Milligan M P, Etokowo G, Kanumuru S, Mannifold N
Obstetrics and Gynaecology, Kent and Canterbury Hospital, Canterbury, Kent CT1 3NG, UK.
J Obstet Gynaecol. 2002 Mar;22(2):201-4. doi: 10.1080/01443610120113436.
The aim of this study was to investigate patients' experiences in the first 3 months following microwave endometrial ablation (MEA) for menorrhagia as well as the suitability of local anaesthesia (LA) versus general anaesthesia (GA) for these procedures. We carried out a cross-sectional questionnaire survey of 173 patients at 3 months after treatment with MEA. All were treated between September 1997 and December 1999. The setting was a small free-standing hospital day unit equipped with a minor operating theatre. Interventions were pretreatment with danazol or goserelin, followed by endometrial ablation with microwaves under GA or LA. Of the 173 patients, 98 (57%) were treated under GA, and 75(43%) under LA. The return of questionnaires was high in both groups (90% for GA and 84% for LA) and all procedures were completed with the planned anaesthetic. Commonly reported symptoms were immediate postoperative pain (61%), abdominal pain in the following weeks (75%), vaginal discharge (87%), vaginal bleeding (74%) and vaginal dryness. Reported symptoms were usually mild and not requiring medical intervention, e.g. in 124 patients (71%), postoperative pain was either absent or mild with no analgesics required. Only 4% had severe pain requiring a single dose of opiate analgesia. The results were similar in both groups. Sixty-nine per cent (104 patients) had no pain 1 week after treatment. This increased to over 90% by the end of the third week. Results were similar in those treated under LA (83% and 96%, respectively). There was early return to normal daily activity (70% by 1 week and 95% by 3 weeks). Reported symptoms were usually mild and not severe enough to warrant consultation of their doctor or the hospital. There were no blood transfusions or hysterectomy within the first 3 months of treatment. We conclude that MEA is well tolerated by patients. Reported side effects are usually minor. LA is comparable to GA and seems to have potential benefits.
本研究的目的是调查月经过多患者在微波子宫内膜切除术（MEA）后的前3个月的体验，以及局部麻醉（LA）与全身麻醉（GA）在这些手术中的适用性。我们对173例接受MEA治疗3个月后的患者进行了横断面问卷调查。所有患者均在1997年9月至1999年12月期间接受治疗。研究地点是一家配备小型手术室的独立日间医院。干预措施为术前使用达那唑或戈舍瑞林，随后在全身麻醉或局部麻醉下进行微波子宫内膜切除术。173例患者中，98例（57%）接受全身麻醉治疗，75例（43%）接受局部麻醉治疗。两组问卷回收率都很高（全身麻醉组为90%，局部麻醉组为84%），所有手术均按计划麻醉完成。常见症状有术后即刻疼痛（61%）、接下来几周的腹痛（75%）、阴道分泌物（87%）、阴道出血（74%）和阴道干燥。报告的症状通常较轻，无需医疗干预，例如124例患者（71%）术后疼痛不存在或较轻，无需使用镇痛药。只有4%的患者有严重疼痛，需要单次使用阿片类镇痛药。两组结果相似。69%（104例患者）在治疗1周后无疼痛。到第三周结束时，这一比例增至90%以上。局部麻醉治疗的患者结果相似（分别为83%和96%）。患者能早期恢复正常日常活动（1周时70%，3周时95%）。报告的症状通常较轻，严重程度不足以促使患者咨询医生或前往医院就诊。治疗的前3个月内无输血或子宫切除情况。我们得出结论，患者对微波子宫内膜切除术耐受性良好。报告的副作用通常较小。局部麻醉与全身麻醉效果相当，似乎还有潜在益处。
