College of Medicine (Drs. Emslie and Berscheid).
Department of Obstetrics and Gynecology (Drs. Mui, Sullivan, Buitenhuis, and Rattray), University of Saskatchewan, Regina, Saskatchewan, Canada.
J Minim Invasive Gynecol. 2023 Nov;30(11):905-911. doi: 10.1016/j.jmig.2023.07.002. Epub 2023 Jul 13.
The purpose of this study was to better elucidate radiofrequency endometrial ablation (REA) durability by assessing the probability of failure as defined by need for postablation hysterectomy. Age at index REA, duration from REA until hysterectomy, and REA failure (REAF) risk factors were analyzed.
A retrospective cohort study was conducted using patient data between April 1, 2002, and March 31, 2019. REAF cases were identified using operative procedure codes. Cox proportional hazard regression assessed the effect of age at index REA on time to postablation hysterectomy. Kaplan-Meier survival curve evaluated timing of postablation hysterectomy, stratified by age at index REA.
This study was conducted at Regina General Hospital in Regina, Saskatchewan, Canada.
Patient population included those who were 21 years of age or older, were premenopausal, and had a history of heavy menstrual bleeding at the time of REA.
The intervention under investigation was REA.
The overall probability of postablation hysterectomy was 22.6%. The probabilities of postablation hysterectomy were 36.1% for women younger than 30 years (n = 128), 28% for women 30 to 34.9 years old (n = 528), 29.6% for women 35 to 39.9 years old (n = 1152), and 17.6% for women 40 years and older (n = 2221). Characteristics associated with REAF included tubal occlusion, cesarean section, dysmenorrhea, and chronic pelvic pain (p <.01) among women younger than 40 years. Leiomyomas accounted for higher failure rates in women 40 years and older (p <.01).
Postablation hysterectomy is more likely to occur in women younger than 40 years. REA can be considered in women aged 30 to 39.9 years old, who have no known REAF risk factors. Women younger than 40 years with REAF risk factors will experience higher rates of hysterectomy. Thus, the decision to proceed with REA should be individualized with careful consideration for the underlying causes of abnormal uterine bleeding, while respecting patient autonomy.
本研究旨在通过评估因需要行刮宫术后子宫切除术而定义的失败概率，更好地阐明射频子宫内膜消融术（REA）的耐久性。分析了指数 REA 时的年龄、从 REA 到子宫切除术的时间以及 REA 失败（REAF）的危险因素。
本研究使用 2002 年 4 月 1 日至 2019 年 3 月 31 日期间的患者数据进行了回顾性队列研究。通过手术程序代码确定 REAF 病例。Cox 比例风险回归评估了指数 REA 时的年龄对刮宫术后子宫切除术时间的影响。Kaplan-Meier 生存曲线评估了按指数 REA 时的年龄分层的刮宫术后子宫切除术的时间。
本研究在加拿大萨斯喀彻温省雷吉纳总医院进行。
患者人群包括 21 岁或以上、绝经前且在 REA 时存在月经过多病史的患者。
研究中的干预措施是 REA。
刮宫术后子宫切除术的总体概率为 22.6%。年龄小于 30 岁的女性（n=128）刮宫术后子宫切除术的概率为 36.1%，30 至 34.9 岁的女性（n=528）为 28%，35 至 39.9 岁的女性（n=1152）为 29.6%，年龄 40 岁及以上的女性（n=2221）为 17.6%。年龄小于 40 岁的女性中，与 REAF 相关的特征包括输卵管结扎术、剖宫产术、痛经和慢性盆腔痛（p<0.01）。40 岁及以上的女性中，子宫肌瘤导致失败率更高（p<0.01）。
刮宫术后子宫切除术更可能发生在年龄小于 40 岁的女性中。30 至 39.9 岁无已知 REAF 危险因素的女性可考虑进行 REA。有 REAF 危险因素的年龄小于 40 岁的女性将经历更高的子宫切除术率。因此，应根据异常子宫出血的潜在原因个体化决定是否进行 REA，同时尊重患者的自主权。
