子宮內膜雷射子宮腔溫熱療法對月經過多有助益


  Sept. 24, 2004 -一項9月號生殖&不孕期刊中的研究顯示,子宮內膜子宮腔溫熱療法(ELITT)對月經過多症之療效優於子宮內膜切除術(TCRE) 。
  
  來自義大利Palermo大學Antonio Perino醫師及其同事指出,在過去20年,子宮內膜剝落已經被當作子宮切除術的一個選擇,被當作是月經過的黃金處理準則;最近對不同類型的非前後倒置子宮內膜剝落手術的描述,ELITT在臨床實驗被證實是一個對月經過多有效的療法。
  
  在教學醫院,116位月經前的不正常子宮出血婦女被隨機分派至 ELITT組及TCRE組;在手術前,兩組均給予促性腺激素釋放荷爾蒙催動劑,主要的結果量測為流血情況、病患滿意度、手術
  過程併發症比率。
  
  結果顯示,兩者手術間沒有顯著的併發症,在12個月中,56%的ELITT組及23%的TCRE組有月經不調;在36個月中,月經不調分別是61% 及24%(P < .005 for both comparisons),兩組患者對治療滿意度相似。
  
  研究人員指出,ELITT比TCRE更加快速且容易完成,所須的技術水準和嵌入子宮環一樣。
  
  研究人員進一步指出,當這個新的技術運用於球狀子宮內膜脫落時,我們的隨機研究已經顯示,ELITT 是一個有效改善月經過多患者生活品質程序,而進一步的研究證實並未有重大的併發症發生,這個技術可能成為有根據之傳統子宮切除術選擇。

Endometrial Laser Intrauterine

By Laurie Barclay, MD
Medscape Medical News

Sept. 24, 2004 — Endometrial laser intrauterine thermotherapy (ELITT) is superior to transcervical hysteroscopic endometrial resection (TCRE) for menorrhagia, according to the results of a randomized trial published in the September issue of Fertility and Sterility.

"In the last 20 years, endometrial ablation has been used as an alternative to hysterectomy, which is considered the gold standard treatment for menorrhagia," write Antonio Perino, MD, from the University of Palermo in Italy, and colleagues. "Among the various nonhysteroscopic endometrial ablation procedures recently described, ELITT has proved to be an effective modality of treatment for menorrhagia in a clinical trial."

At an academic teaching hospital, 116 premenopausal women with abnormal uterine bleeding were randomized to treatment with ELITT or with TCRE. Before the procedure, both groups were treated with gonadotropin-releasing hormone agonists. Primary outcome measures were bleeding status, patient satisfaction with treatment, and intraoperative complication rate.

There were no significant complications with either procedure. At 12 months, 56% of the ELITT group and 23% of the TCRE group had amenorrhea. At 36 months, amenorrhea was present in 61% and 24%, respectively (P < .005 for both comparisons). Patient satisfaction with treatment was similar in both groups.

The authors note that ELITT is faster and easier to perform than TCRE, and it requires the same level of skill as inserting an intrauterine device.

"Nevertheless, we recommend a very careful attitude when using this new technology for global endometrial ablation," the authors add. "Our randomized study has shown that ELITT is an effective procedure in improving the quality of life of patients with menorrhagia. As further studies confirm the absence of major complications, this technique may become a valid alternative to traditional hysteroscopic endometrial resection."

Fertil Steril. 2004;82:731-734

Reviewed by Gary D. Vogin, MD

    
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