Clinical Study Of Novasure Endometrial Ablation Treating Abnormal Uterine Bleeding

[Research Background]Abnormal uterine bleeding (AUB) is a common gynecological disease. Drug treatment is not always effective for patients with severe disease, so they sometimes have to choose the treatment of uterine resection. Endometrial ablation (EA) replaced the hysterectomy in a minimally invasive way by destroying the endometrium but retain the uterus for AUB patients with the possibility. NovaSure impedance control system is one of the second generation of endometrial ablation. In foreign countries, this technology has more than ten years of application history. The system’s principle is the impedance-controlling, by using radiofrequency energy to make endometrium be vaporized and removed. This NovaSure endometrial ablation has the advantages of no preoperative pretreatment, automatic operation, short average time, free period limiting, high safety, obvious curative effect, and etc.[Objective]Discuss effects of NovaSure impedance-controlled endometrial ablation system for treating abnormal uterine bleeding. Provide a reference for clinical treatment.[Materials and Methods]1. SubjectsA retrospective analysis of 81 inpatients who received NovaSure treatment for abnormal uterine bleeding in Qilu Hospital of Shandong University from July 2012 to July 2015.Inclusion criteria:(1) Patients with abnormal uterine bleeding and have no fertility demand; (2) Patients with ineffective medical therapy or cannot tolerate surgery because of severe medical illness; (3) Patients with surgical indications and need to retain the uterus; (4) Patients with preoperative systemic examination and pathological findings exclude malignant disease of the reproductive system; (5) The uterine cavity depth is in 4-10cm.Exclusion criteria:(1) Patients with pregnancy or have fertility demand; (2) Patients with anatomical or pathological weakness in lower uterine muscle wall; (3) Patients with uterine malformations or maldevelopments; (4) Uterine cavity depth is less than 4cm or more than 10cm, width is less than 2.5cm. (5) Patients with reproductive malignant disease or precancerous lesions; (6) Patients with uterine IUD; (7) Patients are in the active stage of urogenital infections such as acute pelvic inflammatory disease, acute genital tract or urinary tract infections.2.MethodsNovaSure impedance-controlled endometrial ablation system is produced by a US company HOLOGIC. The patient’s clinical data including general situation, preoperative examination, preoperative preparation, surgical records, postoperative condition, and some postoperative follow-up review were analyzed.[Results]1. Etiology Analysis:In 81 patients,7 cases for etiology of endometrial polyps(AUB-P),2 cases for Adenomyosis (AUB-A),14 cases for Leiomyoma(AUB-L),13 cases for atypical endometrial hyperplasia(AUB-M),9 cases for ovulatory dysfunction(AUB-O),9 cases for coagulopathy(AUB-C),2 cases for endometrial reason(AUB-E),11 cases for uncategorized reason(AUB-N).2. General condition of patients:The age of 81 patients were from 18 to 55, mean age was (44±5.5) years old, in which the menopause accounted for 80.2%(65/81). In 81 patients,42 cases were overweight,20 cases were normal weight,11 cases were obesity,1 case of very obese and 7 cases were less weight. Among all 81 patients, there were 36 cases with anemia, including 7 cases of severe anemia,19 cases of moderate anemia, and 10 cases of mild anemia.3. Fertility and previous surgery case:In 81 patients, except one case of young patients without fertility, the remaining 80 patients have given birth.43 cases of cesarean section,3 cases of the IUD was taken, 2 cases of cervical cyst cut,2 cases of ovarian cysts cut,1 case of endometrial myomectomy.4 cases were admitted to hospital for NovaSure treatment after taking cervical mirror endometrial electrosurgical excision procedure last time.4. Operation:81 patients were successfully operated (100%), of which 45 cases were anterior uterus, 38 cases were posterior uterus. Endometrial thickness ranges from 4 to 15mm, the average thickness of endometrium is (8.35±3.01) mm.Treatment time is 1.6-1.9min, and bleeding during surgery was less than 10 ml. Effective uterine cavity depth is 5.5-8.0cm and intrauterine width is 2.5-5.2cm. NovaSure treatment application of RF power range is 91-152W, and the average RF power was 119.68±16.84W.5. Postoperative complications:81 patients had no special postoperative discomfort, in which 18.6% of patients felt postoperative abdominal pain. One patient was found abdominal pain, fever, brown vaginal discharge and flow with the odor in one month. One patient had vaginal bleeding and had secondary medical treatment. Two patients recurred abnormal uterine bleeding after receiving NovaSure treatment for two years.6. Postoperative menstruation:After 1 month follow-up rate is 100%, the amenorrhea rate of 55.6%, the efficiency rate 96.3%. After 3 months follow-up rate is 97.5%, amenorrhea rate of 77.2%, the efficiency rate 100%. After 6 months of follow-up rate is 93.5%, amenorrhea rate is 81.6%, the effective rate was 100%.7. Postoperative quality of life:Patients’MS-QOL scale evaluation of each item scores after 1 month,3 months,6 months were higher than before surgery.[Conclusions]1. NovaSure impedance-controlled endometrial ablation is useful to treat abnormal uterine bleeding patients with severe internal medicine clinical disease.2. NovaSure impedance-controlled endometrial ablation is useful to treat abnormal uterine bleeding with high postoperative efficiency and high rate of amenorrhea.3. NovaSure impedance-controlled endometrial ablation treating abnormal uterine bleeding has relatively little adverse reactions.