Department of Obstetrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
Menopause. 2011 Apr;18(4):437-44. doi: 10.1097/gme.0b013e318207fe15.
The aim of this study was to inform the clinician of alternatives to hysterectomy through a critical evaluation of three treatment options: global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound. Studies published in English-language, peer-reviewed journals were systematically searched using Cochrane and Medline. Keywords used included "alternatives to hysterectomy," "endometrial ablation," "uterine fibroid embolization," "uterine artery embolization," and "focused ultrasound." Articles meeting the inclusion criteria were reviewed and analyzed for themes and similarities. All three alternative methods of treatment reviewed are currently approved for use in the United States and abroad. In fact, five different global endometrial ablation devices are approved by the Food and Drug Administration for treatment of menorrhagia. Patient satisfaction scores after endometrial ablation are high (90%-95%), but amenorrhea rates are much lower (15%-60%). Data from randomized trials demonstrate that uterine fibroid embolization results in a shorter hospital stay and quicker return to work as compared with abdominal hysterectomy for leiomyomas, but after embolization, up to 20% of women need a second procedure. Ex-ablative therapy of leiomyomas with focused ultrasound is the newest of the three methods. It has a special set of patient selection criteria and is only available at less than 20 medical centers in the United States. Leiomyoma symptom relief after focused ultrasound therapy at 1 year post-procedure is high (85%-95%). There are many effective alternatives to hysterectomy in women with menorrhagia and/or symptomatic leiomyomas. However, because these procedures are performed by individuals from different subspecialists, primarily gynecologists and interventional radiologists, clinicians must consider using a multidisciplinary approach to find the best procedure for a given patient. There are no randomized trials comparing uterine fibroid embolization to vaginal hysterectomy, laparoscopic hysterectomy, or laparoscopic myomectomy.
这项研究的目的是通过对三种治疗选择的批判性评估，为临床医生提供除子宫切除术以外的选择：全面子宫内膜消融术、子宫肌瘤栓塞术和磁共振引导聚焦超声。系统地检索了在英语同行评议期刊上发表的研究，使用了 Cochrane 和 Medline 关键词，包括“子宫切除术的替代方法”、“子宫内膜消融术”、“子宫肌瘤栓塞术”、“子宫动脉栓塞术”和“聚焦超声”。符合纳入标准的文章进行了回顾和分析，并探讨了主题和相似性。三种替代治疗方法目前都在美国和国外获准使用。事实上，有五种不同的全面子宫内膜消融设备已被食品和药物管理局批准用于治疗月经过多。子宫内膜消融术后患者的满意度评分很高（90%-95%），但闭经率要低得多（15%-60%）。随机试验数据表明，与子宫肌瘤的剖腹子宫切除术相比，子宫肌瘤栓塞术可导致住院时间更短，恢复工作更快，但栓塞后，多达 20%的女性需要进行第二次手术。子宫肌瘤的聚焦超声消融术是这三种方法中最新的一种。它有一套特殊的患者选择标准，并且仅在美国不到 20 个医疗中心提供。聚焦超声治疗后 1 年子宫肌瘤症状缓解率很高（85%-95%）。对于月经过多和/或有症状的子宫肌瘤女性，有许多有效的子宫切除术替代方法。然而，由于这些手术是由不同专科医生（主要是妇科医生和介入放射科医生）进行的，因此临床医生必须考虑采用多学科方法为特定患者找到最佳的手术方法。目前还没有比较子宫肌瘤栓塞术与阴道子宫切除术、腹腔镜子宫切除术或腹腔镜子宫肌瘤切除术的随机试验。
