| Dysfunctional uterine bleeding(DUB) is a kind of procreation endocrine diseases, which isn,t caused by parenchyma focus, it often occurs during adolescence and perimenopausal period. DUB is a common gynecology disease which has a high morbidity. The issue about its therapy has always been the hot point. There are medication and surgery therapy, The hormone druggery can relieve symptom at some extent, and restore normal menses, but lots of clinical research indicate that medication is ineffective or the symptom recurs in a part of patients. Initially, such patients can only been treated by hysterectomy, but the uterine specimen ofen hasn,t any abnormality. The newfashioned micro-traumatic surgery has many more advantages compared with hysterectomy, as for small-injury,short-time be in hospital,reserving uterines and so on, but there are many different conclusions about its curative effect, so it is no doubt that improving its safety and cure rate has important meaning. This research collects 135 cases at random which were diagnosed as DUB and accepted transcervical resection of endometrium(TCRE) in Jinlin university the second hospital during 2000.8~2006.7, to get rid of 19 cases which loss following up, I analysis 116 cases which has complete following up data. I get them through the after-operation inspection records of out-patient department,telephoning the patients,writing letters to them and so on. The duration for following up is 2~73 months, to evaluate the short term and long term outcomes of DUB treated by TCRE as well as the factors which influence the outcomes, and to analysis the safety and criterion of choosing the patients and so on, hoping that can provide clinical guide and theoretical foundation.Among these 116 cases, the minimum age is 27 years old(y), the maximum age is 72 years old, average age is 44.32±5.76y, 70.7% of cases is between 41 and 50y. Abnormal menses is the major symptom, there are 110 cases, 56 cases have succedent anaemia, and 33 cases are of moderate or serious. 14 cases have cervical erosion, 3 of them accepted transcervical resection of cervical focus(TCRC). 104 cases had sonography inspection before operation, there are 69 cases whose thickness of endometrium is over 5mm, account for 66.3%, 13 cases have none-echo bursa at ovary area, account for 12.5%. Endometrial simplicity hyperplasia (gland-bursa hyperplasia ) is the major pathological outcome of diagnostic curettage before operation, there are 81 cases, account for 69.8%, also there are 4 cases of endometrial complexity hyperplasia. 75 cases have hysteroscopy before operation, most of the inspection outcomes are endometrial hyperplasia, has 40 cases. 11 cases in this research have serious medicine diseases, there is no obvious abnormalities during the operation or after it. 8 cases were diagnosed as adenomyosis, to tell part of them to take Danazol(1/once a day, for 2 months). 3 cases appeared slightly reaction of the syndrome of the transurethral resection of the prostate(TURP) 2~3 hours after the operation, urgent inspections of serum electrolyte take on hyponatremia, they got better after being treated properly. Endometrial simplicity hyperplasia is the major pathological outcome after the operation, there are 68 cases, The pathological outcome after the operation of the four patients whose pathological outcome are endometrial complexity hyperplasia before the operation are respectly: 2 cases of endometrial simplicity hyperplasia; 1 case of proliferative phase endometrity; 1 case of longitudinal endometrial hyperplasia, and endometrial complexity hyperplasia in parts. The state of menstruationimproving of different age patients who accepted the operation: 103 cases had menstruation improvement, account for 88.8%, the rate of menstruation improvement in 31~40 ages is 71.4%, between 41~50 age is 92.7%, to compare these two groups, P<0.05, the difference has statistics meaning, the rate of menstruation improvement in 51~60 ages is 88.9%, to compare with 41~50 ages, P>0.05, the difference has not statistics meaning; the rate of menstruation improvement of≤40 ages which are the former two groups is 72.7%, >40 ages which are the later three groups is 92.6%, to compare them, P<0.05,the difference has statistics meaning;the rate of menstruation improvement of≤50 ages which are the former three groups is 88.5%, >50 ages which are the later two groups is 91.7%, to compare them, P>0.05, the difference has not statistics meaning. The period of following up is 2~73 months, the effective rate of corrective anaemia is 85.7%. 7 cases have dysmenorrheal befor the operation, 11 cases have irregular bellyacke before the operation, the symptom of 4 dysmenorrhea cases improved, irregular bellyacke symptom of 6 cases disappeared and 3 cases improved. 9 cases who had not dysmenorrhea or bellyacke had irregular bellyacke after the operation, 3 of them had intrauterine adhension,bleeding, 2 of them had been cured by disassociating adhension and excluding blood with hysteroscopy, 2 cases had adenomyosis, the other 4 cases had unknown bellyacke, but the symptom is feeble. The satisfaction rate for the operation proved: 94 cases were satisfied or very satisfied for the operation, account for 81.0%, 14 cases considerd that it is middling, account for 12.1%, 8 cases were not satisfied for the operation, account for 6.9%. The satisfaction rate for the operation of the I group is 63.6%, the total satisfaction rate of the IV,V,VI groups is 89.3%, to compare them, P<0.05, the difference has statisticsmeaning; the satisfaction rate for the operation of the II group is 60.0%, to compare with the IV,V,VI groups, P<0.05, the difference has statistics meaning; the satisfaction rate for the operation of III group is 77.8%, to compare with the IV,V,VI groups, P>0.05, the difference has not statistics meaning; to compare between the IV,V,VI groups, P>0.05 all the time, the difference has not statistics meaning. 22 cases accepted the second intervene treatment for not improving menstruation,dripping bleeding, including drug and hysterectomy, there are 10 and 12 cases respectively, the overall cure rate achived 81.0% in this research. Of the 22 cases who accepted the second intervene treatment, 7 cases had adenomyosis, 13 cases, age are between 31~40, account for 60% of the 22 patients. The total cure rate of the I,II groups which are the former two years is 68.8%, the total cure rate of the V,VI groups which are the later two years is 87.5%, to compare them, P<0.05, the difference has statistics meaning; the total cure rate of the I,II,III groups which are the former three years is 70.7%, the total cure rate of the IV,V,VI groups which are the later three years is 86.7%, to compare them, P<0.05, the difference has statistics meaning; to compare between IV,V,VI groups, P>0.05 all the time, the difference has not statistics meaning.This research proves that: TCRE is a kind of reserve operation, To choose suit patient to take the operation is an effective method for improving cure rate of the operation. DUB often occurs during perimenopausal period. Sonography inspection,hysteroscopy and diagnostic curettage before operation are necessary assist inspection for excluding parenchyma focus and diagnosing DUB. TCRE is an ideal replacing surgery of hysterectomy for the DUB patients with serious medicine diseases. To heighten the operator's technique and standard theoperation are the key measures for prevention and cure complications during or after the operation and strengthen curative effect of the surgery. Adenomyosis is one of the important reasons for the failure of the surgery. TCRE is a safety and effective micro-traumatic operation for the patients with DUB. Regular inspection after the operation is an effective measure for finding and dealing complications. Age and the duration for following up are the important factors influencing the symptom recrudescence after the operation, with the age decling and the duration for following up prolonging, the rate of recrudescence after the operation takes on rising trend.
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