Buckshee K, Banerjee K, Bhatla H
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi.
Int J Gynaecol Obstet. 1998 Nov;63(2):139-43. doi: 10.1016/s0020-7292(98)00137-4.
To study the clinical efficacy, safety and acceptability of the thermal balloon endometrial ablation (TBEA) in patients with dysfunctional uterine bleeding.
Thirteen patients with DUB who did not respond to medical treatment and dilatation and curettage consented to a trial of TBEA with EASY model of balloon catheter by Gynecare. All procedures were done under intravenous (i.v.) sedation and paracervical block. Patients were mostly discharged within 48 h. Follow-up of 2-19 months is reported. Transvaginal ultrasound and hysteroscopy were performed in six patients after 6 months of TBEA.
Twelve patients (92.3%) reported a significant reduction in bleeding. Two patients (15.4%) experienced amenorrhea. Only two patients (15.4%) underwent subsequent hysterectomy, one for persistent menorrhagia and the other for severe pelvic pain. In successful patients of TBEA, transvaginal ultrasonography revealed marked reduction in endometrial thickness and no endometrium was visible in one patient who had developed amenorrhea. In successful cases follow-up hysteroscopy revealed scarring in more than two-thirds of the endometrium.
Thermal balloon endometrial ablation is a safe, simple, effective, easy and minimally invasive procedure which can be done under i.v. sedation and paracervical block in an office setting. It has several advantages over hysterectomy, including preservation of the uterus, avoidance of surgical incision and potential to perform on an outpatient basis. It is a good alternative to hysteroscopic endometrial ablation with a comparable success rate with minimal risk and no limiting factors except the cost of the balloons. However, large scale randomized controlled studies are needed with TBEA and other endometrial ablation procedures.
研究热球囊子宫内膜消融术（TBEA）治疗功能失调性子宫出血患者的临床疗效、安全性及可接受性。
13例药物治疗及刮宫治疗无效的功能失调性子宫出血患者，同意采用Gynecare公司的EASY型球囊导管进行TBEA试验。所有手术均在静脉镇静及宫颈旁阻滞下进行。患者大多在48小时内出院。报道了2至19个月的随访情况。TBEA术后6个月，对6例患者进行了经阴道超声及宫腔镜检查。
12例患者（92.3%）报告出血明显减少。2例患者（15.4%）出现闭经。仅2例患者（15.4%）随后接受了子宫切除术，1例因持续性月经过多，另1例因严重盆腔疼痛。在TBEA成功的患者中，经阴道超声显示子宫内膜厚度明显减小，1例出现闭经的患者未见子宫内膜。随访宫腔镜检查显示，成功病例中超过三分之二的子宫内膜有瘢痕形成。
热球囊子宫内膜消融术是一种安全、简单、有效、便捷且微创的手术，可在门诊静脉镇静及宫颈旁阻滞下进行。与子宫切除术相比，它有几个优点，包括保留子宫、避免手术切口以及可在门诊进行。与宫腔镜子宫内膜消融术相比，它是一个很好的替代方法，成功率相当，风险最小，除球囊成本外无限制因素。然而，需要对TBEA及其他子宫内膜消融术进行大规模随机对照研究。
