宫腔镜治疗慢性肾功能不全合并异常子宫出血患者回顾性分析
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摘要
目的评估宫腔镜治疗慢性肾功能不全合并异常子宫出血患者的有效性及安全性。方法选择2011年1月至2017年1月于中国医科大学附属盛京医院行宫腔镜治疗慢性肾功能不全合并异常子宫出血患者35例,年龄41～67岁,平均年龄54.4岁。根据肾功能不全分期标准,肾功能不全代偿期18例,肾功能不全失代偿期3例,肾衰竭期4例,尿毒症期10例。对所有患者引起异常子宫出血的病因进行分类,比较治疗前后异常子宫出血改善、贫血纠正情况及对肾功能影响。结果术前、术后患者血清肌酐水平比较[(392.08±357.08)μmol/L vs (380.31±337.50)μmol/L],差异无统计学意义(P> 0.05)。治疗前后血红蛋白及红细胞压积比较[(102.80±23.28) g/L vs (96.86±19.75) g/L、(30.93±7.29)%vs(29.16±6.15)%],差异有统计学意义(P <0.05)。术后1个月随访发现,1例患者再次出现异常子宫出血,考虑为合并子宫腺肌症所致;失访4例;其余患者均明显好转。宫腔镜治疗慢性肾功能不全合并异常子宫出血好转率为96.77%。结论肾功能处于任何程度,宫腔镜治疗对患者肾功能均无影响。宫腔镜治疗慢性肾功能不全合并异常子宫出血患者是安全、有效的。但对于较为严重的子宫腺肌症患者应慎重选择。
Objective To evaluate the effectiveness and safety of patients with chronic renal failure combined abnormal uterine bleeding by hysteroscopy. Methods From January 2011 to January 2017, 35 cases of chronic renal insufficiency combined with abnormal uterine bleeding by hysteroscopy were enrolled, which aged 41-67 years old with mean age of 54.4 years old. According to renal insufficiency stage, there were 18 cases of renal insufficiency in compensatory period, 3 of renal insufficiency in decompensatory period, 4 of renal failure and 10 of uremia. The etiology of abnormal uterine bleeding was classified,and the improvement of abnormal uterine bleeding, correction of anemia and influence on renal function were compared before and after treatment. Results There was no significantly different in serum creatinine between preoperative and postoperative[(392.08 ± 357.08) μmol/L vs(380.31 ± 337.50) μmol/L](P > 0.05). There were statistically significant differences in hemoglobin and hematocrit before and after treatment[(102.80 ± 23.28) g/L vs(96.86 ± 19.75) g/L,(30.93 ± 7.29) % vs(29.16 ± 6.15) %](P < 0.05). One-month follow-up after the operation, 1 patient experienced abnormal uterine bleeding one more time, which was attributed to combination with adenomyosis. Four cases were lost, and the remainders were significantly improved. The cure and improvement rate of chronic renal insufficiency combined with abnormal uterine hemorrhage by hysteroscopy was96.77 %. Conclusion It is demonstrated the hysteroscopy treatment has no effect on renal function in any degree. The hysteroscopic treatment of chronic renal insufficiency combined with abnormal uterine bleeding is safe and effective. However,patients with serious adenomyosis should be selected carefully.
Objective To evaluate the effectiveness and safety of patients with chronic renal failure combined abnormal uterine bleeding by hysteroscopy. Methods From January 2011 to January 2017, 35 cases of chronic renal insufficiency combined with abnormal uterine bleeding by hysteroscopy were enrolled, which aged 41-67 years old with mean age of 54.4 years old. According to renal insufficiency stage, there were 18 cases of renal insufficiency in compensatory period, 3 of renal insufficiency in decompensatory period, 4 of renal failure and 10 of uremia. The etiology of abnormal uterine bleeding was classified,and the improvement of abnormal uterine bleeding, correction of anemia and influence on renal function were compared before and after treatment. Results There was no significantly different in serum creatinine between preoperative and postoperative[(392.08 ± 357.08) μmol/L vs(380.31 ± 337.50) μmol/L](P > 0.05). There were statistically significant differences in hemoglobin and hematocrit before and after treatment[(102.80 ± 23.28) g/L vs(96.86 ± 19.75) g/L,(30.93 ± 7.29) % vs(29.16 ± 6.15) %](P < 0.05). One-month follow-up after the operation, 1 patient experienced abnormal uterine bleeding one more time, which was attributed to combination with adenomyosis. Four cases were lost, and the remainders were significantly improved. The cure and improvement rate of chronic renal insufficiency combined with abnormal uterine hemorrhage by hysteroscopy was96.77 %. Conclusion It is demonstrated the hysteroscopy treatment has no effect on renal function in any degree. The hysteroscopic treatment of chronic renal insufficiency combined with abnormal uterine bleeding is safe and effective. However,patients with serious adenomyosis should be selected carefully.
