Nathani Fatima, Clark T Justin
Academic Department of Obstetrics and Gynecology, Birmingham Women's Hospital, Birmingham, United Kingdom.
J Minim Invasive Gynecol. 2006 Jul-Aug;13(4):260-8. doi: 10.1016/j.jmig.2006.03.015.
In order to assess the efficacy of uterine polypectomy in the treatment of abnormal uterine bleeding (AUB), we conducted a systematic review of the published literature. Relevant papers were identified through electronic scanning of MEDLINE (1966-2004), EMBASE (1980-2004), and the Cochrane Library, and manual searching of bibliographies of known primary and review articles. Studies were selected if the efficacy of uterine polypectomy in treating women with AUB (menstrual dysfunction, postmenopausal bleeding with or without hormone replacement/tamoxifen therapy) was estimated. Study selection, quality assessment, and data abstraction were performed independently and in duplicate. The main outcomes measured were relief of AUB symptoms measured in general terms (improvement from baseline, normalization of bleeding patterns) and patient satisfaction. Secondary outcomes included technical feasibility and complications. Ten uncontrolled observational studies with 617 women were identified. No randomized trials were found. The methodologic quality of included studies was poor. Hysteroscopic resection under general anesthesia was used to remove intrauterine polyps in all studies, although outpatient approaches with local anesthetic also were employed in three of these case series. No technical failures were reported, but three complications including one uterine perforation were described. All studies reported an improvement in symptoms of AUB after polypectomy (range 75%-100%) at follow-up intervals of between 2 and 52 months. A single study compared outpatient polyp removal under local anesthesia with inpatient, general anesthetic treatment and detected no significant difference in treatment outcomes (p = 0.7). It was only possible to stratify treatment outcome according to type of AUB in one small study, which detected no significant difference between polypectomy for menstrual dysfunction or postmenopausal bleeding (p = 0.2). In conclusion, there is a lack of high-quality evidence to reliably inform clinical practice regarding the efficacy of intrauterine polypectomy in women with AUB. The limited available evidence suggests that hysteroscopic polypectomy is a technically successful procedure that improves AUB symptoms. Further research in the form of a multicenter, randomized, controlled trial, stratified by technique, setting, and pattern of AUB, is required to assess the short- and long-term effects of this commonly practiced intervention.
为评估子宫息肉切除术治疗异常子宫出血（AUB）的疗效，我们对已发表的文献进行了系统评价。通过对MEDLINE（1966 - 2004年）、EMBASE（1980 - 2004年）和Cochrane图书馆进行电子检索，以及手动检索已知的原始文献和综述文章的参考文献，来识别相关论文。如果评估了子宫息肉切除术治疗AUB女性（月经功能障碍、绝经后出血伴或不伴激素替代/他莫昔芬治疗）的疗效，则选择该研究。研究选择、质量评估和数据提取由两人独立进行且重复操作。主要测量的结局是用一般术语衡量的AUB症状缓解情况（相对于基线的改善、出血模式正常化）和患者满意度。次要结局包括技术可行性和并发症。确定了10项针对617名女性的非对照观察性研究。未找到随机试验。纳入研究的方法学质量较差。所有研究均采用全身麻醉下的宫腔镜切除术切除宫内息肉，不过在其中3个病例系列中也采用了局部麻醉的门诊手术方法。未报告技术失败情况，但描述了3例并发症，包括1例子宫穿孔。所有研究均报告息肉切除术后随访2至52个月时AUB症状有改善（范围为75% - 100%）。一项研究比较了局部麻醉下门诊息肉切除术与住院全身麻醉治疗，发现治疗结局无显著差异（p = 0.7）。仅在一项小型研究中能够根据AUB类型对治疗结局进行分层，该研究未发现月经功能障碍或绝经后出血的息肉切除术之间存在显著差异（p = 0.2）。总之，缺乏高质量证据来可靠地指导关于子宫息肉切除术治疗AUB女性疗效的临床实践。有限的现有证据表明，宫腔镜息肉切除术是一种技术上成功的手术，可改善AUB症状。需要开展多中心、随机、对照试验形式的进一步研究，按技术、手术环境和AUB模式进行分层，以评估这种常用干预措施的短期和长期效果。
