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中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (03) : 300 -304. doi: 10.3877/cma.j.issn.1673-5250.2013.03.002

所属专题： 文献；

论著

两种射频热凝固术去除内膜治疗功能失调性子宫出血对女性生殖内分泌激素的影响
尹格平1,*,*(), 武爱芳1, 郭秀霞1, 朱彤宇1   
  1. 1. 250031　济南，济南军区总医院妇产科
  • 收稿日期:2013-01-05 修回日期:2013-04-13 出版日期:2013-06-01
  • 通信作者: 尹格平

Influence of Endometrial Ablation Procedures Using Two Different Ways of Radiofrequency Thermocoagulation for Treatment of Dysfunctional Uterine Bleeding on Female Reproductive Endocrine

Ge-ping YIN1(), Ai-fang WU1, Xiu-xia GUO1, Tong-yu ZHU1   

  1. 1. Department of Gynecology, Jinan Millitary General Hospital, Jinan 250031, Shandong Province, China
  • Received:2013-01-05 Revised:2013-04-13 Published:2013-06-01
  • Corresponding author: Ge-ping YIN
  • About author:
    (Corresponding author: YIN Ge-ping, Email: Email: )
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尹格平, 武爱芳, 郭秀霞, 朱彤宇. 两种射频热凝固术去除内膜治疗功能失调性子宫出血对女性生殖内分泌激素的影响[J]. 中华妇幼临床医学杂志(电子版), 2013, 09(03): 300-304.

Ge-ping YIN, Ai-fang WU, Xiu-xia GUO, Tong-yu ZHU. Influence of Endometrial Ablation Procedures Using Two Different Ways of Radiofrequency Thermocoagulation for Treatment of Dysfunctional Uterine Bleeding on Female Reproductive Endocrine[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2013, 09(03): 300-304.

目的

探讨两种射频热凝固术(RFT)去除子宫内膜治疗功能失调性子宫出血(DUB)后，对女性生殖内分泌激素的影响。

方法

选择2006年1月至2010年1月在本院妇科就诊、经药物治疗无效的DUB患者162例为研究对象，平均年龄为(44.5±7.5)岁(33～53岁)。将其按照年龄分别纳入RFT -A组(n＝95)：≥45岁(平均为48岁)，以闭经为治疗目的，采用RFT去除全部子宫内膜；RFT -B组(n＝67)：<45岁(平均为38岁)，以减少月经量为目的，采用RFT去除部分子宫内膜。术前对两组患者均进行月经量评分(PBAC)、采用诊断性刮宫进行组织病理学诊断。对两组患者术前与术后6～12个月和12～24个月时，进行生殖内分泌6项激素血清学检查[雌激素(E2)、孕酮(P)、睾酮(T)、垂体泌乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)]。随机选择同期在本院体检的健康个体纳入对照组(n＝68)，按照年龄分别将其纳入对照组-A(n＝32)，≥45岁[平均为(49.0±3.5)岁]；对照组-B(n＝36)，<45岁[平均为(36.5±3.5)岁]。对4组个体不同时段的内分泌6项激素血清学检测结果进行统计学处理(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。

结果

①RFT-A组经RFT治疗后6～12月时的闭经止血总有效率为96.8%(92/95)，12～24个月时的总有效率为100.0%；RFT后，其PBAC评分结果和血红蛋白(Hb)水平，均较治疗前显著改善，差异有统计学意义(P<0.05)。RFT-A组中，经首次RFT治疗后随访6～12个月时，6例(6.3%，6/95)患者月经仍然过多(PBAC评分>100分)，但经再次RFT后均闭经。RFT-B组经RFT治疗后随访6～12个月时，月经改善总有效率为91.0%(61/67)，其中2例闭经，4例月经量仍然较多(PBAC评分>100分)，但经再次RFT后均闭经。两组RFT治疗后PBAC评分和Hb水平均较治疗前显著改善，差异有统计学意义(P<0.05)。本组无RFT后改行子宫切除患者。②两组RFT前、后血清E2，P，T，PRL，LH及FSH水平比较，RFT-A组经RFT治疗后12～24个月时，33例患者(34.7%，33/95)[年龄为(49.0±3.7)岁]的血清E2，LH，FSH值达到绝经水平，分别为(17.8±6.9) ng/L，(40.5±17.6) g/L及(57.3±28.5) ng/L，与同龄对照组-A比较，差异均无统计学意义(P>0.05)。术后12～24个月时，RFT-A组内分泌6项激素的血清学检测值均达到绝经水平与RFT-B组比较[5例(7.5%)vs. 33例(34.7%)]，差异均有统计学意义(χ2＝16.278，P<0.05)。RFT-A组术前与术后6～12个月时患者潮汗、潮热发生率分别为23.2%(22/95)与26.3%(25/95)；RFT-B组分别为4.5%(3/67)与3.0%(2/67)。两组分别进行组内治疗前及治疗后12～24个月时潮汗、潮热发生率比较，差异均无统计学意义(χ2＝0，254，0.001；P>0.05)。RFT-A组术前与术后6～12个月时潮汗、潮热发生率均显著高于同时段的RFT-B组，差异均有统计学意义(χ2＝10.506，15.398，P<0.05)。

结论

RFT治疗DUB安全、有效及微创化，术后对患者女性生殖内分泌6项激素的血清学检测结果无显著影响。

关键词: 功能失调性子宫出血, 射频热凝固术, 雌激素, 黄体生成素, 卵泡刺激素
Objective

To investigate the influence of serum menopause hormonal changes by different strategies of radiofrequency thermocoagulation (RFT) procedures to remove the endometria for treatment of dysfunctional uterine bleeding(DUB).

