A Clinical Observation On Transcervical Resection Of Endometrium In Treatment Of 46 Cases Of Perimenopausal Uterine Bleeding With Hysteroscope

Dysfunctional uterine bleeding (DUB) is a women's common disease, who suffering from DUB, perimenopausal uterine bleeding (PMUB) accounted for 50%. Traditional treatment methods used for the treatment of perimenopausal uterine bleeding with drug, but there are certain medication side effects, and less effective. transcervical resection of endometrium(TCRE) in treatment of Dysfunctional uterine bleeding with hysteroscope is a safe, simple and efficient method of surgery, which avoid DUB recuring after drug withdrawal and the influence on the hormone levels in the body.Objective: Observing the role of transcervial resection of endometrium in treatment of Dysfunction uterine bleeding,which illustrate that transcervial resection of endometrium in treatment of Dysfunctional uterine bleeding with hysteroscope is a safe,simple and efficient method of surgery.And to detect the changes of patients'function of ovaries.Method: 46 case of patients who suffered PMUB are treated by TCRE,who will divided into two group.group A,26 patients requested amenorrhea after operation,and 20 patients in group B after operation request to retain a small amount of menstruation.After observing the patients'status in operation and postoperative follow-up in 1 month,3 month,6month and 1 year and above to understand menstrual changes,which can determine the clinical efficacy(valid and invalid) and understand postoperative complications.Compared with the uterine'size before and after operation,and compared with the thickness of the preoperative endometrial layer and postoperative rehabilitative endometrial layer to understand the influence on menstruation.Contrast preoperative and postoperative ovarian artery and uterine artery pulsatility index and resistance index,and detect the level of preoperative E2,P,T,FSH,LH,PRL and postoperative E2,P,T,FSH,LH, PRL,to comparative analysis if TCRE would affect ovarian function.Result:1.Effect: 26 patients in group A follow-up to three months are all amenorrhea, but one case emerge that aggravated cyclical hypogastralgia in the left side, who was considered sactosalpinx, in addition to laparotomy,there is no effective way to treat the patient,but she refuse laparotomy, so dropped out. Valid 96.15%, satisfaction rate 96.15%.Follow-up to six months , there are two cases who have a bit menstruation (2 / 26, 7.69%), efficiency of 96.15%. Follow-up to more than 1 year ,amenorrhea in 18 cases (73.07%),a bit menstruation 4 cases(15.38%), a small amount of menstrual two cases (7.69), and one patient had a small irregular bleeding (3.86%). Efficiency 92.31%, 92.31% satisfaction rate. Among them, seven cases of endometrial pretreatment to the patients, follow-up to 1 year, they were all amenorrhea (100%).In group B, among 20 cases were followed up to three months, 19 cases had a small number of menstruation, one case of normal menstruation, menstrual ,average 1.7±3.2 days, the effective rate of 100%. Follow-up to 6 months, 18 cases had a small number of menstruation, 2 cases had normal menstruation, menstrual day, average 1.7±2.3d, 100% efficiency. 2 cases symptoms relapse after 9 months and 12 months ,menstruation increased. Follow-up to more than one year, a small amount of menstruation 16 cases (80%), normal menstrual 2 cases (10%), average 1.7±1.3 days, menorrhagia 2 cases (10%), efficiency 90% ,satisfaction rate of 90% . Although the two groups of patients'postoperative menstruation change requirements are different, most patients in each group had satisfactory surgical results (91.3%), and in the 45 cases of patients, total efficiency is 93.33% follow-up to 1 year. 2.Group A ,patients'postoperative uterine size significantly grown down, postoperative rehabilitative endometrial layer got thinner, amenorrhea rate is 69.23%. Group B,no significant changes in uterine volume, but repaired thin endometrial layer,and had a small amount of menstruation. 3. Complications: in the 46 cases of patients ,no uterine bleeding, perforation, overhydration and complications such as hyponatremia. three cases had Abdominal pain postoperation, including two cases that had cervix-adhere and led to uterine-haematocele, one case that had sactosalpinx. One case had a small amount of irregular vaginal bleeding.4. Ovarian Function: group A, contrast the RI and PI of ovarian artery before and after surgery, 1month,3month,6month postoperation,the RI and PI of ovarian artery were lower than preoperation. Group A , the RI and PI of uterine artery are difference between preoperation and postoperation, they are more in the postoperation. Group B ,before and after surgery ,the RI and PI of ovarian artery in addition to the right ovary RI and PI in 1 month after operation got higher than the preoperative, the rest were lower than the measured value of preoperative. Group B ,three-times after operation, the measured value of RI and PI of uterine artery values was lower than the preoperation. There are no effect on ovarian blood supply after operation. Group A and B patients'FSH, LH, E2, P, T and PRL were no difference before and after TCRE. Conclusions: 1. TRCE can replace hysterectomy in the treatment of perimenopausal uterine bleeding,because it is high-efficiency, fewer-complications .2. Different TRCE modus operandi can satisfy different age patients'requirement for menstru .3.After TRCE ,the ovarian'blood supply and hormone secretion were not affected, that is, no affection in ovarian function.