Narice Brenda F, Delaney Brigitte, Dickson Jon M
Clinical Research Fellow in Obstetrics & Gynaecology; Academic Unit of Reproductive and Developmental Unit, University of Sheffield, Sheffield, S10 2SF, UK.
Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU, UK.
BMC Fam Pract. 2018 Jul 30;19(1):135. doi: 10.1186/s12875-018-0817-3.
One million women per year seek medical advice for abnormal uterine bleeding (AUB) in the United Kingdom. Many low-risk patients who could be managed exclusively in primary care are referred to hospital based gynaecology services. Performing endometrial sampling (ES) in the community may improve care, reduce the rate of referrals and minimise costs. We aimed to search and synthesise the literature on the effectiveness of ES (Pipelle versus other devices) in managing AUB in low-risk patients.
We undertook an electronic literature search in MEDLINE via OvidSP, Scopus, and Web of Science for relevant English-language articles from 1984 to 2016 using a combination of MeSH and keywords. Two reviewers independently pre-selected 317 articles and agreed on 60 articles reporting data from over 7300 patients. Five themes were identified: sample adequacy, test performance, pain and discomfort, cost-effectiveness, and barriers and complications of office ES.
Pipelle seems to perform as well as dilation and curettage and, as well or better than other ES devices in terms of sampling adequacy and sensitivity. It also seems to be better regarding pain/discomfort and costs. However, Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis, pelvic organ prolapse and endometrial atrophy.
The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning. However, the implications of its widespread use in primary care are uncertain and more research is required.
在英国，每年有100万女性因异常子宫出血（AUB）寻求医疗建议。许多本可仅在初级保健机构进行管理的低风险患者被转诊至医院的妇科服务部门。在社区进行子宫内膜取样（ES）可能会改善医疗服务、降低转诊率并使成本最小化。我们旨在检索并综合有关ES（ Pipelle与其他设备）在管理低风险患者AUB方面有效性的文献。
我们通过OvidSP、Scopus和Web of Science在MEDLINE中进行电子文献检索，使用医学主题词（MeSH）和关键词组合检索1984年至2016年的相关英文文章。两名评审员独立预先筛选了317篇文章，并就60篇报告来自7300多名患者数据的文章达成一致。确定了五个主题：样本充足性、检测性能、疼痛和不适、成本效益以及门诊ES的障碍和并发症。
就样本充足性和敏感性而言，Pipelle的表现似乎与刮宫术相当，并且与其他ES设备一样好或更好。在疼痛/不适和成本方面似乎也更好。然而，Pipelle可能会破坏子宫内膜的超声图像，并且可能受到宫颈狭窄、盆腔器官脱垂和子宫内膜萎缩的限制。
目前的证据支持在结合临床评估和超声扫描的情况下，使用Pipelle管理门诊出现症状性AUB的低风险女性。然而，其在初级保健中广泛使用的影响尚不确定，需要更多的研究。
