Overton C, Hargreaves J, Maresh M
Clinical Audit Unit, Royal College of Obstetricians and Gynaecologists, St Mary's Hospital for Women and Children, Manchester, UK.
Br J Obstet Gynaecol. 1997 Dec;104(12):1351-9. doi: 10.1111/j.1471-0528.1997.tb11003.x.
To study the frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators.
Prospective survey with additional retrospective reporting by theatre staff.
300 National Health Service and independent hospitals in the United Kingdom (excluding Scotland).
10,686 women registered by 690 doctors (1-222 cases/doctor) from April 1993 to October 1994.
Mailings were sent to relevant medical and non medical staff at every hospital to ascertain who performed the operations. These doctors were asked to complete a questionnaire detailing their previous experience. Completed patient registration forms were returned each month. Theatre contacts returned lists of cases reported in theatre registers.
Perioperative, post-operative and delayed complications by method of surgery and experience of operator.
Two directly related deaths were reported. Laser and rollerball ablations were associated with least operative and post-operative complications. Combined loop and rollerball diathermy was associated with a higher rate, but with fewer immediate operative complications than loop resection alone. Endometrial thinning agents were not associated with decreased complications. Fibroids were associated with increased operative haemorrhage. Early post-operative complication rates ranged from 0.77% to 1.51%. Six-week follow up in 82.5% of the women revealed few complications (1.25% to 4.58%). Increasing operative experience was associated with fewer uterine perforations in the loop resection alone group (chi 2 for trend, P < 0.001), but had no effect on operative haemorrhage in any group.
These procedures were used widely in 1993 to 1994 with low morbidity and mortality. The techniques may be relatively easily learned in the apprenticeship system without compromising safety. Combined diathermy resection appears safer than loop resection alone, but laser and rollerball ablation were safest.
研究子宫内膜切除术和消融术治疗月经紊乱的并发症发生率以及手术医生经验的影响。
前瞻性调查，并由手术室工作人员进行额外的回顾性报告。
英国300家国民医疗服务体系及独立医院（不包括苏格兰）。
1993年4月至1994年10月间，690名医生登记的10686名女性（每位医生1 - 222例）。
向每家医院的相关医护人员邮寄信件，以确定手术实施者。要求这些医生填写一份详细说明其既往经验的问卷。每月返还填写完整的患者登记表。手术室联系人返还手术室登记报告的病例清单。
根据手术方法和手术医生经验统计围手术期、术后及延迟并发症。
报告了2例直接相关死亡病例。激光和滚球消融术的手术及术后并发症最少。联合环形电极和滚球透热疗法的并发症发生率较高，但与单纯环形切除术相比，即时手术并发症较少。子宫内膜变薄药物与并发症减少无关。子宫肌瘤与手术出血增加有关。术后早期并发症发生率在0.77%至1.51%之间。82.5%的女性进行了六周随访，发现并发症较少（1.25%至4.58%）。手术经验增加与单纯环形切除术组子宫穿孔减少相关（趋势检验χ²，P < 0.001），但对任何组的手术出血均无影响。
1993年至1994年期间，这些手术广泛应用，发病率和死亡率较低。这些技术在学徒制系统中相对容易学习，且不影响安全性。联合透热切除术似乎比单纯环形切除术更安全，但激光和滚球消融术最安全。
