Mall Alison, Shirk Gerald, Van Voorhis Bradley J
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Obstet Gynecol. 2002 Oct;100(4):659-64. doi: 10.1016/s0029-7844(02)02185-3.
To determine risk factors for hysterectomy, pelvic pain, and continued menorrhagia after rollerball endometrial ablation.
All women having rollerball endometrial ablations between 1990 and 2000 were sent standardized questionnaires on pre- and postablation symptoms, satisfaction with the ablation, and subsequent gynecologic surgery. Pathology reports from surgery after the ablation were reviewed when available.
Two hundred forty women had a rollerball ablation during this period and 174 (72.5%) responded to the questionnaire. The average age of women at the time of the ablation was 43.1 years and the mean follow-up time since the ablation was 49 months. Seventy-four percent of women were satisfied with the ablation and 92% reported decreased or absent menstrual bleeding since the ablation. However, 13% of women reported new or worsening pelvic pain symptoms since the ablation and 21 women (12%) had a hysterectomy after the ablation for continued symptoms. A previous tubal ligation was a risk factor for having a hysterectomy (hazard ratio of 3.3, P =.03) and for having worsened pelvic pain (hazard ratio of 3.2, P =.05) after an ablation. Women who had a previous tubal ligation were more likely to use pain medications for pelvic pain after an ablation. Age over 35 at the time of the ablation was predictive of less bleeding after the ablation. Pathologic findings consistent with the postablation tubal sterilization syndrome were observed in five surgical specimens for an incidence of 6%.
Having a tubal ligation is a risk factor for the development of pelvic pain and for having a hysterectomy after rollerball endometrial ablation. The incidence of pathologically confirmed postablation tubal sterilization syndrome is 6%, but clinical manifestations of this syndrome may be higher. Relatively older age at the time of the ablation is associated with a higher rate of improved bleeding symptoms after ablation.
确定滚球子宫内膜切除术（rollerball endometrial ablation）后子宫切除术、盆腔疼痛和月经过多持续存在的危险因素。
向1990年至2000年间所有接受滚球子宫内膜切除术的女性发送关于术前和术后症状、对手术的满意度以及随后妇科手术情况的标准化问卷。如有可用的资料，会对切除术后手术的病理报告进行回顾。
在此期间，240名女性接受了滚球子宫内膜切除术，174名（72.5%）回复了问卷。接受手术时女性的平均年龄为43.1岁，自手术以来的平均随访时间为49个月。74%的女性对手术满意，92%的女性报告自手术后月经出血减少或停止。然而，13%的女性报告自手术后出现新的或加重的盆腔疼痛症状，21名女性（12%）因症状持续在手术后进行了子宫切除术。既往输卵管结扎是切除术后进行子宫切除术（风险比为3.3，P = 0.03）和盆腔疼痛加重（风险比为3.2，P = 0.05）的危险因素。既往有输卵管结扎的女性在切除术后更有可能使用止痛药来缓解盆腔疼痛。手术时年龄超过35岁可预测切除术后出血较少。在5份手术标本中观察到与切除术后输卵管绝育综合征一致的病理结果，发生率为6%。
输卵管结扎是滚球子宫内膜切除术后发生盆腔疼痛和进行子宫切除术的危险因素。病理证实的切除术后输卵管绝育综合征的发生率为6%，但该综合征的临床表现可能更高。手术时年龄相对较大与切除术后出血症状改善率较高相关。
