Preutthipan Sangchai, Herabutya Yongyoth
Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Obstet Gynaecol Res. 2010 Oct;36(5):1031-6. doi: 10.1111/j.1447-0756.2010.01251.x. Epub 2010 Sep 16.
The aim of this study was to assess the long-term effectiveness and safety of hysteroscopic rollerball endometrial ablation as a surgical management of adenomyosis with menorrhagia and/or dysmenorrhea. We compared the results of patients who underwent pretreatment with gonadotropin-releasing hormone (GnRH) agonist with the results of those who did not.
A retrospective study included 190 adenomyotic patients who suffered from menorrhagia and/or dysmenorrhea and underwent hysteroscopic rollerball endometrial ablation. Main outcome measures were rates of successful operation, complications, improvement of abnormal uterine bleeding and pelvic pain after the surgery.
The majority of the patients (142, 74.7%) underwent hysteroscopic rollerball endometrial ablation during the early proliferative phase of the menstrual cycle. The rest were operated on after GnRH agonist pretreatment for 6-8 weeks. Ablations were successfully performed on all patients in a day surgery setting. The average operation time was 36.3 ± 7.1 min. The mean glycine deficit was 583.4 ± 247.3 mL. The ablation in the no-pretreatment group took a significantly longer time and had more glycine absorption compared to the GnRH agonist pretreatment group (P < 0.0001). Mean postoperative follow-up duration was five years (range 1-10 years). A total of 187 patients (98.4%) who had undergone hysteroscopic endometrial ablation reported decreased bleeding: amenorrhea in 58 (30.5%), hypomenorrhea in 78 (41.1%), and eumenorrhea in 51 (26.8%) patients. Three patients (1.6%) underwent hysterectomy due to symptoms recurrence. A total of 165 (86.8%) patients with dysmenorrhea reported either reduced or no dysmenorrhea. There was no significant difference in the efficacy of hysteroscopic rollerball endometrial ablation between patients who underwent pretreatment with GnRH agonists and those who did not. No major complications related to the procedure were reported.
Hysteroscopic rollerball endometrial ablation as a surgical management of menorrhagia and dysmenorrhea that develops in patients with adenomyosis is an effective and safe procedure. It can reduce the need for the unnecessary major surgery of hysterectomy.
本研究旨在评估宫腔镜下滚球子宫内膜切除术作为治疗子宫腺肌病伴月经过多和/或痛经的手术方法的长期有效性和安全性。我们比较了接受促性腺激素释放激素（GnRH）激动剂预处理的患者与未接受预处理的患者的结果。
一项回顾性研究纳入了190例患有月经过多和/或痛经并接受宫腔镜下滚球子宫内膜切除术的子宫腺肌病患者。主要观察指标为手术成功率、并发症发生率、术后异常子宫出血和盆腔疼痛的改善情况。
大多数患者（142例，74.7%）在月经周期的增殖早期接受了宫腔镜下滚球子宫内膜切除术。其余患者在接受GnRH激动剂预处理6 - 8周后进行手术。所有患者均在日间手术环境下成功完成手术。平均手术时间为36.3±7.1分钟。平均甘氨酸缺失量为583.4±247.3毫升。与GnRH激动剂预处理组相比，未预处理组的消融时间明显更长，甘氨酸吸收更多（P < 0.0001）。术后平均随访时间为5年（范围1 - 10年）。共有187例（98.4%）接受宫腔镜子宫内膜切除术的患者报告出血减少：闭经58例（30.5%），月经过少78例（41.1%），月经正常51例（26.8%）。3例（1.6%）患者因症状复发接受了子宫切除术。共有165例（86.8%）痛经患者报告痛经减轻或消失。接受GnRH激动剂预处理的患者与未接受预处理的患者在宫腔镜下滚球子宫内膜切除术的疗效方面无显著差异。未报告与该手术相关的重大并发症。
宫腔镜下滚球子宫内膜切除术作为治疗子宫腺肌病患者月经过多和痛经的手术方法是有效且安全的。它可以减少不必要的子宫切除等大手术的需求。
