Levy-Zauberman Y, Legendre G, Nazac A, Faivre E, Deffieux X, Fernandez H
AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
Eur J Obstet Gynecol Reprod Biol. 2014 Jul;178:51-5. doi: 10.1016/j.ejogrb.2014.03.023. Epub 2014 Apr 25.
Hysteroscopic endometrial destruction procedures for abnormal uterine bleeding are an alternative to hysterectomy. Such procedures are not contraceptive and are performed on fertile patients, requiring long-term contraception. This is the first study evaluating long-term results of a combined procedure associating endometrial destruction and concomitant hysteroscopic tubal sterilization by Essure(®) micro-inserts. Our goal is to evaluate efficacy of endometrial destruction as well as hysteroscopic sterilization and satisfaction after a combined procedure in the case of abnormal uterine bleeding in non-menopausal patients.
This is a retrospective study (Canadian task force II-2) that includes 131 patients operated with combined endometrial destruction and hysteroscopic tubal sterilization between 2002 and 2011 at our university hospital. The patients were contacted to answer a questionnaire. Statistical analysis was performed with SAS© version 9.2. (SAS Institute Inc., Cary, NC).
Ninety-three patients out of 131 could be reached. The mean follow-up was of 37.8 months (min=8, max=87, SD=6.2). Thirty-eight patients (29%) were lost to follow-up. Essure(®) micro-inserts introduction success rate (evaluated on 131 patients) was 95.8%, and their position was appropriate in 81.1% of the 106 patients with position control. Efficacy of the procedure on the haemorrhagic symptoms (evaluated on 93 patients) was 80.6%. Twelve patients (12.9%) underwent a hysterectomy, 7 of which (58.3%) were a direct consequence of treatment failure. No pregnancies were reported. Satisfaction rate was of 90.3%.
Inadequate position rates of the micro-inserts after 3 months seem somewhat above literature findings, though no pregnancy has been reported. However, recurrent bleeding symptoms and hysterectomy rates are consistent with those observed after an endometrial destruction procedure alone. Limitations are the limited number of patients, the bias inherent to retrospective studies (lost of follow-up, selection bias). The concomitant endometrial destruction and tubal sterilization by micro-inserts is a safe and efficient procedure.
宫腔镜下子宫内膜破坏术用于治疗异常子宫出血，是子宫切除术的一种替代方法。此类手术不具有避孕作用，且适用于有生育能力的患者，因此需要长期避孕措施。本研究首次评估了子宫内膜破坏术联合经宫腔镜植入爱舒（Essure®）微型植入物行输卵管绝育术的长期效果。我们的目的是评估非绝经期患者因异常子宫出血接受联合手术后子宫内膜破坏术、宫腔镜绝育术的疗效及患者满意度。
这是一项回顾性研究（加拿大工作组II-2级），纳入了2002年至2011年间在我院接受子宫内膜破坏术联合宫腔镜输卵管绝育术的131例患者。研究人员联系这些患者以获取问卷调查结果。采用SAS© 9.2版软件（SAS Institute Inc., Cary, NC）进行统计分析。
131例患者中93例取得联系。平均随访时间为37.8个月（最短8个月，最长87个月，标准差6.2）。38例患者（29%）失访。爱舒（Essure®）微型植入物的植入成功率（基于131例患者评估）为95.8%，在接受位置检查的106例患者中，81.1%的植入位置合适。该手术对出血症状的疗效（基于93例患者评估）为80.6%。12例患者（12.9%）接受了子宫切除术，其中7例（58.3%）是治疗失败的直接后果。无妊娠报告。满意度为90.3%。
尽管未报告妊娠情况，但术后3个月微型植入物位置不当率似乎略高于文献报道。不过，复发性出血症状及子宫切除率与单纯子宫内膜破坏术后观察到的情况一致。本研究的局限性在于患者数量有限，以及回顾性研究固有的偏差（失访、选择偏倚）。子宫内膜破坏术联合微型植入物行输卵管绝育术是一种安全有效的手术。
