| Objective:To evaluate the efficacy, influencing factors of outcomes and safety of Microwave endometrial ablation (MEA) for abnormal uterine bleeding .Methods: Prospective, observation study. 87 pre-and post-menopausal patients without further fertility and with failed medical for abnormal uterine bleeding were treated with MEA, exclusion criteria included abnormal uterine cavity and (pre) malignant lesions. The cervix dilated to Hegar 9mm with urine tube 12 hours preoperation. Intravenous sedation (Dolantin 50mg and Promethazinun 25mg) was used 15 minutes before operation. Preoperative endometrial thinning agent was thorough uterine curettage. 2 cases of endometrial polyps of greater than 1cm in diameter were performed polypetomy before MEA. Some patients took norethisterone (2.5~3.75)mg for (1.5~2.5) months postoperation. Follow up data at 1 and 3 and 6 and 12 months on menstrual flow, Dysmenorrhoea, premenstrual symptoms and pelvic pain, some patients had a transvaginal scan and/or hysteroscopy. Full blood count were repeated 3 months postoperation. Assessment of satisfaction was based on the reduction of menses toeumenorrhoea or less and satisfaction in premenopausal women, no bleeding in postmenopausal. Results:1.Clinical material:The mean age was (45.2±8.0) years(range 32~73). 23 were dysfunctional uterine bleeding and 25 leiomyoma (23 intramural and subserous, 2 submucosal) and 30 endometrial polyps and 1 uterine submucous adenomyomas, generalized severe disease with uterine bleeding including 8 renal failure, 4 thrombocytopenic purpura and 6 aplastic anemia, 5 brain infarction, 1 postoperative renal transplantation, 1lung sarcoidosis, 9 hypertension and diabetes mellilus, 6 postmenopausal bleeding were endometrial polyps. 57 women were preoperative amemia, The mean duration of preoperative menorrhagia was (2.4±3.2)years(range 4months～12years),5 were severe amemia, 36 moderate, 16 mild. The mean uterine sounding was (9.2±1.1) cm(range 7～11.5), the mean treatment time was 286.5±74.6 seconds (range 119-430). The inhalation of nitrous oxide premixied with oxygen (50%: 50%) for analgesia only was required in 1 woman (1/87) for pain intraoperation, postoperative pelvic pain was mild and only 3 women(3/87) had severe pain requiring oral analgesia. postoperative vaginal discharge were reported in 0 to more than 40 days. Average follow-up time was 13±4(range 6-24)months. 2.The changes of menstrual blood loss: Approximately 56% patients had vaginalbleeding 1month postoperation in 1 to more than 50 days, from then on some were amenorrhea or hypomenorrhoea, administration of norethisterone could reduce vaginal bleeding significantly. 81 were premenopausal, 1 case died of uremia 3 months postoperation. follow-up of 80 cases was up to 6 months postoperation, overall satisfication was 97.5%(78/80), with 48(60%) amenorrhea, 22(27.5%) spotting, 8(10%) hypomenorrhoea and eumenorroea, and 2(2.5%) irregular bleeding, whom menstrual blood loss was reduced significantly were dissatisfied for irregular bleeding. When reviewed the appearance of hysteroscopy finding the endometrium in antero-posterior wall of cavity was a little red, so incomplete endometrial destruction was probably the cause of irregular bleeding. Follow-up of 30 cases was up to 12 months after operation, satisfication was 100%, with 16(53.3%) amenorrhea,8(26.7%) spotting, 6(20.0%) hypomenorrhoea and eumenorroea. The mean duration of menstrual flow reduced significantly from 15.4±9.3 days/cycle (range 4~30) to 1.7±3.6 days/cycle (range 0~20) 6 months postoperation, P＜0.01. All patients had stable menstrual pattern in 2 years follow-up. 6 postmenopausal patients were amenorrhea postoperation, satisfication rate were 100%. 3. The changes of amemia: The mean haemoglobin rose significantly from 85±22 g.l-1(range 34~119) to 116±18g.l-1 (range 60~138) 3 months postoperation in preoperative amemia women, P＜0.01. 4. The changes of dysmenorrhoea and premenstrual symptoms: Dysmenorrhoea and premenstrual symptoms im... |
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