Objective: Hysteroscopic endometrial resection is an innovative and conservative surgical technique considered, very often, as an alternative to hysterectomy. The aim of the study was to evaluate long-term efficacy of...Objective: Hysteroscopic endometrial resection is an innovative and conservative surgical technique considered, very often, as an alternative to hysterectomy. The aim of the study was to evaluate long-term efficacy of endometrial resection performed in women with menorrhagia. Study design: Retrospective study of 111 premenopausal women with menorrhagia, unresponsive to medical treatment, who underwent endometrial resection by resectohysteroscope (electrocautery technique supplied with a fundus roller ball electrode, with corneal areas, and with a 90° loop for intrauterine walls and used with glycine 1% as distending fluid) between 1994 and 1999. Results: Long-term follow-up questionnaires were completed in 106 cases, while 5 cases dropped-out (4.5% ). The mean-age at menopause in our subjects was 52.8 years (17.6 ± 18.4 months after operation). After 53.2 ± 16.4 months, 82 patients (77.4% ) showed a normal menstrual pattern or amenorrhea, while failure was recorded in 24 patients (22.6% ) and 12/24 patients underwent hysterectomy. Percentage of success in the older population ( > 49 years)- (94% ) was significantly higher than in the younger population (70% ). The histologic finding of only fibrosis (41.7% ) correlated with failure of the technique. Conclusion: Our data suggest that endometrial resection by resectohysteroscope is an innovative and conservative but not exclusive surgical technique in selected younger women, while in older women endometrial resection nearly always resolves long-term menorrhagia.展开更多
Objective: To assess the level of patient satisfaction after transcervical endometrial resection(TCRE) with no preoperative hormonal preparation. Study design: A retrospective audit of a continuous case series was acc...Objective: To assess the level of patient satisfaction after transcervical endometrial resection(TCRE) with no preoperative hormonal preparation. Study design: A retrospective audit of a continuous case series was accomplished on 131 consecutive patients who underwent TCRE for dysfunctional uterine bleeding. Data of postal questionnaires were analysed and subjected to survival analysis. Results: Thirty-three cases were lost to follow-up; thus, the data on 98 of the 131(74.8%)-patients were analysed. The average follow-up period was 94.8 months(60-132). Twenty(20.4%) women required D&C and 15(15.3%) had hysterectomy. In eight of the 15 cases, the indication for hysterectomy was not related with the primary operation. The chance of avoiding hysterectomy reached a plateau after 72 months, at 78.3%(SE: 5.05%). The chance of avoiding D&C at up to 36 months was 98.6%(SE: 1.4%), and reached a plateau after 107 months at 67.11%(SE: 6.1%)-; 55.8%of the patients became amenorrhoeic, the remaining cases reporting good improvements in the amount and duration of bleeding, and dysmenorrhoea. Eighty-six of the 98 patients(88%) were satisfied or very satisfied with the result. Conclusions: TCRE affords reasonable long-term effectiveness in the treatment of dysfunctional uterine bleeding, even without any preoperative hormonal endometrial preparation.展开更多
文摘Objective: Hysteroscopic endometrial resection is an innovative and conservative surgical technique considered, very often, as an alternative to hysterectomy. The aim of the study was to evaluate long-term efficacy of endometrial resection performed in women with menorrhagia. Study design: Retrospective study of 111 premenopausal women with menorrhagia, unresponsive to medical treatment, who underwent endometrial resection by resectohysteroscope (electrocautery technique supplied with a fundus roller ball electrode, with corneal areas, and with a 90° loop for intrauterine walls and used with glycine 1% as distending fluid) between 1994 and 1999. Results: Long-term follow-up questionnaires were completed in 106 cases, while 5 cases dropped-out (4.5% ). The mean-age at menopause in our subjects was 52.8 years (17.6 ± 18.4 months after operation). After 53.2 ± 16.4 months, 82 patients (77.4% ) showed a normal menstrual pattern or amenorrhea, while failure was recorded in 24 patients (22.6% ) and 12/24 patients underwent hysterectomy. Percentage of success in the older population ( > 49 years)- (94% ) was significantly higher than in the younger population (70% ). The histologic finding of only fibrosis (41.7% ) correlated with failure of the technique. Conclusion: Our data suggest that endometrial resection by resectohysteroscope is an innovative and conservative but not exclusive surgical technique in selected younger women, while in older women endometrial resection nearly always resolves long-term menorrhagia.
文摘Objective: To assess the level of patient satisfaction after transcervical endometrial resection(TCRE) with no preoperative hormonal preparation. Study design: A retrospective audit of a continuous case series was accomplished on 131 consecutive patients who underwent TCRE for dysfunctional uterine bleeding. Data of postal questionnaires were analysed and subjected to survival analysis. Results: Thirty-three cases were lost to follow-up; thus, the data on 98 of the 131(74.8%)-patients were analysed. The average follow-up period was 94.8 months(60-132). Twenty(20.4%) women required D&C and 15(15.3%) had hysterectomy. In eight of the 15 cases, the indication for hysterectomy was not related with the primary operation. The chance of avoiding hysterectomy reached a plateau after 72 months, at 78.3%(SE: 5.05%). The chance of avoiding D&C at up to 36 months was 98.6%(SE: 1.4%), and reached a plateau after 107 months at 67.11%(SE: 6.1%)-; 55.8%of the patients became amenorrhoeic, the remaining cases reporting good improvements in the amount and duration of bleeding, and dysmenorrhoea. Eighty-six of the 98 patients(88%) were satisfied or very satisfied with the result. Conclusions: TCRE affords reasonable long-term effectiveness in the treatment of dysfunctional uterine bleeding, even without any preoperative hormonal endometrial preparation.
