Baggish M S, Sze E H
Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH 45220-2489, USA.
Am J Obstet Gynecol. 1996 Mar;174(3):908-13. doi: 10.1016/s0002-9378(96)70324-1.
Our purpose was to retrospectively review the intraoperative and long-term outcomes of 568 patients with abnormal uterine bleeding who were treated by endometrial ablation over an 11-year period.
From 1893 to 1994, 401 endometrial ablations were performed with the neodymium-yttrium-aluminum-garnet laser and another 167 patients were treated by electrosurgery. The majority of the patients were treated for irregular, heavy menses. Fifty-seven had ablation because of abnormal bleeding associated with a serious medical disorder, 12 with a bleeding diathesis, and 50 with morbid obesity. All patients had preoperative endometrial sampling that demonstrated benign histology. Nineteen patients had submucous myomas that were resected at the time of hysteroscopic ablation. All patients received preoperative and postoperative suppression. The minimum follow-up period was 1 year.
The average operative time was 32.5 minutes. The mean hospital stay was 8 hours. Four patients who received 32% dextran 70 in dextrose (Hyskon) as the distending medium had pulmonary edema postoperatively. One case of endometritis was also detected. No uterine perforations were observed. Amenorrhea developed in 58% of the patients, 34% reported light or normal menstrual flow, and 8% did not respond (continued heavy flow).
This study represents one of the largest published series of endometrial ablation, with a mean follow-up of 4.5 years. It demonstrates that hysteroscopic endometrial ablation is a reliable, safe alternative to hysterectomy for the surgical management of abnormal uterine bleeding.
我们旨在回顾性分析568例子宫异常出血患者在11年期间接受子宫内膜切除术的术中及长期结局。
1893年至1994年期间，401例患者接受了钕钇铝石榴石激光子宫内膜切除术，另有167例患者接受了电外科治疗。大多数患者因月经不规律、经量过多接受治疗。57例因严重内科疾病伴异常出血接受切除术，12例因出血素质，50例因病态肥胖。所有患者术前子宫内膜取样均显示组织学良性。19例患者有黏膜下肌瘤，在宫腔镜切除时一并切除。所有患者均接受术前及术后激素抑制治疗。最短随访期为1年。
平均手术时间为32.5分钟。平均住院时间为8小时。4例以32%右旋糖酐70葡萄糖溶液（Hyskon）作为膨宫介质的患者术后发生肺水肿。还发现1例子宫内膜炎。未观察到子宫穿孔。58%的患者出现闭经，34%的患者报告经量少或正常，8%的患者无反应（持续大量出血）。
本研究是已发表的最大系列子宫内膜切除术研究之一，平均随访4.5年。结果表明，宫腔镜子宫内膜切除术是治疗子宫异常出血的一种可靠、安全的替代子宫切除术的手术方法。
