Chullapram T, Song J Y, Fraser I S
Sydney Centre for Reproductive Health Research, Department of Obstetrics and Gynaecology, University of Sydney, Australia.
Obstet Gynecol. 1996 Jul;88(1):71-6. doi: 10.1016/0029-7844(96)00085-3.
To assess the medium-term efficacy of rollerball endometrial ablation.
From January 1990 to December 1993, 142 women underwent rollerball endometrial ablation for menorrhagia, most with ovulatory dysfunctional uterine bleeding. Each was sent a detailed questionnaire 12-52 months later and then followed-up, with an overall 93% response rate. Thirty-two had uterine myomas (13 with hysteroscopic myoma resection) and 11 had a large endometrial polyp (four with both). Most of the women were pretreated with danazol.
Thirty-two of 128 (25%) achieved long-term, complete amenorrhea and only three eventually resumed their periods after prolonged amenorrhea. Four women experienced late amenorrhea, which was probably due to menopause. The percentage of satisfactory outcomes decreased gradually with time (95.5, 85.5, and 75% for 13-24, 25-36 and more than 36 months respectively; P = .051); this was not statistically significant. One hundred twenty-one patients (85.2%) did not need further surgical treatment. The incidence of repeat ablation (8.5%) and hysterectomy (8.5%) increased gradually with time over the first 3 years but not thereafter, although total numbers are still small. Cyclic pelvic pain and premenstrual symptoms were much improved in both short and long term. Most women remained satisfied with the operation (84%) and would recommend it to others (89%).
Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the management of intractable menorrhagia due to ovulatory dysfunctional uterine bleeding. However, with the findings of slightly less satisfactory results with time, longer-term follow-up is still needed to establish the ultimate effectiveness of the procedure using different techniques.
评估滚球子宫内膜切除术的中期疗效。
1990年1月至1993年12月，142名妇女因月经过多接受了滚球子宫内膜切除术，其中大多数患有排卵性功能失调性子宫出血。12至52个月后，向每位妇女发送了一份详细问卷，然后进行随访，总体回复率为93%。32名妇女患有子宫肌瘤（13名接受了宫腔镜下肌瘤切除术），11名妇女有较大的子宫内膜息肉（4名两者皆有）。大多数妇女术前接受了达那唑治疗。
128名患者中有32名（25%）实现了长期、完全闭经，只有3名在长时间闭经后最终恢复了月经。4名妇女出现了晚期闭经，这可能是由于绝经所致。满意结果的百分比随时间逐渐下降（13至24个月、25至36个月和超过36个月时分别为95.5%、85.5%和75%；P = 0.051）；这在统计学上无显著意义。121名患者（85.2%）无需进一步手术治疗。重复消融术（8.5%）和子宫切除术（8.5%）的发生率在最初3年内随时间逐渐增加，但此后未再增加，尽管总数仍然较少。周期性盆腔疼痛和经前症状在短期和长期均有明显改善。大多数妇女对手术仍感到满意（84%），并会向他人推荐（89%）。
滚球子宫内膜切除术是治疗排卵性功能失调性子宫出血所致顽固性月经过多的一种简单、有效且可接受的方法。然而，鉴于随着时间推移结果稍欠满意，仍需要更长时间的随访来确定使用不同技术该手术的最终疗效。
