Intrauterine Saline Infusion Cycle Of Heat Treatment Of Dysfunctional Uterine Bleeding Study

Dysfunctional uterine bleeding(DUB) is the result of HPO axis dysfunction is not caused by organic disease of abnormal uterine bleeding,and more performance for excessive menstruation,extended menstruation,menstruation and other menstrual disorders are not dripping.Usually as a first-line treatment drug,progesterone, estrogen alone and/or in combination can reduce the amount of menstruation 25% -80%,GnRHa can be achieved in ovariectomized caused by the effect of temporary amenorrhea.Regular medication with significant side effects,but some patients after discontinuation of treatment will be the re-emergence of the symptoms of menorrhagia, for this part of the dysfunctional uterine bleeding in patients with severe need surgery. Hysterectomy is the traditional surgical methods,in recent years,under hysteroscopic endometrial cervical electrosurgical excision procedure has become a reliable method of treatment,can avoid the traditional hysterectomy caused by pelvic floor dysfunction and the risk of ovarian blood supply of premature ovarian failure and improve the quality of life of women.However,endometrial TURP has its own shortcomings,for example,the doctor-related requirements of a higher technical level,there is uterine perforation and water poisoning(the negative super-fluids,hyponatremia) and other serious complications,and the cost also relatively high.Therefore,to find a reliable effect,but the simple method has been applied to clinical treatment is very meaningful. Part 1 Study on the validity of the hydro thermablationObjective:Of drug treatment failure or can not tolerate the treatment of drugs,find a few complications,simple,reliable efficacy of surgical treatment.Methods:2003-2007 collection of Qilu Hospital medical records of 57 cases of complete loss of follow-up of non-surgical treatment of dysfunctional uterine bleeding cases,of which 23 regular cycle of hot saline infusion for the study group(A group), 34 endometrial TCRE for the control group(B group),two groups of patients in age, menstrual volume,uterine cavity depth of the location and there was no statistical difference.Treatment effect will be divided into:a.non-menstrual or menstrual guttate; b.a small amount of menstruation;c.the volume of normal menstruation;d.the volume of more than four levels of normal menstruation,and effective for the treatment of the first three,the latter for treatment failure.Respectively 6 months after treatment(Ⅰgroup),24 months(Ⅱgroup) level of the effect of horizontal comparison(A group and B group comparisons between),on the study and control groups,respectively, compared to vertical(A group and B group of their own time before and after comparison),to observe the effect of the stability of all levels.The use of SPSS statistical analysis software system.Results:In groupⅠ,the horizontal comparison,the study and control groups of a,b and d the effect of three types of treatment showed no significant difference(P＞0.05), A,B two groups only in c(the normal amount of menstruation) are different(P＜0.05), the experimental group was 43.5%,17.6%for the control group;Ⅱgroup in the horizontal comparison,a,b,c and d no significant difference(P＞0.05).The study and control groupsⅠandⅡin the longitudinal comparison was no significant difference (P＞0.05).Conclusion:Saline infusion cycle is a heat treatment of dysfunctional uterine bleeding effective means to effectively correct the symptoms of menorrhagia and improve the quality of life of patients,efficacy is also a certain stability,but also easy to operate, easy to grasp,less complications,is A treatment can be universal. Part 2 Study on the factors of hydro thermablation effectsObjective:Clearly affect the cycle of heat treatment of saline perfusion factors, clinical applications in order to reach a satisfactory therapeutic effect.Methods:2004-2008 15 cases of hysterectomy cases,preoperative examination to exclude malignancy,hysterectomy before the hot cycle of intrauterine saline infusion, the uterus from anterior,posterior,Palace at the end of the cervix and fallopian tube near the extraoral uterine tissue,cross-sectional area of about 0.8*0.8cm.The production of conventional HE staining biopsy,the use of image processing tools for measuring PS endometrial and superficial myometrial depth of thermal necrosis using SPSS software system that may affect the cycle of heat treatment saline perfusion of factors,such as hot brine temperature difference and average temperature,uterine pressure,hot saline perfusion time,and the depth of necrosis regression analysis.Results:Basal layer of normal myometrial invasion of endometrial glands up to 2-3cm,follicular phase endometrial thickness for the 1-2mm,the late luteal up to 12mm.To the extent possible,to remove the endometrium,request removal of shallow depth of myometrial 3mm.Intrauterine saline infusion thermal cycle can achieve the desired depth of the intimal injury.Among the many factors,uterine pressure and is most closely related to the depth of injury(P=0.012),To achieve the desired therapeutic effect,uterine pressure should be maintained at or above 49mmHg;cavity depth and the depth of thermal damage of a negative correlation(P=0.028);hot brine temperature are also important factors,and the depth of thermal damage was positively correlated,and can increase the heat input when the brine temperature, controlled at 92℃above average temperatures to enhance the treatment effect;age, uterine position and depth of thermal damage was no significant correlation.Fallopian tube near the mouth Department has not been any marked necrosis of heat injury,the only cervical canal＜2mm of superficial thermal damage.Conclusion:Intrauterine saline infusion thermal cycle can achieve the desired depth of heat injury,and safety.Among the many factors,the impact of uterine pressure is the key to control of treatment conditions,saline infusion at the same time period heat input temperature,average temperature and temperature difference with the depth of thermal injury there is a certain positive correlation,the depth of the cavity was a negative related to each other.Age,the uterus before and after the bit depth of the injury was no significant impact.