Department of Gynecology, Guangdong Women's and Children's Hospital, Guangdong, China.
J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):30-6. doi: 10.1016/j.jmig.2009.09.012.
To assess the appearance of the endometrial cavity after microwave endometrial ablation.
Prospective observational study.
GuangDong Women's and Children's Hospital, GuangDong, China.
A total of 349 patients who underwent microwave endometrial ablation from January 2000 through August 2008 were followed up for 1 month to 8 years. At follow-up in 2007 and 2008, patients were advised of this clinical study and were randomly selected for participation if they agreed to undergo outpatient hysteroscopy to assess the uterine cavity during follow-up visits. Fifty three patients (median [range] age, 43.1 [33-53] years) were recruited into the study at the time of endometrial ablation.
Outpatient hysteroscopy.
Within the first 3 months after ablation, outpatient hysteroscopy revealed varying amounts of necrotic tissue from the endometrium and superficial myometrium of the uterus. Six months postablation, a granulomatous reaction and fibrosis were present. A fibrotic cavity was also evident, and menstrual flow was reduced or had ceased. One year after ablation, hysteroscopy demonstrated a fibrotic cavity with myofibrous scars. Most patients developed amenorrhea at this time. Two years or more postablation, a second hysteroscopy demonstrated various types of intrauterine adhesions in 28 of the 53 women (52.8%). A cervical adhesion was observed in 1 patient (1.9%), focal adhesions in the fundal area in 12 (22.6%), a narrowed and scarred uterine cavity with bilateral stenotic tubal ostia in 11 (20.7%), and complete obliteration of the cavity in 4 (7.5%). Of these 28 women, 22 had amenorrhea, 3 had vaginal spotting during menstruation, and 2 had hypomenorrhea. Of those without intrauterine adhesions, only 5 had amenorrhea, 10 had vaginal spotting, and 8 had hypomenorrhea.
The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance.
评估微波子宫内膜消融术后子宫内膜腔的外观。
前瞻性观察性研究。
中国广东妇女儿童医院。
2000 年 1 月至 2008 年 8 月期间共对 349 例接受微波子宫内膜消融术的患者进行了随访，随访时间为 1 个月至 8 年。在 2007 年和 2008 年的随访中，告知患者本临床研究，如果患者同意在随访期间进行门诊宫腔镜检查以评估子宫腔，则随机选择参加。53 例患者（中位数[范围]年龄，43.1[33-53]岁）在子宫内膜消融时被纳入研究。
门诊宫腔镜检查。
消融后 3 个月内，门诊宫腔镜检查显示子宫内膜和子宫浅肌层有不同量的坏死组织。消融后 6 个月，出现肉芽肿反应和纤维化。还可见纤维化腔，月经减少或停止。消融后 1 年，宫腔镜检查显示纤维性腔和纤维肌性疤痕。此时大多数患者出现闭经。消融后 2 年或更长时间，53 例患者中的 28 例（52.8%）在第二次宫腔镜检查中显示各种类型的宫内粘连。1 例（1.9%）患者出现宫颈粘连，12 例（22.6%）患者出现宫底部局灶性粘连，11 例（20.7%）患者出现狭窄和瘢痕化的宫腔，双侧输卵管口狭窄，4 例（7.5%）患者宫腔完全闭塞。在这 28 例患者中，22 例闭经，3 例月经期阴道点滴出血，2 例月经过少。无宫内粘连的患者中，仅有 5 例闭经，10 例月经期阴道点滴出血，8 例月经过少。
微波子宫内膜消融术后子宫腔的宫腔镜表现差异很大。在本研究中，术后子宫腔外观与月经结局相关。
