Department of Obstetrics and Gynaecology, ICaR-VU Institure, VU University Medical Centre, Amsterdam, the Netherlands.
Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands.
BJOG. 2018 Feb;125(3):326-334. doi: 10.1111/1471-0528.14733. Epub 2017 Jul 5.
To compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect.
Multicentre randomised controlled trial.
Eleven hospitals collaborating in a consortium for women's health research in the Netherlands.
Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography.
Women were randomly allocated to hysteroscopic niche resection or expectant management for 6 months.
The primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation.
We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2-7 days) in the intervention group and 7 days (IQR 3-10 days) in the control group (P = 0.04); on a scale of 0-10, discomfort as a result of spotting had a median score of 2 (IQR 0-7) in the intervention group, compared with 7 (IQR 0-8) in the control group (P = 0.02).
In women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting-related discomfort.
A hysteroscopic niche resection is an effective treatment to reduce niche-related spotting.
比较宫腔镜下憩室切除术与不治疗对剖宫产后月经后点滴出血且存在子宫剖宫产瘢痕缺损的妇女的疗效。
多中心随机对照试验。
荷兰妇女健康研究合作联盟的 11 家医院。
在经阴道超声检查中发现有≥3mm 残余子宫肌层的憩室且有剖宫产后月经后点滴出血的妇女。
将妇女随机分配到宫腔镜下憩室切除术或期待治疗组，治疗时间为 6 个月。
主要结局是随机分组后 6 个月的月经后点滴出血天数。次要结局是月经末期出血、经间出血、尿痛、超声下憩室测量、手术参数、生活质量、患者满意度、性功能和额外治疗。在 3 个月和随机分组后 6 个月时进行评估，除了憩室测量，其他结局在 6 个月时进行评估。
我们将 52 名妇女随机分配到宫腔镜下憩室切除术组，51 名妇女分到期待治疗组。两组的基线月经后点滴出血天数中位数均为 8 天。随机分组后 6 个月，干预组的月经后点滴出血天数中位数为 4 天（四分位距，IQR 2-7 天），对照组为 7 天（IQR 3-10 天）（P = 0.04）；干预组因点滴出血导致的不适评分中位数为 2（IQR 0-7），对照组为 7（IQR 0-8）（P = 0.02）。
对于残余子宫肌层≥3mm 的憩室，宫腔镜下憩室切除术可减少月经后出血和相关出血引起的不适。
宫腔镜下憩室切除术是治疗憩室相关出血的有效方法。
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