Department of Obstetrics and Gynaecology, Roskilde University Hospital, Roskilde, Denmark.
J Minim Invasive Gynecol. 2012 Mar-Apr;19(2):212-6. doi: 10.1016/j.jmig.2011.12.011. Epub 2012 Jan 31.
To analyze the long-term efficacy of hydrothermal ablation (HTA) in women with a normal uterine cavity and submucous uterine myomas.
Retrospective study (Canadian Task Force classification II-2).
Roskilde University Hospital surgical daycare unit.
One hundred sixty-six consecutive patients with abnormal uterine bleeding who underwent HTA from 2004 to 2008. All patients were asked to fill out a specific questionnaire that included questions related to postoperative bleeding patterns, complications, and satisfaction with the procedure. One hundred thirty-six patients (81.9%) completed the questionnaire, including 33 women (24.3%) with submucous myomas.
The HTA procedure was performed in accordance with previous descriptions.
Mean (SD; 95% CI) follow-up was 33 (10.5; 25.5-31.8) months. Amenorrhea was achieved in 57 women with myomas (55.3%) and 17 women (51.5%) without myomas (p = .47). Postoperative light bleeding was reported in 26 women with myomas (25.2%) and 6 women (18.2%) without myomas. During follow-up, 13 women with myomas (12.6%) underwent hysterectomy, compared with 6 women without myomas (18.2%). Postoperatively, the mean (SD; 95% CI) number of days per month with bleeding was reduced in both groups, from 13.62 (7.90; 11.87-15.37) to 1.34 (2.32; 0.84-1.84) days in the group with myomas, and from 14.78 (8.81; 10.97-18.59), to 1.88 (4.38; 0.12-3.65) without myomas. Similarly, both groups reported improved quality of life: 74.8% and 72.7%, respectively (p = .59). Compared with patients with myomas 3 cm or smaller, patients with myomas larger than 3 cm demonstrated a significantly higher rate of severe bleeding postoperatively (p = .02).
Our results demonstrate that HTA is associated with a high rate of amenorrhea in patients with or without submucous myomas. However, a significantly lower effect may be observed in patients with myomas larger than 3 cm.
分析宫腔正常、黏膜下子宫肌瘤患者行热疗消融术（HTA）的长期疗效。
回顾性研究（加拿大卫生保健适宜技术研究所分类 II-2 级）。
罗斯基勒大学医院日间手术病房。
2004 年至 2008 年期间，166 例因异常子宫出血而行 HTA 的连续患者。所有患者均被要求填写一份专门的问卷，其中包括与术后出血模式、并发症和对手术的满意度相关的问题。136 例患者（81.9%）完成了问卷，其中 33 例（24.3%）患者有黏膜下肌瘤。
HTA 手术按照先前的描述进行。
平均（SD；95%CI）随访时间为 33（10.5；25.5-31.8）个月。有肌瘤的 57 例患者（55.3%）和无肌瘤的 17 例患者（51.5%）达到闭经（p =.47）。26 例有肌瘤的患者（25.2%）和 6 例无肌瘤的患者（18.2%）报告术后轻度出血（p =.47）。随访期间，13 例有肌瘤的患者（12.6%）行子宫切除术，而无肌瘤的患者为 6 例（18.2%）。术后，两组患者的每月出血天数均减少，有肌瘤组从 13.62（7.90；11.87-15.37）天减少至 1.34（2.32；0.84-1.84）天，无肌瘤组从 14.78（8.81；10.97-18.59）天减少至 1.88（4.38；0.12-3.65）天。同样，两组患者的生活质量均得到改善：分别为 74.8%和 72.7%（p =.59）。与肌瘤直径≤3 cm 的患者相比，肌瘤直径＞3 cm 的患者术后严重出血的发生率显著更高（p =.02）。
我们的研究结果表明，HTA 可使有或无黏膜下肌瘤的患者闭经率较高。然而，肌瘤直径＞3 cm 的患者效果可能较低。
