Clinical Analysis Of Novasure Endometrial Ablation And Hysteroscopic Endometrial Resection In The Treatment Of Abnormal Perimenopausal Uterine Bleeding

Objective:To compare the clinical significance of NovaSure endometrial ablation and hysteroscopic endometrial resection in the treatment of abnormal perimenopausal uterine bleeding.Method:This study selected 87 patients with abnormal uterine bleeding during the perimenopausal period in the general gynecology department of the First Affiliated Hospital of Jilin University from December 2017 to August 2019,including 62patients with abnormal ovulatory dysfunctional uterine bleeding(AUB-0).25 cases of uterine adenomyosis abnormal uterine bleeding(AUB-A).31 cases of AUB-O patients underwent NovaSure endometrial ablation as the research object(NovaSure group),and 31 cases of AUB-O patients underwent hysteroscopic endometrial electrical resection as the control group(TCRE group).Twenty-five AUB-A patients were treated with NovaSure endometrial ablation.A total of 13 cases were treated with NovaSure endometrial ablation(NovaSure group of adenomyosis),and 7 cases were combined on the basis of NovaSure endometrial ablation.Levonorgestrel intrauterine system(NovaSure+LNG-IUS group of adenomyosis).A total of 12patients underwent hysteroscopy endometrial resection,6 cases underwent simple hysteroscopy endometrial resection(Adenomyosis TCRE group),and 6 cases underwent hysteroscope endometrial electrotomy On the basis of combined use of levonorgestrel intrauterine birth control system(adenomyosis TCRE+LNG-IUS group).The NovaSure group’s equipment uses the US-based Nuoshu impedance endometrial ablation control system.The equipment in the TCRE group of the control group used the hysteroscope system provided by the Japanese company Olympus(OLYMPUS).Analyze the general clinical data before surgery,operation time,average intraoperative blood loss,average postoperative hospital stay,average hospitalization cost,average postoperative vaginal drainage days,postoperative significant efficiency,postoperative effective rate,in NovaSure group and TCRE group.Postoperative amenorrhea rate and postoperative satisfaction.Analysis of preoperative and postoperative dysmenorrhea scores in patients with adenomyosis;the postoperative dysmenorrhea scores of adenomyosis NovaSure group and adenomyosis NovaSure+LNG-IUS group,adenomyosis TCRE group and adenomyosis TCRE+LNG-IUS group Amenorrhea and vaginal bleeding at 6 months after surgery.SPSS 23.0 was used for statistical analysis of the data in this study.Measurement data that does not conform to the normal distribution are expressed by the median and upper and lower quartiles[M(Q1,Q3)].The measurement data conforming to the normal distribution are expressed as mean±standard deviation(`x±s),the T test was used for comparison between groups,thec~2 test is used for the count data,and P<0.05 is statistically significant.The Kruskal-WallisH test of non-rank sum test was used for group comparison of patients with adenomyosis.The Wilcoxon signed rank sum test was used for group comparison,p<0.05 was statistically significant.Result:(1)The general clinical data of NovaSure group and TCRE group of AUB-O patients:age,duration of disease,preoperative hemoglobin,preoperative endometrial thickness,PBAC score at 3 months before surgery,and uterine cavity depth were not statistically different(P>0.05);There was a statistically significant difference between the two groups in the degree of anemia and the number of medical disease comorbidities(P<0.05).The NovaSure group had more cases of severe anemia and medical disease comorbidities.(2)The average operation time of NovaSure group and TCRE group of AUB-O patients was statistically different(P<0.05);the average bleeding volume of NovaSure group and TCRE group was statistically different(P<0.05).The NovaSure group had a shorter average operation time and less average bleeding.(3)AUB-O patients in the NovaSure group and the TCRE group had a statistically significant difference in average hospital stays(P<0.05);the NovaSure group and the TCRE group had a statistically significant difference in hospitalization costs(P<0.05).The average hospital stay in the NovaSure group was short,and the average hospitalization cost was high.(4)The average postoperative drainage time of NovaSure group and TCRE group in AUB-O patients was statistically different(P<0.05).The average drainage time of the NovaSure group was shorter.(5)There was no statistically significant difference in significant efficiency,amenorrhea rate and satisfaction between NovaSure group and TCRE group in AUB-O patients(P>0.05).(6)There was no statistically significant difference in age,preoperative PBAC score,preoperative hemoglobin,intimal thickness and uterine cavity depth between the groups of patients with adenomyosis(P>0.05)(7)6 patients with adenomyosis NovaSure surgery alone had statistically significant difference in pre-and post-operative dysmenorrhea scores(P<0.05);7patients with LNG-IUS combined with NovaSure endometrial ablation had statistically significant differences in pre-and post-operative dysmenorrhea scores(P<0.05).6 cases of simple hysteroscopy endometrial resection patients had statistically significant difference in pre-and postoperative dysmenorrhea scores(P<0.05);6 cases combined with LNG-IUS based on hysteroscope endometrial resection The dysmenorrhea scores before and after operation were statistically different(P<0.05).Postoperative dysmenorrhea scores of adenomyosis NovaSure group and NovaSure+LNG-IUS group were statistically different(P<0.05).Postoperative dysmenorrhea scores of adenomyosis TCRE group and TCRE+LNG-IUS group were statistically different(P<0.05).Postoperative amenorrhea in NovaSure+LNG-IUS group was better than NovaSure group,and postoperative amenorrhea in TCRE+LNG-IUS group was better than TCRE group.There is statistical difference(P<0.05).Conclusion:(1)NovaSure uterine ablation surgery has a short time-consuming operation,less intraoperative bleeding,fast postoperative recovery,short hospital stay,and high surgical safety.It is a safe and effective surgical treatment method for patients with abnormal uterine bleeding during perimenopause.(2)NovaSure endometrial ablation is more advantageous in the treatment of perimenopausal AUB patients with medical diseases or severe anemia in old age due to the short operation time and less bleeding and other factors.(3)NovaSure uterine ablation surgery has a short time-consuming operation,less intraoperative bleeding,fast postoperative recovery,short hospital stay,and high surgical safety.It is a safe and effective surgical treatment method for patients with abnormal uterine bleeding during perimenopause.