引文
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[15]HOU Ping,HU Wei.Treatment of utrine bleeding after renal transplantation[J].Journal of Kunming Medical University,2010,31(9):88-90.[侯苹,胡伟.肾移植术后异常子宫出血的治疗[J].昆明医学院学报,2010,31(9):88-90.]
[16]LUO Xiao-mei,LI Li.Clinical application of diagnostic curettage in the diagnosis and treatment of abnormal uterine bleeding during perimenopausal[J/CD].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2014,6(10):37-39.[罗晓梅,李丽.诊断性刮宫术在诊治围绝经期异常子宫出血中的临床应用研究[J/CD].中国医学前沿杂志(电子版),2014,6(10):37-39.]
[17]WANG Yu.The observation of treating 89 cases of abnormal uterine bleeding by hysteroscope[J].Guide of China Medicine,2013,11(11):461-462.[王玉.宫腔镜治疗异常子宫出血89例疗效观察[J].中国医药指南,2013,11(11):461-462.]
[18]FO Xin-yan,WANG Qun-ying,SUN Yang-ling,et al.The diagnostic value of hysteroscopy in the etiology of abnormal uterine bleeding[J].Chinese Community Doctors,2016,32(8):117-118.[佛新艳,王群英,孙养玲,等.宫腔镜在异常子宫出血病因中的诊断价值[J].中国社区医师,2016,32(8):117-118.]
[19]Revel A,Shushan A.Investigation of the infertile couple:hysteroscopy with endometrialbiopsy is the gold standard investigation for abnormal uterine bleeding[J].Hum Reprod,2002,17(8):1947-1949.
[20]TANG Guo-lian.A comparative study of clinical efficacy of hysteroscopy and laparotomy in the treatment of abnormal uterine bleeding[J].Modern Diagnosis&Treatment,2014,25(17):4031-4031.[唐国莲.宫腔镜与开腹手术治疗异常子宫出血临床疗效对比研究[J].现代诊断与治疗,2014,25(17):4031-4031.]
[21]Royal College of Obstetricians and Gynaecologists,British Society for Gynaecological Endoscopy.2016 RCOG/BSGEjoint guideline:Management of endometrial hyperplasia[S/EB].https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hyperplasia.pdf.
[22]JIANG Huai-fang.Clinical application of blood-muscle ratio in the evaluation of renal function in chronic nephropathy[J/CD].World Latest Medicine Information,2015,15(57):138-139.[姜怀芳.血肌酐值在慢性肾病肾功能评价中的临床应用[J/CD].世界最新医学信息文摘,2015,15(57):138-139.]
[2]Gynecological Endocrinolgy Group,Obstetrics and Gynecology Branch,Chinese Medical Association.Guidelines for diagnosis and treatment of abnormal uterine bleeding[J].Chinese Journal of Obstetrics and Gynecology,2014,49(11):801-806.[中华医学会妇产科学分会妇科内分泌学组.异常子宫出血诊断与治疗指南[J].中华妇产科杂志,2014,49(11):801-806.]
[3]Chinese Society of Traditional Chinese Medicine.Guidelines for the diagnosis and treatment of chronic renal failure[J].Chinese Medicine Modern Distance Education of China,2011,9(9):132-133.[中华中医药学会.慢性肾衰竭诊疗指南[J].中国中医药现代远程教育,2011,9(9):132-133.]
[4]Ghazizadeh S,Lessan-Pezeshki M,Mahdavi M,et al.Menstrual problems among kidney transplant recipients[J].Transplant Proc,2003,35(7):2720-2721.
[5]LIU Qiong-hua.Comparison of the effect of hysteroscopic electrotomy and hysteroscopic curettage in the treatment of abnormal uterine bleeding[J].Maternal&Child Health Care of China,2015,30(4):634-636.[刘琼花.异常子宫出血采取宫腔镜下电切术与宫腔镜下刮宫术治疗的效果对比[J]中国妇幼保健,2015,30(4):634-636.]
[6]Fraser IS,Critchley HO,Munro GM,et al.Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding[J]?Hum Reprod,2007,22(3):635-643.
[7]Fraser IS,Critchley HO,Munro MG,et al.A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding[J].Fertil Steril,2007,87(3):466-476.
[8]ZHANG Yi-wen.FIGO’s consensus on terms related to menstrual abnormalities and a new classification system for causes of abnormal uterine hemorrhage[J].Journal of International Obstetrics and Gynecology,2013,40(2):105-107.[张以文.FIGO关于月经异常相关术语的共识和异常子宫出血病因的新分类系统[J].国际妇产科学杂志,2013,40(2):105-107.]
