诺舒子宫内膜切除术治疗子宫腺肌病疗效与相关影响因素分析

Effect of Novasure system endometrial ablation for adenomyosis and related factors analysis

目的探讨诺舒子宫内膜切除术治疗子宫腺肌病月经过多和痛经的疗效及其相关影响因素。方法回顾性分析2012年1月至2017年5月在宁波市第四医院妇科行子宫内膜切除术治疗伴有痛经和月经过多症状子宫腺肌病患者的临床资料,根据治疗方式不同将其分为诺舒子宫内切除术组(n=73)和传统经宫颈子宫内膜电切术组(n=73)。随访两组患者术后1年内月经过多及痛经改善状况,并分析影响诺舒组痛经疗效的相关影响因素。结果诺舒组患者手术时间、术中出血量和住院时长明显低于电切组患者,其差异具有统计学意义(P<0.05)。术后12个月随访中,诺舒组患者子宫切除率为4.1%(3/73),月经过多治疗的总有效率为93.2%(68/73),与电切组患者相比(2.7%和91.8%),其差异均无统计学意义(均P>0.05)。诺舒组和电切组患者术后痛经缓解率比较(76.7%比79.5%),其差异无统计学意义(Z=0.322,P=0.748),但诺舒组患者术后3个月和12个月VAS评分改善情况明显优于电切组(均P<0.05)。多因素logistic回归分析结果显示,病程、痛经程度分级和组织类型是子宫腺肌病患者痛经治疗有效的独立危险因素。结论诺舒子宫内膜切除术能够显著改善子宫腺肌病患者月经过多和痛经症状,与传统经宫颈子宫内膜电切术疗效相当,但对于病程长、术前痛经程度分级高和弥漫型子宫腺肌病患者,应当注意术后痛经难以缓解的情况发生。

Objective To investigate the efficacy and related factors of NovaSure system endometrial ablation for menorrhagia and dysmenorrhea in adenomyosis patients.Methods The clinical data of adenomyosis patients who underwent endometrial ablation in the Fourth Hospital of Ningbo from January 2012 to May 2017was retrospectively analyzed.According to different treatment methods,patients were divided into NovaSure system endometrial ablation group(NovaSure group,n=73)and conventional transcervical endometrial resection group(conventional group,n=73).All the patients in the two groups were followed up for more than a year,and the related factors affecting dysmenorrhea in the NovaSure group were analyzed.Results The operation time,intraoperative blood loss and length of hospital stay in the NovaSure group were significantly lower than those in the conventional group,with statistically significant differences(P<0.05).During the 12-month follow-up,the degree of hysterectomy(4.1%,3/73)and the total effective rate of menorrhagia(93.2%,68/73)in the NovaSure group were higher than those in the conventional group(2.7%and 91.8%),without statistically significant difference(all P>0.05).There was no significant difference in postoperative dysmenorrhea remission rate between the NovaSure group and the conventional group(76.7%vs 79.5%).However,the improvement of VAS score at 3 months and 12 months after surgery in the NovaSure group were significantly better than that in the conventional group(all P<0.05).Multivariate logistic regression analysis showed that disease duration,grade of dysmenorrhea,and tissue type were independent risk factors for dysmenorrhea.Conclusions NovaSure system endometrial ablation in the treatment of adenomyosis can significantly improve the menorrhagia and menstrual pain,with comparable effect to traditional transcervical endometrial resection.For patients with long duration,high preoperative dysmenorrhea grade and diffuse adenomyosis,close attention should be paid to the difficulty to relieve postoperative menstrual pain.