Levy-Zauberman Y, Fernandez H, Pourcelot A-G, Legendre G
Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France.
Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2014 Jan;43(1):35-9. doi: 10.1016/j.jgyn.2013.10.006. Epub 2013 Nov 25.
Hysteroscopic endometrial resection or destruction in the indication of abnormal uterine bleeding or post-menopausal bleeding represents an alternative to hysterectomy, as it carries a lower morbidity rate. In case of failure of such procedure though, hysterectomy will most often be proposed as a second line of treatment. The place of the repetition of an endometrial destruction procedure has not yet been evaluated. The aim of our study is to evaluate the efficiency and the satisfaction after two consecutive techniques of endometrial destruction in case of abnormal uterine bleeding or post-menopausal bleeding.
Nineteen patients presenting with recurring abnormal uterine bleeding after one procedure of endometrial destruction, underwent in our department, between 2004 and 2011, a second conservative endometrial procedure.
No complication occurred during the repeated procedure. Sixteen of the nineteen patients (84.2 %) included answered a questionnaire. The mean delay since the second procedure was 27 months [25; 29]. Eight patients (i.e. 50 %) later underwent a hysterectomy, with 5 of them (31.25 % of all 16 patients) being directly attributed to treatment failure. Patients said to be satisfied with the management of their condition in 68.75 % of cases, and 93.75 % of them would recommend it to a friend.
Our results suggest that a second conservative management in case of recurrence of AUB is effective. Hysterectomy could be avoided in 50 % of cases. A second conservative treatment could be an interesting option for patients with medical contra-indication for heavier surgery, as well as for patients willing to keep their uterus.
对于异常子宫出血或绝经后出血患者，宫腔镜下子宫内膜切除术或破坏术是子宫切除术的一种替代方案，因为其发病率较低。然而，如果该手术失败，子宫切除术通常会作为二线治疗方案被提出。子宫内膜破坏术重复进行的情况尚未得到评估。我们研究的目的是评估在异常子宫出血或绝经后出血情况下，连续两次进行子宫内膜破坏术的有效性和患者满意度。
2004年至2011年间，19例在进行一次子宫内膜破坏术后出现复发性异常子宫出血的患者在我们科室接受了第二次保守性子宫内膜手术。
重复手术过程中未发生并发症。纳入研究的19例患者中有16例（84.2%）回答了问卷。自第二次手术以来的平均时间为27个月[25；29]。8例患者（即50%）后来接受了子宫切除术，其中5例（占所有16例患者的31.25%）直接归因于治疗失败。68.75%的患者表示对病情管理满意，其中93.75%的患者会向朋友推荐。
我们的结果表明，对于复发性异常子宫出血进行第二次保守治疗是有效的。50%的病例可以避免子宫切除术。对于有更大型手术医学禁忌证的患者以及希望保留子宫的患者，第二次保守治疗可能是一个有意思的选择。
