承孟水,钟顺莲,沙仁高娃

异常子宫出血（AUB）是指育龄妇女妊娠外发生的子宫出血，其规律性、频率、体积或持续时间参数异常。AUB是一种严重影响生活质量的常见疾病。超声、宫腔镜则为常见影像学检查技术，在疾病诊断及病因判断中具有重要作用，但存在各自优劣势。药物治疗和手术治疗是围绝经期AUB的主要治疗方式。药物治疗首选性激素，其他还包括非甾体抗炎药、氨甲环酸、孕激素拮抗剂、促性腺激素释放激素类似物以及中成药等；手术治疗主要包括宫腔镜或腹腔镜下子宫切除术和子宫内膜病损去除术两种方式。每种治疗方法适用范围略有不同，且各有利弊。在临床实践中,医师应根据患者的具体情况并充分尊重患者的主观诉求综合考虑,选择个性化治疗方案。本研究探讨了AUB的诊断和治疗方法，旨在为临床提供参考。

异常子宫出血；超声；宫腔镜；药物治疗；手术治疗

[1] 施晓燕,李丽君,贾芸,等.曼月乐治疗育龄期异常子宫出血患者的疗效观察[J].中国妇产科临床杂志,2021,22(1):84-85. [2] 戴河柳,李昌盛,黄亚雄,等.单纯经阴道超声与联合宫腔镜检查对子宫内膜癌诊断价值分析[J].中国性科学,2019,28(1):63-65. [3] 李磊,宋淑芳.围绝经期功血的治疗进展[J].世界最新医学信息文摘,2018,18(76):90,94. [4] Munro MG,Critchley HOD,Fraser IS;FIGO Menstrual Disorders Committee.The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years:2018 revisions.Int J Gynaecol Obstet.2018 Dec;143(3):393-408. [5] Yoon DJ,Jones M,Taani JA,Buhimschi C,Dowell JD.A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology,Diagnosis,and Transcatheter Treatment.AJP Rep.2016 Mar;6(1):e6-e14. [6] Munro MG.Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years.Best Pract Res Clin Obstet Gynaecol.2017 Apr;40:3-22. [7] Leal CRV,Vannuccini S,Jain V,Dolmans MM,Di Spiezio Sardo A,Al-Hendy A,Reis FM.Abnormal uterine bleeding:The well-known and the hidden face.J Endometr Uterine Disord.2024 Jun;6:100071. [8] Jain V,Munro MG,Critchley HOD.Contemporary evaluation of women and girls with abnormal uterine bleeding:FIGO Systems 1 and 2.Int J Gynaecol Obstet.2023 Aug;162 Suppl 2(Suppl 2):29-42. [9] Liu Z,Doan QV,Blumenthal P,Dubois RW.A systematic review evaluating health-related quality of life,work impairment,and health-care costs and utilization in abnormal uterine bleeding.Value Health.2007 May-Jun;10(3):183-94. [10] 陈璐,王燕,冯同富,等.门诊宫腔镜对10565例异常子宫出血患者PALM-CORIN病因分类的应用[J].现代妇产科进展, 2016,25(9):641-645. [11] 江卫红,徐娟,林敏,等.女性不同时期异常子宫出血病因分析[J].陕西医学杂志,2018,47(07):849-851. [12] 李绍林.功能性子宫出血的中医病机及治疗思路探析[J].世界中西医结合杂志,2017,12(09):1185-1188. [13] 刘慧丽,柳静,刘桂琴.辨证治疗青春期功能失调性子宫出血156例[J].北京中医药大学学报,2003(04):87-88. [14] 郝莉.益肾健脾固冲汤联合地屈孕酮治疗脾肾亏虚型围绝经期功血的临床观察[D].南京中医药大学,2020. [15] Expert Panel on GYN and OB Imaging;Robbins JB,Sadowski EA,Maturen KE,Akin EA,Ascher SM,Brook OR,Cassella CR,Dassel M,Henrichsen TL,Learman LA,Patlas MN,Saphier C,Wasnik AP,Glanc P.ACR Appropriateness Criteria®Abnormal Uterine Bleeding.J Am Coll Radiol.2020 Nov;17(11S):S336-S345. [16] 靳静.宫腔镜联合阴道超声检查对异常子宫出血病因诊断的价值[J].医学临床研究,2017,34(5):923-924. [17] 王燕,周萍,郭徐英,高翔,徐凤英,等.经阴道超声与宫腔镜检查在异常子宫出血诊断中应用分析[J].贵州医药,2018,42(2):234-235. [18] 刘元君,万映,孟繁繁.阴道超声与宫腔镜诊断异常子宫出血病因准确性比较[J].中国计划生育学杂志,2021,29(6):1244-1246. [19] 李燕,张爱英,臧学利,等.雌激素联合醋酸甲羟孕酮治疗功能失调性子宫出血患者的临床研究[J].中国临床药理学杂志, 2020,36(20):3208-3211. [20] ACOG committee opinion no.557:Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women.Obstet Gynecol.2013 Apr;121(4):891-896. [21] ACOG Committee Opinion No.785,Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding:Correction.Obstet Gynecol.2023 Jan 1;141(1):228. [22] Wouk N,Helton M.Abnormal Uterine Bleeding in Premenopausal Women.Am Fam Physician.2019 Apr 1;99(7):435-443. PMID:30932448. [23] Marnach ML,Laughlin-Tommaso SK.Evaluation and Management of Abnormal Uterine Bleeding.Mayo Clin Proc.2019 Feb; 94(2):326-335. [24] Vitale SG,Della Corte L,Ciebiera M,Carugno J,Riemma G,Lasmar RB,Lasmar BP,Kahramanoglu I,Urman B,MikušM,De Angelis C,Török P,Angioni S.Hysteroscopic Endometrial Ablation:From Indications to Instrumentation and Techniques-A Call to Action. Diagnostics(Basel).2023 Jan 17;13(3):339. [25] Yan L,Huang H,Lin J,Yu R.High-intensity focused ultrasound treatment for symptomatic uterine fibroids:a systematic review and meta-analysis.Int J Hyperthermia.2022;39(1):230-238. [26] Munro MG,Critchley HO,Fraser IS.The FIGO classification of causes of abnormal uterine bleeding:Malcolm G.Munro,Hilary O.D.Crithcley,Ian S.Fraser,for the FIGO Working Group on Menstrual Disorders.Int J Gynaecol Obstet.2011 Apr;113(1):1-2. [27] Dhombres F,Bonnard J,Bailly K,Maurice P,Papageorghiou AT,Jouannic JM.Contributions of Artificial Intelligence Reported in Obstetrics and Gynecology Journals:Systematic Review.J Med Internet Res.2022 Apr 20;24(4):e35465.

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