Sirkeci R Fusun, Belli Anna Maria, Manyonda Isaac T
St George's, University of London, London, UK.
Department of Radiology, St George's Healthcare NHS Foundation Trust, St George's, University of London, London, UK.
Gynecol Surg. 2017;14(1):11. doi: 10.1186/s10397-017-1014-4. Epub 2017 Jul 6.
The demand for uterus-sparing treatments is increasing as more women postpone childbirth to their 30-40s, when fibroids are more symptomatic. With an increasing choice of treatment options and changing care-provider profiles, now is an opportune time to survey current practices and opinions. Using a 25-stem questionnaire, a web-based survey was used to capture the practices and opinions of UK consultant gynecologists on the treatment of symptomatic fibroids, including the types of procedure most frequently used, methods used to reduce blood loss, and awareness and acceptability of treatment options, and to assess the impact of gender and experience of the treating gynecologist.
The response rate was 22%. Laparascopic myomectomy is used least frequently, with 80% of the respondents using GnRHa preoperatively to minimize blood loss and correct anemia, while vasopressin is most frequently used to reduce intraoperative blood loss. Female consultants operate significantly less frequently than males. Those with more than 10 years consultant experience are more likely to perform an open myomectomy compared to those with less than 10 years experience.
Compared to a similar survey performed 10 years ago, surgical methods remain to be the most common treatments, but use of less invasive treatments such as UAE has increased. Consultants' attitudes appear to be responding to the patient demand for less radical treatments. However, it is yet to be seen if the changing consultant demographics will keep up with this demand. The low response rate warrants cautious interpretation of the results, but they provide an interesting snapshot of current views and practices.
随着越来越多的女性将生育推迟到30至40岁，此时子宫肌瘤症状更为明显，对保留子宫治疗的需求正在增加。随着治疗选择的增多和医疗服务提供者情况的变化，现在是调查当前做法和观点的适当时机。通过一份包含25个问题的问卷，开展了一项基于网络的调查，以了解英国妇科顾问医生对有症状子宫肌瘤治疗的做法和观点，包括最常用的手术类型、减少失血的方法、治疗选择的知晓度和可接受性，并评估治疗妇科医生的性别和经验所产生的影响。
回复率为22%。腹腔镜子宫肌瘤切除术使用频率最低，80%的受访者术前使用促性腺激素释放激素激动剂（GnRHa）以减少失血并纠正贫血，而血管加压素最常用于减少术中失血。女性顾问医生的手术操作频率明显低于男性。与经验不足10年的顾问医生相比，经验超过10年的顾问医生更有可能进行开放性子宫肌瘤切除术。
与10年前进行的类似调查相比，手术方法仍然是最常见的治疗方式，但诸如子宫动脉栓塞术（UAE）等侵入性较小的治疗方法的使用有所增加。顾问医生的态度似乎在回应患者对不那么激进治疗的需求。然而，不断变化的顾问医生人口统计学情况是否能跟上这一需求还有待观察。低回复率使得对结果的解读需谨慎，但它们提供了当前观点和做法的有趣概况。
