subjects was 52.8 years (17.6+/-18.4 months after operation). After 53.2+/-16.4 months, 82 patients (77.4%) showed a normal menstrual pattern or amenorrhea, while failure was recorded in 24 patients (22.6%) and 12/24 patients underwent hysterectomy. Percentage of success in the older population (>49 years) (94%) was significantly higher than in the younger population (70%). The histologic finding of only fibrosis (41.7%) correlated with failure of the technique.
Our data suggest that endometrial resection by resectohysteroscope is an innovative and conservative but not exclusive surgical technique in selected younger women, while in older women endometrial resection nearly always resolves long-term menorrhagia.
宫腔镜子宫内膜切除术是一种创新的保守手术技术，常被视为子宫切除术的替代方法。本研究的目的是评估月经过多女性接受子宫内膜切除术后的长期疗效。
对111例绝经前月经过多且药物治疗无效的女性进行回顾性研究，这些女性在1994年至1999年间接受了经宫腔镜子宫内膜切除术（采用带有宫底滚球电极、角膜区域及用于子宫内壁的90度环形电极的电灼技术，以1%甘氨酸作为膨宫液）。
106例完成了长期随访问卷，5例失访（4.5%）。我们研究对象的平均绝经年龄为52.8岁（术后17.6±18.4个月）。53.2±16.4个月后，82例患者（77.4%）月经模式正常或闭经，24例患者（22.6%）治疗失败，其中12/24例患者接受了子宫切除术。老年人群（>49岁）的成功率（94%）显著高于年轻人群（70%）。仅纤维化的组织学表现（41.7%）与手术失败相关。
我们的数据表明，经宫腔镜子宫内膜切除术对于特定的年轻女性是一种创新且保守但并非唯一的手术技术，而对于老年女性，子宫内膜切除术几乎总能解决长期月经过多的问题。
