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

1	Shazly SA, Famuyide AO, El-Nashar SA, et al. Intraoperative predictors of long-term outcomes after radiofrequency endometrial ablation [J]. J Minim Invasive Gynecol, 2016，23(4): 582-589.
2	Gimpelson RJ. Ten-year literature review of global endometrial ablation with the NovaSure device [J]. Int J Womens Health, 2014，6(1): 269-280.
3	Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding [J]. Cochrane Database Syst Rev, 2016. URL
4	Athanatos D, Pados G, Venetis CA, et al. Novasure impedance control system versus microwave endometrial ablation for the treatment of dysfunctional uterine bleeding: a double-blind, randomized controlled trial [J]. Clin Exp Obstet Gynecol, 2015，42(3): 347-351.
5	Gallinat A. An impedance-controlled system for endometrial ablation: five-year follow-up of 107 patients [J]. J Reprod Med, 2007，52(6): 467-472.
6	Fulop T, Rakoczi I, Barna I. NovaSure impedance controlled endometrial ablation: long-term follow-up results [J]. J Minim Invasive Gynecol, 2007，14(1): 85-90.
7	Herman MC, Penninx JP, Mol BW, et al. Ten-year follow-up of a randomised controlled trial comparing bipolar endometrial ablation with balloon ablation for heavy menstrual bleeding [J]. BJOG, 2013，120(8): 966-970.
8	Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart [J]. Br J Obstet Gynaecol, 1990，97(8): 734-739.
9	Comino R, Torrejon R. Hysterectomy after endometrial ablation-resection [J]. J Am Assoc Gynecol Laparosc, 2004，11(4): 495-499.
10	Peeters JA, Penninx JP, Mol BW, et al. Prognostic factors for the success of endometrial ablation in the treatment of menorrhagia with special reference to previous cesarean section [J]. Eur J Obstet Gynecol Reprod Biol, 2013，167(1): 100-103.
11	Longinotti MK, Jacobson GF, Hung YY, et al. Probability of hysterectomy after endometrial ablation [J]. Obstet Gynecol, 2008，112(6): 1214-1220.
12	Thomassee MS, Curlin H, Yunker A, et al. Predicting pelvic pain after endometrial ablation: which preoperative patient characteristics are associated[J]. J Minim Invasive Gynecol, 2013，20(5): 642-647.
13	Soini T, Rantanen M, Paavonen J, et al. Long-term follow-up after endometrial ablation in finland [J]. Obstet Gynecol, 2017，130(3): 554-560.
14	Mengerink BB, Wurff AA, Ter Haar JF, et al. Effect of undiagnosed deep adenomyosis after failed NovaSure endometrial ablation [J]. J Minim Invasive Gynecol, 2015，22(2): 239-244.
15	Lin CJ, Hsu TF, Chang YH, et al. Postoperative maintenance levonorgestrel-releasing intrauterine system for symptomatic uterine adenomyoma [J]. Taiwan J Obstet Gynecol, 2018, 57(1): 47-51.
16	Zhao H, Yang BJ, Feng LM, et al. Comparison of combined bipolar radiofrequency impedance-controlled endometrial ablation with levonorgestrel intrauterine system versus bipolar radiofrequency endometrial ablation alone in women with abnormal uterine bleeding[J]. J Minim Invasive Gynecol, 2020, 27(3): 774-780.
17	楼俊瑶，黄秀峰，张丽凤，等．第二代子宫内膜消融术可提高左炔诺孕酮宫内节育系统对子宫腺肌病患者的疗效[J]. 浙江大学学报(医学版), 2019, 48(2): 136-141.
18	Park DS, Kim ML, Song TJ, et al. Clinical experiences of the levonorgestrel-releasing intrauterine system in patients with large symptomatic adenomyosis [J]. Taiwan J Obstet Gynecol, 2015，54(4): 412-415.

[1]	钱雅君, 虞竹溪, 徐颖, 董丹江, 顾勤. 危重型新型冠状病毒感染合并侵袭性肺曲霉病的临床特征和高危因素分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(01): 3-9.
[2]	张舒沁, 陈练. 产后宫腔内妊娠物残留的诊断和临床处理[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 493-497.
[3]	隋龙. 门诊和日间宫腔镜手术模式的建立与思考[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(06): 745-.
[4]	常青. 异常子宫出血的诊断及治疗[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 496-496.
[5]	杨一君, 董雯, 刘晓平, 石灿, 张磊, 谷琎, 龚咪, 华馥. 腹腔镜折叠对接缝合联合宫腔镜憩室开渠法治疗剖宫产瘢痕憩室的疗效[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 330-337.
[6]	冯力民. ISGE指南——宫腔镜子宫肌瘤去除术[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 250-250.
[7]	王秀红, 李炳辉, 李军, 梅燕, 裴红兵, 龙飘, 张艳, 张文涛, 杜烨, 邝莉雯, 张晨晨, 李恭驰. 足病修复师足部综合干预在降低糖尿病足高危因素发生率中的作用[J/OL]. 中华损伤与修复杂志(电子版), 2023, 18(01): 53-58.
[8]	陈滔, 罗洪, 周进军. 老年食管癌单纯放疗及同期放化疗患者急性不良反应影响因素分析[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(04): 405-407.
[9]	王晓丹, 王媛, 崔向宇, 任晓磊. 上尿路结石内镜手术后尿源性脓毒血症病原菌耐药及死亡高危因素分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 611-615.
[10]	魏莉, 张浩, 谭欣, 邓姗, 黄秀峰, 冯力民. 《宫腔镜下子宫肌瘤去除术管理规范》团体标准的解读[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 199-204.
[11]	张生澎, 尚宏瑜, 李茹苑, 张露平, 杨保军, 冯力民. 双极射频阻抗控制系统联合左炔诺孕酮宫内节育系统治疗异常子宫出血的临床研究[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(02): 101-105.
[12]	刘锦秀, 王晓伟, 张同乐, 姜爱华. 青年社会体检者、医务工作者及心肌梗死患者心血管疾病高危因素的对比研究[J/OL]. 中华临床医师杂志(电子版), 2023, 17(03): 249-254.
[13]	祁明花, 宋善兰, 俞丕超, 祁雁凌. 宫腔镜电切术联合生化汤加减治疗子宫内膜息肉的疗效及对短期复发的影响[J/OL]. 中华临床医师杂志(电子版), 2023, 17(02): 171-175.
[14]	戴莉, 高红艳, 邢肖肖, 王清, 彭妍, 李沁, 王慧. 经阴道子宫憩室修补联合宫腔镜内膜电灼术治疗剖宫产瘢痕憩室的效果分析[J/OL]. 中华临床医师杂志(电子版), 2022, 16(12): 1243-1247.
[15]	李云飞, 夏恩兰, 黄晓武, 王翠芝. 绝经后无症状子宫内膜增厚的宫腔镜诊治分析[J/OL]. 中华临床医师杂志(电子版), 2022, 16(11): 1096-1102.

阅读次数

全文

HTML			PDF

最新录用	在线预览	正式出版	最新录用	在线预览	正式出版
0	0	0	0	0	0

摘要

最新录用	在线预览	正式出版

0	0	70

来源	本网站	其他网站

次数	34	36
比例	49%	51%

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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