Pathology of Endometrial Ablation Failures: A Clinicopathologic Study of 164 Cases
Pathology of Endometrial Ablation Failures: A Clinicopathologic Study of 164 Cases
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DOI：
10.1097/pgp.0000000000000147
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发表时间：
2015-05-01
影响因子：
2.4
通讯作者：
Sung, C. James
中科院分区：
文献类型：
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作者：
Simon, Rochelle A.;Quddus, M. Ruhul;Sung, C. James
子宫内膜消融术是一种微创的子宫切除术治疗子宫异常出血的替代方法。尽管失败率较低，但消融后确实会出现持续出血或盆腔疼痛。我们分析了164例子宫内膜切除术后的子宫切除标本的临床病理特征，其中19例是因手术失败而切除子宫的（对照组）。病理结果包括：子宫内膜表面的致密纤维化和玻璃样变子宫腔内的消融性坏死并粘附于子宫内膜表面，消融后持续数月;子宫腔内排列着浅表、大、充血、通畅的血管，伴有动脉粥样硬化;消融变化仅存在于子宫下段;子宫角区域存在残留的子宫内膜。消融性坏死的患者比无此类碎片的患者更早接受后续子宫切除术（中位数分别为5个月和23个月）。浅表异常血管患者的消融-子宫切除间隔也可能比无浅表异常血管患者短（中位数分别为2个月和18个月）。伴有子宫腺肌病或输卵管结扎的患者更可能持续出血。持续异常出血或盆腔疼痛的可能来源包括：消融性坏死或浅表异常血管的存在，尽管在本研究中这种相关性未达到统计学显著性;消融不完全，仅影响子宫下段或保留子宫角区;结扎后输卵管子宫内膜异位症;以及子宫腺肌病引起的子宫内膜再生。
Endometrial ablation is a minimally invasive alternative to hysterectomy for abnormal uterine bleeding. Although the failure rate is low, continued bleeding or development of pelvic pain after ablation does occur. We analyzed the clinicopathologic features of 164 hysterectomy specimens after endometrial ablation, 19 of which were performed for indications other than failed ablation (control cases). Pathologic findings included: dense fibrosis and hyalinization of the endometrial surface ablative necrosis within the uterine cavity and adherent to the endometrial surface, persistent months after ablation; uterine cavity lined by superficial, large, congested, patent blood vessels with atherosis; ablation changes present only in the lower uterine segment; and residual endometrium present in the cornual regions. Patients with ablative necrosis underwent subsequent hysterectomy sooner than those without such debris (median of 5 vs. 23 mo, respectively). Patients with superficial abnormal vessels were also more likely to have a shorter ablation-hysterectomy interval than those without (median of 2 vs. 18 mo, respectively). Patients with associated adenomyosis or prior tubal ligation were significantly more likely to have continued bleeding. Possible sources of continued abnormal bleeding or pelvic pain include: the presence of ablative necrosis or superficial abnormal blood vessels, although the association did not reach statistical significance in this study; incomplete ablation, affecting only the lower uterine segment or sparing the cornual region; tubal endometriosis after ligation; and endometrial regeneration via adenomyosis.