Methods

From January 2006 to January 2010, a total of 162 patients who were diagnosed as DUB were included into this study. Their ages ranged from 33 to 53 years old, and the average age was (44.5±7.5) years old. They were divided into RFT-A group (n=95, ≥45 years old) and RFT-B group (n=67, <45 years old) according to their ages. RFT-A group received RFT to remove all endometria and their therapeutic purposes were amenorrhoea. Meanwhile, RFT-B group received RFT to remove parts of endometria and their therapeutic purposes were to decrease menstrual blood quantity. All the patients had the results of pictorial blood loss assessment chart (PBAC), endometrial currettage pathology before the operation. And another six kinds of serum endocrine markers were detected, including estradiol (E2), progesterone (P), testosterone (T), pituitary prolactin (PRL), corpus luteum erythropoietin (LH), follicle-stimulating hormone (FSH) before and after RFT within 6-12 and 12-24 months. Meawhile, another 68 healthy women were recruited as control group. They were divided into two groups according to their ages, too, control group-A (n=32, ≥45 years old) and control group-B (n=36, <45 years old). The six kinds of serum endocrine markers as the same as RFT groups were detected. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Jinan Millitary General Hospital. Informed consent was obtained from each participant.

Results

①Total effective rates of amenorrhoea of RFT-A group within 6-12 months after RFT was 96.8%(92/95), and within 12-24 months was 100%. ②The PBAC scores and hemoglobin (Hb) levels had significant improvement compared with pre-operation, with the significant difference (P<0.05). During 6-12 months followed-up, six patients showed poor effects (PABC scores>100) and received second RFT. The total effective rates of menstruation improvement of RFT-B group within 6-12 months after RFT was 91.0% (61/67). Among RFT group, two patients showed amenorrhea, for patients showed poor effects(PABC scores>100). Statistically, PBAC scores and Hb in RFT-A and RFT-B during followed-up were obviously improved (P<0.05). ②Levels of serum E2, P, T, PRL, LH, FSH between two RFT groups within 6-12 and 12-24 months after RFT had no statistical difference(P>0.05). Thirty-three(34.7%, 33/95) patients in RFT-A groupo and 5 (7.5%) cases in RFT-B group which levels of serum E2, LH, FSH reached levels of menopause in 12-24 months after RFT, which was statistically different (P<0.05). The incidence of perspiration and hot flashes in RFT-A group were 23.2% (22/95) before RFT and 26.3% (25/95) after RFT, 4.5% (3/67) and 3.0% (2/67) in RFT-B group. There was no statistically significant difference before and after RFT within 12-24 months of intra-group comparisons of both RFT groups (χ2=0, 254, 0.001; P>0.05); And there had significant difference before and after RFT within 6-12 months between RFT-A group and RFT-B group (χ2=10.506, 15.398; P<0.05).

Conclusions

RFT is a safe, effective and minimally invasive method in the treatment for DUB without postoperative gynecological endocrine change.

Key words: dysfunctional uterine bleeding, radiofrequency treatment, estradiol, luteinizing hormone, follicle stimulating hormone
表1 两组患者治疗前、后月经量PBAC评分结果和血红蛋白水平比较(±s)
Table 1 Comparision of PBAC scores and levels of hemoglobin between RFT-A and RFT-B group before and after radiofrequency thermocoagulation (±s)
随访时间 n PBAC评分 Hb(g/L) t P
RFT-A组 95 　 　 　 　
　 治疗前 　 167.3±72.0 87.2± 3.1 　 　
　 治疗后6～12个月 　 － 110.6±10.8a 2.320 <0.05
　 治疗后12～24个月 　 － 127.7±10.0b 2.438 <0.05
RFT-B组 67 　 　 　 　
　 治疗前 　 187.5±59.5 87.2± 3.6 　 　
　 治疗后6～12个月 　 55.3±21.5a 122.5±11.2a 2.373 <0.05
　 治疗后12～24个月 　 50.9±19.9b 130.8±11.0b 2.414 <0.05
表2 两组患者治疗前、后血清E2，P，T，PRL，LH及FSH水平比较(±s)
Table 2 Comparision of serum E2，P，T，PRL，LH and FSH levels between RFT-A and RFT-B groups before and after treatment by radiofrequency thermocoagulation (±s)
组别 n E2(ng/L) P(μg/L) T(μg/L) PRL(μIU/mL) LH(IU/L) FSH(IU/L)
RFT-A组 95 　 　 　 　 　 　
　 治疗前 　 37.9±22.5 2.3±1.7 0.6±0.2 246.6±122.7 12.8±3.5 16.2± 4.8
　 治疗后6～12个月 　 30.5±24.1 2.3±1.7 0.5±0.3 298.6± 94.4 16.4±4.3 17.6±14.5
　 治疗后12～24个月 　 33.7±20.5 2.1±1.3 0.5±0.2 311.6± 89.1 18.6±4.0 21.3±13.9
对照组-A 32 32.3±14.0 1.9±0.9 0.7±0.3 312.3±132.1 10.6±3.5 15.9±10.8
RFT-B组 67 　 　 　 　 　 　
　 治疗前 　 50.3±20.3 2.2±1.1 0.5±0.3 367.6±141.1 5.9±3.2 7.4±3.6
　 治疗后6～12个月 　 52.7±23.4 1.9±1.2 0.4±0.3 335.6± 82.0 5.6±4.1 6.4±2.8
　 治疗后12～24个月 　 67.1±27.4 4.3±2.1 0.6±0.2 379.3± 90.6 7.9±3.7 8.7±4.4
对照组-B 36 41.7±18.5 1.7±1.0 0.5±0.1 351.6±126.0 7.6±3.0 6.9±4.1
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