Erian J
Farnborough Hospital, Orpington, Kent, UK.
Br J Obstet Gynaecol. 1994 Jul;101 Suppl 11:19-22. doi: 10.1111/j.1471-0528.1994.tb13691.x.
A prospective 5-year multicentre study, involving three UK gynaecology centres with a special interest in endoscopic laser surgery, was set up to determine the safety, acceptability, clinical effectiveness and complications of neodymium yttrium-aluminium-garnet laser ablation of the endometrium in the treatment of menorrhagia. A total of 2342 women with disabling menorrhagia that was unresponsive to medical therapy were involved. The main outcome measures were: preoperative endometrial preparation; duration of laser ablation, intra- and postoperative complications, amenorrhoea rate, oligomenorrhoea rate, and the women's subjective assessment of treatment. No major complications occurred in the 2342 treatments. Nine (0.4%) cases of transient fluid overload, 11 (0.5%) of infection and five (0.2%) of uterine perforation occurred. None of the women required a laparotomy. The mean duration of the laser ablation was 24 min. The post-surgery amenorrhoea rate was higher in women pretreated with danazol. Of the 1866 women followed up for at least 1 year after treatment, 1043 (56%) developed complete amenorrhoea, 701 (38%) reported continuing but satisfactorily reduced menstruation, and 122 (7%) patients failed to improve with the first treatment (57 of these 122 women responded to a second laser ablation). Overall, 1744 (93%) had a satisfactory response to laser ablation and only 33 (1.8%) required subsequent hysterectomy. In conclusion, this study showed that hysteroscopic endometrial laser ablation is an acceptable alternative to hysterectomy for the treatment of menorrhagia.
一项前瞻性的5年多中心研究在英国三个对内镜激光手术有特殊兴趣的妇科中心开展,旨在确定钕钇铝石榴石激光子宫内膜消融术治疗月经过多的安全性、可接受性、临床有效性及并发症情况。共有2342名因月经过多而致残且药物治疗无效的女性参与研究。主要观察指标包括:术前子宫内膜准备情况;激光消融持续时间、术中和术后并发症、闭经率、月经过少率以及女性对治疗的主观评价。2342例治疗中未发生重大并发症。发生9例(0.4%)短暂性液体超负荷、11例(0.5%)感染和5例(0.2%)子宫穿孔。所有女性均无需剖腹手术。激光消融的平均持续时间为24分钟。用达那唑预处理的女性术后闭经率更高。在1866例治疗后至少随访1年的女性中,1043例(56%)出现完全闭经,701例(38%)报告月经持续但明显减少,122例(7%)患者首次治疗无效(这122例女性中有57例对第二次激光消融有反应)。总体而言,1744例(93%)对激光消融反应满意,仅33例(1.8%)需要后续行子宫切除术。总之,本研究表明宫腔镜子宫内膜激光消融术是治疗月经过多的一种可接受的子宫切除术替代方法。