Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Am J Obstet Gynecol. 2014 Nov;211(5):556.e1-6. doi: 10.1016/j.ajog.2014.07.005. Epub 2014 Jul 11.
The objectives of the study were to compare among women who had an endometrial ablation the risks of treatment failure and subsequent gynecological procedures between women with regular and irregular heavy uterine bleeding and to determine other characteristics associated with the risk of treatment failure.
This study was a retrospective cohort of 968 women who underwent endometrial ablation between January 2007 and July 2009. Preoperative bleeding pattern was categorized as regular or irregular. Treatment failure was defined as reablation or hysterectomy. Subsequent gynecological procedures included endometrial biopsy, dilation and curettage, hysteroscopy, reablation, or hysterectomy. We calculated the odds of treatment failure and gynecological procedures using multiple logistic regression.
Bleeding pattern prior to ablation was heavy and regular in 30% (n = 293), heavy and irregular in 36% (n = 352), and unspecified in 30% (n = 286). We found no differences in treatment failure (13% vs 12%, P = .9) or subsequent procedures (16% vs 18%, P = .7) between women with regular and irregular bleeding. Compared with the women with regular bleeding, the women with irregular bleeding were not at increased odds of treatment failure or subsequent procedures (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.65-1.74 and OR, 1.17; 95% CI, 0.76-1.80, respectively). Factors associated with an increased odds of treatment failure and subsequent procedures included tubal ligation (OR, 1.94; 95% CI, 1.30-2.91 and OR, 1.71; 95% CI, 1.20-2.43, respectively); dysmenorrhea (OR, 2.42; 95% CI, 1.44-4.06 and OR, 1.93; 95% CI, 1.20-3.13, respectively); and obesity (OR, 1.82; 95% CI, 1.21-2.73 and OR, 1.75; 95% CI, 1.22-2.50, respectively).
Preoperative bleeding pattern did not appear to affect failure rates or the need for gynecological procedures after endometrial ablation. Other risk factors for ablation failure identified included preoperative dysmenorrhea, prior tubal ligation, and obesity.
本研究旨在比较因子宫内膜消融术而就诊的女性中，月经出血模式为规则性大出血和不规则性大出血患者的治疗失败率和后续妇科手术风险，并确定与治疗失败风险相关的其他特征。
本研究为回顾性队列研究，纳入了 2007 年 1 月至 2009 年 7 月间行子宫内膜消融术的 968 例女性。术前出血模式分为规则性和不规则性。治疗失败定义为再次消融术或子宫切除术。后续妇科手术包括子宫内膜活检、扩张和刮宫术、宫腔镜检查、再次消融术或子宫切除术。我们使用多变量逻辑回归计算治疗失败和妇科手术的比值比。
消融术前出血模式为大量且规则性出血占 30%（n=293），大量且不规则性出血占 36%（n=352），不明原因出血占 30%（n=286）。我们发现规则性出血和不规则性出血患者的治疗失败率（13% vs 12%，P=0.9）或后续手术率（16% vs 18%，P=0.7）无差异。与规则性出血患者相比，不规则性出血患者治疗失败或后续手术的比值比无显著差异（比值比[OR]，1.07；95%置信区间[CI]，0.65-1.74 和 OR，1.17；95% CI，0.76-1.80）。与治疗失败和后续手术风险增加相关的因素包括输卵管结扎术（OR，1.94；95% CI，1.30-2.91 和 OR，1.71；95% CI，1.20-2.43）；痛经（OR，2.42；95% CI，1.44-4.06 和 OR，1.93；95% CI，1.20-3.13）；肥胖（OR，1.82；95% CI，1.21-2.73 和 OR，1.75；95% CI，1.22-2.50）。
术前出血模式似乎并不影响子宫内膜消融术后的失败率或妇科手术需求。消融术失败的其他风险因素包括术前痛经、既往输卵管结扎术和肥胖。
