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【目的】探讨频率9.2GHz微波行子宫内膜去除术治疗月经过多的疗效及其病理机理。【方法】收集44例月经过多行微波子宫内膜去除术的病例,随机取其中13例同时行术前术后宫腔镜检查及术后取子宫内膜作病理及电镜检查。术后随诊6～12个月,了解月经情况以判断疗效。【结果】MEA术后随机取的其中13 例子宫内膜均呈急性热损伤改变。损伤深达基底层全层,基底层细胞基质细胞核固缩,部分细胞核核膜消失。细胞器分辨不清,变性坏死属不可逆改变。浅肌层中细胞平滑肌细胞较为完整,可见核仁、核膜,胞核异染色质边集,线粒体、内质网结构尚在,溶酶体肿胀但完整。变化尚处于可逆性阶段。术后随诊患者达到月经改善,无需再次手术治疗的成功率达91.4%(40144),术后无严重并发症发生。【结论】高频微波能有效地破坏子宫内膜达基底层,而对子宫肌层无创伤,从而达到有效,安全治疗月经过多目的。
【Objective】 To investigate the therapeutic effect and pathological mechanism of menopause with frequency 9.2GHz microwave endometrial ablation. 【Methods】 Forty-four patients underwent microwave endometrial ablation underwent menstruation. Thirteen patients were randomly selected to undergo hysteroscopy before operation and endometrium after operation for pathology and electron microscopy. Follow-up postoperative 6 to 12 months, to understand the menstrual situation to determine the efficacy. 【Results】 Thirteen cases of endometrial lesions were randomly selected after MEA. Damage to the full depth of the basal layer, basal cell stromal cell nuclear condensation, part of the nuclear nuclear membrane disappear. Organelle distinguish, degeneration and necrosis is irreversible change. Smooth muscle cells in the superficial muscle cells more complete, showing the nucleolus, nuclear membrane, nucleus heterochromatin edge set, mitochondria, endoplasmic reticulum structure is still, lysosome swelling but complete. Changes are still in a reversible phase. Follow-up patients after surgery to achieve improvement of menstruation, no need for re-operation of the success rate of 91.4% (40,144), no serious postoperative complications. 【Conclusion】 High-frequency microwave can effectively destroy the basal lamina of endometrium, but not invasiveness of the myometrium so as to achieve effective and safe treatment of menorrhagia.