Li Li, Luo Xi-Ping, Deng Qun-di, Chen Wei-Fang, He Xiu-Kui, Zeng Li-Qin
Department of Obstetrics and Gynecology, Guangdong Province Maternal and Child Health Hospital, Guangzhou 510010, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Nov;44(11):816-20.
To evaluate long term effect and related factors in patients with menorrhagia treated by microwave endometrial ablation (MEA).
Total of 334 women with menorrhagia were treated by MEA, the range of age was from 29 to 59 years old. Among them, 59 cases were complicated by adenomyosis. All the patients were followed up on the change of menstrual cycle, the amount of flow, improvement of anaemia and complication. Fifty-three women underwent outpatient diagnostic hysteroscopy, the biopsy tissue was taken from the endometrium for histopathological examination. The mean duration of follow-up was 64.7 months (3 - 96 months).
The overall curative rate was 91.3% (305/334), of which amenorrhea rate was 49.7% (166/334), menstruation reduction rate was 41.6% (139/334) ; 71.1% (140/197) of the cases who previously had dysmenorrhea had relieved their pelvic pain and the satisfactory rate was 91.9% (307/334). Among patients > 40 years, 92.9% (196/211) of operation effective rate, 93.8% (198/211) of satisfactory rate and 64.9% (137/211) of amenorrhea rate were obtained, while patients </= 40 years, 88.6% (109/123) of operation effective rate, 88.6% (109/123) of satisfactory rate and 23.6% (29/123) of amenorrhea rate were obtained. There was significant difference in rate of operation effectiveness, satisfaction and amenorrhea (P < 0.05). Forty-two cases required subsequent treatment due to recurrence, of which 9 cases were given by secondary MEA and 33 cases (9.9%, 33/334) underwent hysterectomy indicated by frequent menorrhagia, adenomyosis or leiomyoma. A completely destroyed endometrium was observed by hysteroscopy after MEA, pathologic characteristics of MEA showed two zones of necrotic tissue: the inner zone was coagulation necrosis and the outer zone of necrosis was hypocellular hyalinized myometrium.
MEA is the safe and efficacious management to treat menorrhagia. Incomplete removal of endometrium was the major reason resulting in postoperative recurrence. Young age and complicated with adenomyosis were the main factors influencing long term clinical effect of MEA.
评估微波子宫内膜去除术（MEA）治疗月经过多患者的长期疗效及相关因素。
334例月经过多妇女接受了MEA治疗，年龄范围为29至59岁。其中59例合并子宫腺肌病。所有患者均随访月经周期变化、月经量、贫血改善情况及并发症。53例妇女接受了门诊诊断性宫腔镜检查，取子宫内膜活检组织进行组织病理学检查。平均随访时间为64.7个月（3至96个月）。
总治愈率为91.3%（305/334），其中闭经率为49.7%（166/334），月经量减少率为41.6%（139/334）；既往有痛经的患者中71.1%（140/197）盆腔疼痛缓解，满意率为91.9%（307/334）。40岁以上患者手术有效率为92.9%（196/211），满意率为93.8%（198/211），闭经率为64.9%（137/211）；40岁及以下患者手术有效率为88.6%（109/123），满意率为88.6%（109/123），闭经率为23.6%（29/123）。手术有效率、满意率和闭经率差异有统计学意义（P<0.05）。42例因复发需要后续治疗，其中9例接受了二次MEA，33例（9.9%，33/334）因月经过多、子宫腺肌病或子宫肌瘤而行子宫切除术。MEA术后宫腔镜检查可见子宫内膜完全破坏，MEA病理特征显示坏死组织有两个区域：内部区域为凝固性坏死，外部坏死区域为细胞减少的透明样变肌层。
MEA是治疗月经过多的安全有效方法。子宫内膜去除不完全是导致术后复发的主要原因。年轻及合并子宫腺肌病是影响MEA长期临床疗效的主要因素。
