Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Acta Obstet Gynecol Scand. 2020 Nov;99(11):1554-1560. doi: 10.1111/aogs.13949. Epub 2020 Jul 20.
Transcervical resection of the endometrium (TCRE) is a first-line surgical treatment of abnormal uterine bleeding. However, many women experience unsuccessful results, causing hysterectomy in up 17% of cases. The aim of this study was to describe the odds of hysterectomy in women with abnormal uterine bleeding, treated with TCRE and levonorgestrel intrauterine contraceptive device (TCRE + LNG-IUCD) or TCRE alone. The secondary aim was to analyze the rate of amenorrhea.
Designed as a retrospective cohort study, and conducted at Odense University Hospital, Denmark, the study included women with abnormal uterine bleeding, who underwent TCRE from January 2013 to December 2015. The decision of treatment with respect to LNG-IUCD was at the woman's discretion. Data were collected from medical records and a self-reported retrospective bleeding-pattern questionnaire. A multivariate regression model was used, enabling adjustment for potential and identified confounders.
Out of 432 women, 276 (62%) consented to inclusion and of these, 16 (4%) were excluded. In total 88 (34%) received combined treatment and 172 (66%) received TCRE alone. Ten women (11%) treated with TCRE + LNG-IUCD underwent hysterectomy, compared with 27 (16%) treated with TCRE alone (OR = 0.69, 95% CI 0.28-1.56; P = .34). Multivariate analysis disclosed a significant effect of TCRE + LNG-IUCD (OR = 0.35, 95% CI 0.13-0.97; P = .04) on hysterectomy. The presence of fibromas was shown to increase the odds of treatment failure, resulting in hysterectomy (OR 2.69, 95% CI 1.15-6.31; P = .02). Furthermore, the incidence of amenorrhea was 59% in the TCRE + LNG-IUCD group and 36% in the TCRE alone group (OR = 2.56, 95% CI 1.46-4.49; P < .01).
The study showed significantly lower odds of hysterectomy in the TCRE + LNG-IUCD group when adjusted for confounders. Combination treatment improves the bleeding patterns significantly compared with monotherapy with TCRE.
经宫颈子宫内膜切除术（TCRE）是治疗异常子宫出血的一线手术治疗方法。然而，许多女性的治疗结果并不成功，导致 17%的病例需要进行子宫切除术。本研究旨在描述接受 TCRE 和左炔诺孕酮宫内节育器（TCRE+LNG-IUCD）或 TCRE 单独治疗的异常子宫出血妇女行子宫切除术的几率。次要目的是分析闭经的发生率。
该研究设计为回顾性队列研究，在丹麦欧登塞大学医院进行，纳入 2013 年 1 月至 2015 年 12 月期间接受 TCRE 治疗的异常子宫出血妇女。是否使用 LNG-IUCD 治疗的决定由患者自行决定。数据来自病历和一份自我报告的回顾性出血模式问卷。采用多变量回归模型，可调整潜在和已确定的混杂因素。
在 432 名妇女中，276 名（62%）同意纳入研究，其中 16 名（4%）被排除。总共 88 名（34%）接受联合治疗，172 名（66%）接受 TCRE 单独治疗。10 名接受 TCRE+LNG-IUCD 治疗的妇女（11%）行子宫切除术，而 27 名接受 TCRE 单独治疗的妇女（16%）行子宫切除术（OR=0.69，95%CI 0.28-1.56；P=0.34）。多变量分析显示 TCRE+LNG-IUCD 有显著的子宫切除术效应（OR=0.35，95%CI 0.13-0.97；P=0.04）。存在纤维瘤表明治疗失败的几率增加，导致子宫切除术（OR 2.69，95%CI 1.15-6.31；P=0.02）。此外，TCRE+LNG-IUCD 组闭经发生率为 59%，TCRE 组为 36%（OR=2.56，95%CI 1.46-4.49；P<0.01）。
本研究表明，在调整混杂因素后，TCRE+LNG-IUCD 组行子宫切除术的几率显著降低。与 TCRE 单独治疗相比，联合治疗显著改善了出血模式。
