Journal of minimally invasive gynecology · 2012
Clinical outcome after hydrothermal ablation treatment of menorrhagia in patients with and without submucous myomas.
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Hachmann-Nielsen Elise, Rudnicki Martin
Аннотация
STUDY OBJECTIVE: To analyze the long-term efficacy of hydrothermal ablation (HTA) in women with a normal uterine cavity and submucous uterine myomas.
DESIGN: Retrospective study (Canadian Task Force classification II-2).
SETTING: Roskilde University Hospital surgical daycare unit.
PATIENTS: One hundred sixty-six consecutive patients with abnormal uterine bleeding who underwent HTA from 2004 to 2008. All patients were asked to fill out a specific questionnaire that included questions related to postoperative bleeding patterns, complications, and satisfaction with the procedure. One hundred thirty-six patients (81.9%) completed the questionnaire, including 33 women (24.3%) with submucous myomas.
INTERVENTION: The HTA procedure was performed in accordance with previous descriptions.
MEASUREMENTS AND MAIN RESULTS: Mean (SD; 95% CI) follow-up was 33 (10.5; 25.5-31.8) months. Amenorrhea was achieved in 57 women with myomas (55.3%) and 17 women (51.5%) without myomas (p = .47). Postoperative light bleeding was reported in 26 women with myomas (25.2%) and 6 women (18.2%) without myomas. During follow-up, 13 women with myomas (12.6%) underwent hysterectomy, compared with 6 women without myomas (18.2%). Postoperatively, the mean (SD; 95% CI) number of days per month with bleeding was reduced in both groups, from 13.62 (7.90; 11.87-15.37) to 1.34 (2.32; 0.84-1.84) days in the group with myomas, and from 14.78 (8.81; 10.97-18.59), to 1.88 (4.38; 0.12-3.65) without myomas. Similarly, both groups reported improved quality of life: 74.8% and 72.7%, respectively (p = .59). Compared with patients with myomas 3 cm or smaller, patients with myomas larger than 3 cm demonstrated a significantly higher rate of severe bleeding postoperatively (p = .02).
CONCLUSION: Our results demonstrate that HTA is associated with a high rate of amenorrhea in patients with or without submucous myomas. However, a significantly lower effect may be observed in patients with myomas larger than 3 cm.
DESIGN: Retrospective study (Canadian Task Force classification II-2).
SETTING: Roskilde University Hospital surgical daycare unit.
PATIENTS: One hundred sixty-six consecutive patients with abnormal uterine bleeding who underwent HTA from 2004 to 2008. All patients were asked to fill out a specific questionnaire that included questions related to postoperative bleeding patterns, complications, and satisfaction with the procedure. One hundred thirty-six patients (81.9%) completed the questionnaire, including 33 women (24.3%) with submucous myomas.
INTERVENTION: The HTA procedure was performed in accordance with previous descriptions.
MEASUREMENTS AND MAIN RESULTS: Mean (SD; 95% CI) follow-up was 33 (10.5; 25.5-31.8) months. Amenorrhea was achieved in 57 women with myomas (55.3%) and 17 women (51.5%) without myomas (p = .47). Postoperative light bleeding was reported in 26 women with myomas (25.2%) and 6 women (18.2%) without myomas. During follow-up, 13 women with myomas (12.6%) underwent hysterectomy, compared with 6 women without myomas (18.2%). Postoperatively, the mean (SD; 95% CI) number of days per month with bleeding was reduced in both groups, from 13.62 (7.90; 11.87-15.37) to 1.34 (2.32; 0.84-1.84) days in the group with myomas, and from 14.78 (8.81; 10.97-18.59), to 1.88 (4.38; 0.12-3.65) without myomas. Similarly, both groups reported improved quality of life: 74.8% and 72.7%, respectively (p = .59). Compared with patients with myomas 3 cm or smaller, patients with myomas larger than 3 cm demonstrated a significantly higher rate of severe bleeding postoperatively (p = .02).
CONCLUSION: Our results demonstrate that HTA is associated with a high rate of amenorrhea in patients with or without submucous myomas. However, a significantly lower effect may be observed in patients with myomas larger than 3 cm.