Department of Obstetrics and Gynaecology, Bolton Foundation NHS Trust, Bolton, UK.
J Obstet Gynaecol. 2020 Nov;40(8):1145-1147. doi: 10.1080/01443615.2019.1700945. Epub 2020 Feb 3.
Endometrial ablation in outpatient setting is associated with shorter hospital stay and quicker recovery. The primary outcome of this observational study was initiation and completion of procedure and secondary outcome measures were pain during the procedure and complications. The study was conducted in outpatient women's health clinic of Bolton Foundation NHS Trust UK, between March 2015 and July 2017. Out of 151 patients, all had oral analgesia at home. The procedure was initiated and completed in 83% cases. The median time for procedure was 78.5 s with range (34-120 s). The median intraoperative and immediate post-op pain score was 8 and 2, respectively. Post-procedure hysteroscopy confirmed intact cavity in all. Post-op analgesia was required in 2% cases. Eight-nine percent were discharged immediately, 10% had to be rested and observed for 30-60 min. None had serious complications. Ninety percent were satisfied with outpatient service and would recommend to friends and family.Impact Statement Second-generation endometrial ablation is an effective first-line management option for heavy menstrual bleeding. Outpatient procedure is associated with shorter hospital stay, quicker recovery and avoids general anaesthesia and its complications. This observational study confirmed that it was suitable to start the procedure in 83% cases. Once started, it was possible to complete in 100%. The most common cause for not being able to start the procedure was intolerability to the patients. The median immediate post-procedure pain score was 2 which was highly acceptable to patients. 90% of patients who underwent the outpatient endometrial ablation would choose to have further hysteroscopic procedures as outpatient. Patients should be given choice for endometrial ablation either with or without general anaesthesia. Patients should be carefully selected for outpatient procedure taking into account informed consent, tolerability of speculum examination and endometrial pipelle biopsy as well as understanding anticipation of some discomfort. Further randomised controlled trials should be carried out to determine patient satisfaction with endometrial ablation with or without general anaesthesia.
门诊子宫内膜消融术与住院时间更短和恢复更快相关。本观察性研究的主要结局为手术的开始和完成，次要结局指标为手术过程中的疼痛和并发症。该研究于 2015 年 3 月至 2017 年 7 月在英国博尔顿基金会国民保健制度信托基金的门诊妇科诊所进行。151 名患者均在家中接受口服镇痛。83%的患者完成了手术。手术中位数时间为 78.5 秒，范围（34-120 秒）。术中即刻和术后疼痛评分为 8 分和 2 分。术后宫腔镜检查证实所有患者宫腔完整。2%的患者需要术后镇痛。89%的患者立即出院，10%的患者需要休息和观察 30-60 分钟。无严重并发症。90%的患者对门诊服务满意，并愿意向朋友和家人推荐。
影响陈述 第二代子宫内膜消融术是治疗月经过多的有效一线治疗选择。门诊手术与住院时间更短、恢复更快相关，并且可以避免全身麻醉及其并发症。本观察性研究证实，83%的患者适合开始手术。一旦开始，就有可能 100%完成。不能开始手术的最常见原因是患者不耐受。术后即刻疼痛评分中位数为 2，患者高度可接受。90%接受门诊子宫内膜消融术的患者会选择再次作为门诊进行宫腔镜检查。患者应根据全身麻醉或非全身麻醉的选择来进行子宫内膜消融术。应根据知情同意、阴道镜检查和子宫内膜刮匙活检的耐受性以及对某些不适的理解和预期，仔细选择门诊手术患者。应开展更多的随机对照试验，以确定有无全身麻醉的患者对子宫内膜消融术的满意度。