[9]ZHANG Ning-ning,ZHAO Cheng-zhi,YANG Qing.Clinical study on perimenopausal dysfunctional uterine bleeding treated by bysteroscopic endometrial radiofrequency ablation and endometrial electroresection[J].Chinese Journal of Practical Gynecology and Obstetrics,2015,31(4):342-345.[张宁宁,赵成志,杨清.宫腔镜子宫内膜射频消融术与内膜电切术治疗围绝经期功血疗效比较研究[J].中国实用妇科与产科杂志,2015,31(4):342-345.]
[10]Turnbull H,Glover A,Morris EP,et al.Investigation and management of abnormal peri-menopausal bleeding[J].Menopause Int,2013,19(4):147-154.
[11]WANG Jing,HE Mian,XIA Meng,et al.Surgical treatment for abnormal uterine bleeding after renal transplantation[J].Organ Transplantation,2012,3(6):324-328.[王晶,何勉,夏梦,等.肾移植术后异常子宫出血的手术治疗[J].器官移植,2012,3(6):324-328.]
[12]Ghazizadeh S,Lessan-Pezeshki M,Mahdavi M,et al.Menstrual problem among kidney transplant recipients[J].Transplant Proc,2003,35(7):2720-2721.
[13]JIN Zhi-jun,LIU Xiao-jun,LIU Yan,et al.Treatment of abnormal uterine bleeding and radiofrequency after renal transplantation[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2009,18(26):3197-3198.[金志军,刘晓军,刘彦,等.肾移植术后的异常子宫出血及射频治疗[J].现代中西医结合杂志,2009,18(26):3197-3198.]
[14]BI Zeng-qi.Chronic renal failure:clinical prevention and treatment and theoretical basis[M].Beijing:Peking Union Medical University Press,2003:373-374.[毕增祺.慢性肾功能衰竭:临床防治与理论基础[M].北京:中国协和医科大学出版社,2003:373-374.]
[15]HOU Ping,HU Wei.Treatment of utrine bleeding after renal transplantation[J].Journal of Kunming Medical University,2010,31(9):88-90.[侯苹,胡伟.肾移植术后异常子宫出血的治疗[J].昆明医学院学报,2010,31(9):88-90.]
[16]LUO Xiao-mei,LI Li.Clinical application of diagnostic curettage in the diagnosis and treatment of abnormal uterine bleeding during perimenopausal[J/CD].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2014,6(10):37-39.[罗晓梅,李丽.诊断性刮宫术在诊治围绝经期异常子宫出血中的临床应用研究[J/CD].中国医学前沿杂志(电子版),2014,6(10):37-39.]
[17]WANG Yu.The observation of treating 89 cases of abnormal uterine bleeding by hysteroscope[J].Guide of China Medicine,2013,11(11):461-462.[王玉.宫腔镜治疗异常子宫出血89例疗效观察[J].中国医药指南,2013,11(11):461-462.]
[18]FO Xin-yan,WANG Qun-ying,SUN Yang-ling,et al.The diagnostic value of hysteroscopy in the etiology of abnormal uterine bleeding[J].Chinese Community Doctors,2016,32(8):117-118.[佛新艳,王群英,孙养玲,等.宫腔镜在异常子宫出血病因中的诊断价值[J].中国社区医师,2016,32(8):117-118.]
[19]Revel A,Shushan A.Investigation of the infertile couple:hysteroscopy with endometrialbiopsy is the gold standard investigation for abnormal uterine bleeding[J].Hum Reprod,2002,17(8):1947-1949.
[20]TANG Guo-lian.A comparative study of clinical efficacy of hysteroscopy and laparotomy in the treatment of abnormal uterine bleeding[J].Modern Diagnosis&Treatment,2014,25(17):4031-4031.[唐国莲.宫腔镜与开腹手术治疗异常子宫出血临床疗效对比研究[J].现代诊断与治疗,2014,25(17):4031-4031.]
[21]Royal College of Obstetricians and Gynaecologists,British Society for Gynaecological Endoscopy.2016 RCOG/BSGEjoint guideline:Management of endometrial hyperplasia[S/EB].https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hyperplasia.pdf.
[22]JIANG Huai-fang.Clinical application of blood-muscle ratio in the evaluation of renal function in chronic nephropathy[J/CD].World Latest Medicine Information,2015,15(57):138-139.[姜怀芳.血肌酐值在慢性肾病肾功能评价中的临床应用[J/CD].世界最新医学信息文摘,2015,15(57):138-139.]