Berry D L, DeLeon F D
Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, Texas, USA.
J Reprod Med. 1996 Mar;41(3):183-5.
Hereditary hemorrhagic telangiectasia is a rare, inherited disease characterized by abnormal visceral and superficial blood vessel anastomoses. These telangiectasias predispose the patient to a lifelong history of recurrent bleeding for the nasal and gastrointestinal mucosa. Less commonly involved organs include the liver, brain and lung. To date there is no cure for this disease. Management requires many palliative minor surgical procedures to stop actively bleeding sites. Major surgery is often contraindicated in these patients due do coexisting medical sequelae of their underlying disease.
Menorrhagia was diagnosed in a 42 year-old multipara with known history of hereditary hemorrhagic telangiectasia. The bleeding was unresponsive to hormonal therapy. Substantial preexisting conditions, including profound anemia, history of multiple strokes, a seizure disorder and ventricular arrhythmias, precluded major surgical intervention, including hysterectomy. Serial injections of leuprolide acetate injections were followed by hysteroscopic "rollerball" electrocoagulation of the endometrium under regional anesthesia. On long-term follow up, the patient was cured of her menorrhagia.
Endometrial ablation provides patients who have significant medical complications with an effective, minimally invasive alternative to hysterectomy for control of menorrhagia.
遗传性出血性毛细血管扩张症是一种罕见的遗传性疾病，其特征为内脏和浅表血管异常吻合。这些毛细血管扩张使患者终生有鼻黏膜和胃肠道黏膜反复出血的病史。较少累及的器官包括肝脏、脑和肺。迄今为止，这种疾病无法治愈。治疗需要进行许多姑息性小手术来止住活动性出血部位。由于这些患者存在潜在疾病的合并症，大手术通常是禁忌的。
一名42岁经产妇被诊断为月经过多，她有遗传性出血性毛细血管扩张症病史。出血对激素治疗无反应。患者存在大量既存病症，包括严重贫血、多次中风病史、癫痫发作障碍和室性心律失常，因此无法进行包括子宫切除术在内的大手术干预。在区域麻醉下，先多次注射醋酸亮丙瑞林，然后进行宫腔镜下子宫内膜“滚球”电凝术。长期随访显示，该患者的月经过多得到治愈。
对于有严重内科并发症的患者，子宫内膜消融术为控制月经过多提供了一种有效、微创的替代子宫切除术的方法。
