ABSTRACT
Background: Dysfunctional uterine bleeding (DUB) affects 10% to 15% women of reproductive age group. A prospective observational study was performed to study the efficacy, rate of satisfaction and adverse effects of Transcervical resection of endometrium (TCRE) in the treatment of DUB in premenopausal women.Methods: 30 patients with DUB attending the hospital underwent TCRE and patients were followed up after 6 week, 3 months, 6 months up to 1 year and there bleeding score was calculated. Their response to treatment, complications and satisfaction rate were studied.Results: 43.3% of the women in this study were in the age group of 40-44 years. Post TCRE, 43.33% (n=13) had hypomenorrhea. 33.33% (n=10) had regular cycle, 13.33% (n=4) women had amenorrhea and 10% (n=3) had no response and underwent hysterectomy. 86.66% (n=26) women were satisfied with the treatment whereas 13.33% (n=4) were not satisfied. One patient had uterine perforation and serosal bowel injury due to extended cautery injury. Bleeding reduced considerably and a statistically significant (paired t-test, p-value <0.05) difference was observed in pre and post procedure (6 weeks, 3 months, 6 months and 1 year) bleeding scores.Conclusions: Considering advantages like shorter operative time, uterine conservation and early mobility TCRE is a procedure of choice in patients in whom hysterectomy is either technically difficult or medically contraindicated or in those who are not suitable for long term medical management.
ABSTRACT
Objective To observe the effects of hysteroscopic transcervical resection of endometrium combined with levonorgestrel-relea-sing intrauterine system in the treatment of adenomyosis. Methods Clinical data of 62 cases with adenomyosis from January 2009 to January 2011 were randomly divided into 2 groups with 31 cases each. The observation group was given hysteroscopic transcervical resection of endo-metrium ( TCRE) combined with levonorgestrel-releasing intrauterine system( LNG-IUS) ,the control group was given LNG-IUS. All patients were followed up in 0,1,3,6,12 months after treatmenting with LNG-IUS. The menstrual blood volume,score of VAS,volume of uterus, CA125 and the levels of serum reproductive hormone were analyzed before treatment and after treatment. Results After the therapy,the cur-ative effects of controlling menorrhea were improved and the the observation group was significantly better than the control group(P0. 05). Conclusion It is exact effect to treat adenomyosis by TCRE combined with LNG-IUS,which can prevent dripping bleeding induced by application of LNG-IUS effectively.
ABSTRACT
Objective To analyze clinical characteristics and treatment experience for late complications after hysteroscopic transcervical resection of endometrium ( TCRE) . Methods Clinical data of 13 cases of late complications after hysteroscopic TCRE for dysfunctional uterine bleeding from January 2006 to June 2014 were retrospectively analyzed .A re-operation of hysteroscopic exploration and resection were required . Results The re-operation in the 13 patients found 6 cases of hematocele in uterine cavity (4 cases in the uterine horn, 2 cases in the uterine cavity) and 7 cases of focal or whole uterine endometrial hyperplasia (including 1 cases of PASS syndrome and 1 case of endometrial pathology of grade Ⅰatypical hyperplasia ) .Postoperative symptoms were relieved in 7 cases (53.8%).Laparoscopic total hysterectomy was performed in 3 cases of adenomyosis complicated with secondary progressive dysmenorrhea (23.1%), 2 cases of endometrial proliferation associated with a breast cancer history (15.4%), and 1 case of endometrial atypical hyperplasia grade Ⅰ (7.7%). Conclusion After hysteroscopic TCRE, residual functional endometrium or future regeneration of endometrium may lead to late complications , which need further clinical diagnosis and treatment .
ABSTRACT
Objective To investigate the efficacy and influence factors of hysteroscopic guiding endometrial resection on dysfunctional uterine bleeding.Methods One hundred and eighty women with dysfunctional uterine bleeding were selected as our subjects in Maternal and Child Health Hospital of Qinhuangdao from Jan.2009 to Jan.2011.One hundred and fifty which meet with operation indications underwent hysteroscopic guiding endometrial resection.Operation periods,blood loss,adverse effects rate were recorded.Serum follicle stimulating hormone (FSH),luteinizing hormone (LH),estradiol (E2) and progesterone (P) hormone levels were detected at preoperative and postoperative.The efficacy was recorded at 6 and 12 months after the procedure.Results The average operation time and amount of bleeding were (31.2 ± 11.0)min and (32.3 ± 10.5) ml,and no blood transfusion performed during the operation.All cases got the succeed operation.There were no significant difference in terms of serum FSH,LH,E2 and P concentrations before and after treatment(P ＞0.05).At 6 months after treatment,improvement rate was 64.0％ (96/150),and effective rate was 32.0％ (48/150).The total effective rate was 96.0％ (144/150).At 12 months after treatment,the improvement rate was 58.0％ (87/150),effective rate was 36.0％ (54/150).The total effective rate was 94.0％(141/150).There was significant different in terms of total effective rate between 6 months and 12 months after treatment(x2 =113.6,P ＞ 0.05).Postoperative complications occurred in 2 cases,including 1 cases of abdominal pain,and 1 cases of dysmenorrhea.Uterine cavity depth,age and disease duration were the main factors affect the clinical efficacy.(OR(95 ％ CI):-1.14 (-1.17 to-1.07),1.60 (1.31 to 2.08),-1.02(-1.14 to-1.08),P ＜ 0.05).Conclusion Treatment of hysteroscopic guiding endometrial resection on dysfunctional uterine bleeding is proved to be efficacy due to the less adverse reaction.
ABSTRACT
Objective To study the expressions of EGFR and VEGF in endometrium after danazol pretreatment and the pathological changes of endometrium. Methods A total of 60 patients with anovulartory functional bleeding were randomly divided into two groups: Danazol group and control group with 30 cases in each group. Danazol group were given transcervical resection of endometrium with danazol pretreatment, and control group without any pretreatment. The endometrium resected from uterus was sent for histological assessment, observation of the grandular quantity and stromal loose degree, and of the expressions of EGFR and VEGF in endometrium. Results The endometrium of patients who took Danazol were almost in proliferative phase(similar to early proliferative phase).The numbers of endometrial glands near the basal layer with Danazol pretreatment were lower than that in the control group; the stromal components (+～) were more compact than the contral group (～). The expression intensity and rates of EGFR and VEGF in glands were higher than those of stromal components. Danazol decreased the expression of EGFR and VEGF in endometrium compared to the control group. Conclusion Pretreatment with Danazol can suppress the prolifieration of endometrial cells, thin the endometrium,and disperse the glands, compact the stromal components, and it can also reduce the expressions of EGFR and VEGF in endometrial glands and stromal components compared with the control group.