Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
PLoS One. 2019 Jul 10;14(7):e0219294. doi: 10.1371/journal.pone.0219294. eCollection 2019.
Abnormal uterine bleeding needs surgical treatment if medical therapy fails. After introduction of non-hysteroscopic endometrial ablation as alternative to hysteroscopic endometrial resection, we aimed to compare short and long-term outcomes for women treated with these two minimally-invasive procedures. A secondary goal was comparing the present cohort to a previous cohort of women treated with hysteroscopic resection only.
Historical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during 2006-2014. Similar patient file and patient-reported outcome data were collected from 386 hysteroscopic resections in a previous cohort (1992-1998). Categorical variables were compared by Chi-square or Fisher´s Exact-test, linear variables by Mann-Whitney U-test and time to hysterectomy by the Kaplan-Meier method.
During 2006-2014, 772 women were treated with endometrial resection or ablation, 468 women (61%) consented to study-inclusion; 333 women (71%) were treated with hysteroscopic resection and 135 (29%) with endometrial ablation. Preoperative characteristics were significantly different for women treated with hysteroscopic resection compared to endometrial ablation in the 2006-2014-cohort and between the two time-cohorts regarding menopausal, sterilization and myoma status (p≤0.036). The endometrial ablation group had significantly shorter operation time, median 13 minutes (95% Confidence Interval (CI) 12-14) and a lower complication rate (2%) versus operation time, median 25 minutes (95% CI 23-26) and complication rate (13%) in the hysteroscopy group, all p ≤0.001. The patient-reported rate of satisfaction with treatment was equivalent in both groups (85%, p = 0.955). The endometrial ablation group had lower hysterectomy rate (8% vs 16%, p = 0.024). Patient-reported satisfaction rate was higher (85%) in the 2006-2014-cohort compared with the 1992-1998-cohort (73%), p<0.001.
Endometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding.
如果药物治疗无效，异常子宫出血需要手术治疗。非宫腔镜子宫内膜消融术作为宫腔镜子宫内膜切除术的替代方法引入后，我们旨在比较这两种微创程序治疗女性的短期和长期结果。次要目标是将本队列与仅接受宫腔镜切除术治疗的先前队列中的女性进行比较。
对 2006 年至 2014 年在豪克兰大学医院接受宫腔镜切除术或子宫内膜消融术治疗异常子宫出血的女性进行历史队列研究。从前一个队列（1992-1998 年）中收集了 386 例宫腔镜切除术相似的患者档案和患者报告的结局数据。通过卡方检验或 Fisher 精确检验比较分类变量，通过 Mann-Whitney U 检验比较线性变量，通过 Kaplan-Meier 方法比较子宫切除术时间。
2006 年至 2014 年期间，772 名女性接受了子宫内膜切除术或消融术治疗，468 名女性（61%）同意研究纳入；333 名女性（71%）接受宫腔镜切除术治疗，135 名女性（29%）接受子宫内膜消融术治疗。与 2006-2014 年队列中的子宫内膜消融术相比，宫腔镜切除术治疗的女性术前特征差异显著，绝经、绝育和肌瘤状态在两个时间队列中也存在差异（p≤0.036）。与宫腔镜组相比，子宫内膜消融组的手术时间明显更短，中位数为 13 分钟（95%置信区间（CI）12-14），并发症发生率为 2%，而宫腔镜组的手术时间中位数为 25 分钟（95%CI 23-26），并发症发生率为 13%，所有 p≤0.001。两组患者对治疗的满意度相当（85%，p=0.955）。子宫内膜消融组的子宫切除术率较低（8%对 16%，p=0.024）。2006-2014 年队列中患者报告的满意度较高（85%），与 1992-1998 年队列相比（73%），p<0.001。
子宫内膜消融术具有相似的患者满意度，但手术时间更短、并发症发生率更低，可能是宫腔镜子宫内膜切除术治疗异常子宫出血的良好替代方法。
