诺舒子宫内膜去除术治疗异常子宫出血的远期疗效分析

Long term efficacy analysis of NovaSure endometrial ablation for the treatment of abnormal uterine bleeding

目的评估应用诺舒子宫内膜去除术治疗异常子宫出血(abnormal uterine bleeding,AUB)的远期临床疗效及术后再次干预情况。方法对2011年1月至2018年12月因AUB于首都医科大学附属北京天坛医院接受诺舒子宫内膜去除术的患者进行随访,观察患者术后的闭经率、有效率、痛经缓解率、满意率、并发症、再次干预情况。结果285例患者中排除84例不符合纳入标准或资料缺失的患者,最终201例患者纳入临床研究,随访时间12~106个月,中位数随访时间53(36,79)个月。患者术后1、2、3、4、5~8年时间点,闭经率分别为67.66%、70.27%、76.32%、75.83%、78.82%,有效率分别为96.02%、95.68%、95.36%、95.00%、92.94%,痛经缓解率分别为83.51%、80.46%、86.67%、77.97%、84.85%,满意率分别为90.55%、88.65%、90.79%、87.50%、88.24%,并发症发生率分别为2.49%、3.78%、5.26%、6.67%、8.24%,再次干预率分别为6.47%、10.27%、14.47%、15.00%、18.82%,子宫切除率分别为1.49%、3.24%、5.26%、7.50%、8.24%。术后累计再次干预治疗33例,包括保留子宫的保守性手术20例、全子宫切除手术13例。结论诺舒子宫内膜去除术治疗AUB远期疗效显著,尤其适用于合并严重内、外科疾病或急性严重的子宫出血的患者。患者再次的子宫出血和(或)下腹痛问题是治疗失败、再次干预的主要原因,这可能与术后残留或异位的子宫内膜有关。

Objective The purpose of this study is to evaluate the long-term clinical efficacy and secondary postoperative intervention of NovaSure endometrial ablation in the treatment of abnormal uterine bleeding(AUB).Methods From Jan.2011 to Dec.2018,AUB patients who underwent NovaSure endometrial ablation in Beijing Tiantan Hospital Affiliated to Capital Medical University were followed up.The postoperative amenorrhea rate,effective rate,dysmenorrhea remission rate,patient satisfaction,complications and reintervention were analyzed.Results There were 285 AUB patients received NovaSure endometrial removal,after strict screening,84 patients were excluded,201 patients were finally selected for the clinical study.The follow-up time ranged from 12 to 106 months and the median follow-up time was 53 months.At the time points of 1 year,2 years,3 years,4 years,5-8 years after NovaSure operation,the amenorrhea rate was 67.66%,70.27%,76.32%,75.83%,78.82%;the effective rate was 96.02%,95.68%,95.36%,95.00%,92.94%;the remission rate of dysmenorrhea was 83.51%,80.46%,86.67%,77.97%,84.85%;the satisfaction rate was 90.55%,88.65%,90.79%,87.50%,88.24%;the incidence of complications was 2.49%、3.78%、5.26%、6.67%、8.24%.The re-intervention rate was 6.47%,10.27%,14.47%,15.00%,18.82%,respectively;the hysterectomy rate was 1.49%,3.24%,5.26%,7.50%,8.24%respectively.There were 33 cases of postoperative intervention.The re-intervention therapies include conservative operation with uterus preservation and hysterectomy.A total of 33 cases were re-intervened,including 20 cases of conservative surgery and 13 cases of total hysterectomy.Conclusions NovaSure Endometrial ablation has significant long-term effects in the treatment of AUB,especially for patients with severe internal or surgical diseases or acute severe massive hemorrhage.Recurring uterine bleeding and(or)pain after operation are the main reasons for treatment failure and re-intervention,which may be related to the residual or ectopic of endometrium after operation.