异常子宫出血NovaSure子宫内膜去除术后再干预的危险因素分析

doi:10.3877/cma.j.issn.1674-6899.2020.04.008

目的

探讨和分析NovaSure子宫内膜去除术后患者再次干预的高危因素。

方法

回顾性分析2011年1月至2018年1月就诊于首都医科大学附属北京天坛医院妇产科，行NovaSure子宫内膜去除术的192例异常子宫出血患者的临床资料，包括患者的一般信息及病史相关特征、超声结果及手术记录中的相关资料，通过单因素分析以及Logistic回归分析的方法找出子宫内膜去除术后需再次手术干预的高危因素，分析这类患者的临床特点。

结果

本研究192例异常子宫出血患者中，20例(10.42%)术后2年内需再次手术干预，其中13例表现为阴道出血，3例表现为腹痛，4例则两种症状均有。单因素分析提示NovaSure子宫内膜去除术后再次干预与年龄、月经失血图评分、腹痛的视觉模拟评分、子宫腺肌症以及术后是否放置曼月乐有关(P<0.05)；而与体质量指数、孕产次、宫腔深度、子宫体积、剖宫产史、合并子宫肌瘤无关(P>0.05)。多因素分析提示年龄、子宫腺肌症、腹痛的视觉模拟评分及术后是否放置曼月乐是再次干预患者的独立影响因素(P<0.05)。

结论

年龄、子宫腺肌症、腹痛的视觉模拟评分及术后是否放置曼月乐是异常子宫出血患者NovaSure子宫内膜去除术后需再次干预的独立影响因素，而阴道出血是再次干预患者的主要临床表现。

关键词: 异常子宫出血, 子宫内膜去除, 宫腔镜, 高危因素

Objective

To analyze the characteristics and risk factors of patients undergoing re-intervention for failed NovaSure endometrial ablation.

Methods

This study is a retrospective cohort study. A total of 192 patients with abnormal uterine bleeding underwent NovaSure endometrial ablation at the department of gynaecology of Beijing Tiantan Hospital from Jan. 2011 to Jan. 2018. The clinical data of these patients were collected, including the basic information, the characteristics of the patient′s medical history and symptom, ultrasound results and the data of the surgical records. Univariate analysis and Logistic regression analysis were used to analyze the characteristics and risk factors of patients undergoing re-intervention for failed NovaSure endometrial ablation.

Results

A total of 192 people were eventually included in this study. 20(10.42%) patients need re-intervention after 2 year of the surgery, 13patients were vaginal bleeding, 3 patients were abdominal pain and 4 patients had both symptoms. Univariate analysis suggested that re-intervention after NovaSure was correlated with age, scores of PBLAC, Visual Analogue Score, adenomyosis and whether to use Mirena (P<0.05). The number of parity and gravity, BMI, the length of uterine cavity, uterine volume, the history of cesarean section, intramural fibroid, were not the risk factors (P>0.05). Multivariable binary logistic regression indicated that age, adenomyosis, Visual Analogue Score and whether to use Mirena were independent factors for re-intervention (P<0.05).

Conclusions

Age, adenomyosis, Visual Analogue Score and whether to use Mirena were independent predictor of patients undergoing re-intervention for failed NovaSure endometrial ablation, and vaginal bleeding was the main clinical manifestation of the patients for re-intervention.

Key words: Abnormal uterine bleeding, Endometrial ablation, Hysteroscopy, High-risk factors

表1 NovaSure子宫内膜去除术后再次手术干预的单因素分析

因素	干预组(20例)	正常组(172例)	统计值	P值
年龄(岁，±s)	42.50±4.35	46.62±4.52	t＝3.867	<0.001
BMI(kg/m²，±s)	25.48±2.73	25.45±2.74	t＝0.050	0.960
孕(次，±s)	2.80±1.70	2.85±1.43	t＝0.158	0.875
产(次，±s)	1.35±0.75	1.46±0.74	t＝0.622	0.535
PBLAC评分(分)	485.00(258.25～598.75)	232.50(125.00～478.75)	Z＝-2.615	0.009
VAS评分(分)	6(3～8)	0(0～4)	Z＝-3.506	<0.001
宫腔深度(cm，±s)	9.03±0.79	8.88±1.06	t＝0.611	0.542
子宫体积(cm，±s)	17.86±2.19	17.14±2.64	t＝1.166	0.245
放置曼月乐[例(%)]	3(15.00)	70(40.70)	χ²＝3.990	0.046
剖宫产史[例(%)]	8(40.00)	61(35.47)	χ²＝0.160	0.689
子宫腺肌症[例(%)]	11(55.00)	39(22.67)	χ²＝9.721	0.002
子宫平滑肌瘤[例(%)]	7(35.00)	71(41.28)	χ²＝0.293	0.588

表1 NovaSure子宫内膜去除术后再次手术干预的单因素分析

因素	干预组(20例)	正常组(172例)	统计值	P值
年龄(岁，±s)	42.50±4.35	46.62±4.52	t＝3.867	<0.001
BMI(kg/m²，±s)	25.48±2.73	25.45±2.74	t＝0.050	0.960
孕(次，±s)	2.80±1.70	2.85±1.43	t＝0.158	0.875
产(次，±s)	1.35±0.75	1.46±0.74	t＝0.622	0.535
PBLAC评分(分)	485.00(258.25～598.75)	232.50(125.00～478.75)	Z＝-2.615	0.009
VAS评分(分)	6(3～8)	0(0～4)	Z＝-3.506	<0.001
宫腔深度(cm，±s)	9.03±0.79	8.88±1.06	t＝0.611	0.542
子宫体积(cm，±s)	17.86±2.19	17.14±2.64	t＝1.166	0.245
放置曼月乐[例(%)]	3(15.00)	70(40.70)	χ²＝3.990	0.046
剖宫产史[例(%)]	8(40.00)	61(35.47)	χ²＝0.160	0.689
子宫腺肌症[例(%)]	11(55.00)	39(22.67)	χ²＝9.721	0.002
子宫平滑肌瘤[例(%)]	7(35.00)	71(41.28)	χ²＝0.293	0.588

表2 NovaSure子宫内膜去除术后再次手术干预的多因素分析

因素	Beta	SE	Wald	OR值(95% CI)	P值
年龄	0.174	0.062	7.816	0.840(0.744～0.949)	0.005
子宫腺肌症	1.413	0.656	4.645	4.110(1.137～14.863)	0.031
VAS评分	0.206	0.090	5.306	1.229(1.031～1.465)	0.021
放置曼月乐	-2.609	0.819	10.141	0.074(0.015～0.367)	0.001

表2 NovaSure子宫内膜去除术后再次手术干预的多因素分析

因素	Beta	SE	Wald	OR值(95% CI)	P值
年龄	0.174	0.062	7.816	0.840(0.744～0.949)	0.005
子宫腺肌症	1.413	0.656	4.645	4.110(1.137～14.863)	0.031
VAS评分	0.206	0.090	5.306	1.229(1.031～1.465)	0.021
放置曼月乐	-2.609	0.819	10.141	0.074(0.015～0.367)	0.001

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High-risk factors of re-intervention after NovaSure endometrial ablation in patients with abnormal uterine bleeding

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High-risk factors of re-intervention after NovaSure endometrial ablation in patients with abnormal uterine bleeding