Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: clinical outcomes in the medicine or surgery trial.
Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: clinical outcomes in the medicine or surgery trial.
复制标题
子宫切除术与异常子宫出血的扩大治疗：药物或手术试验的临床结果。
DOI：
10.1097/01.aog.0000124272.22072.6f
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发表时间：
2004
影响因子：
7.2
通讯作者：
MedicineorSurgeryResearchGroup
中科院分区：
文献类型：
--
作者：
Learman,LeeA;SummittJr,RobertL;Varner,REdward;Richter,HollyE;Lin,Feng;Ireland,ChristineC;Kuppermann,Miriam;Vittinghoff,Eric;Showstack,Jonathan;Washington,AEugene;Hulley,StephenB;MedicineorSurgeryResearchGroup
目的：比较临床结果后，随机子宫切除术与药物治疗难治性醋酸甲羟孕酮治疗慢性异常子宫出血患者。方法：我们随机分配63例绝经前妇女异常子宫出血难治性环甲羟孕酮治疗接受子宫切除术或扩大的药物治疗。在每个随机分组中，具体的治疗方法由患者和提供者的偏好决定。主要分析通过使用意向治疗方法比较了6个月和24个月时临床结局的变化。调整基线协变量后的二次治疗分析比较了随机分配到药物治疗的参与者，他们继续使用药物治疗方法，与那些交叉到子宫切除术的参与者。尿急（P=. 01）。膀胱排空不全（P=. 03）。03）、乳房疼痛（P=.阴道出血停止率分别为87%和11%（P<0.01）。001）。32名分配到医学组的妇女中有17名（53%）最终接受了子宫切除术，到24个月时，意向治疗的统计学显著差异仅限于潮热的改善（P<0.05）。01)阴道出血停止（P<. 01）。第2年的组内分析显示，无论是通过随机分组还是交叉分组，子宫切除术女性的大多数症状较基线均有统计学显著改善。继续接受药物治疗的女性在骨盆疼痛、骨盆/膀胱压力和压力性尿失禁方面有统计学显著改善。在一项非随机对照研究中，与那些在第2年仍在接受药物治疗的妇女相比，那些接受子宫切除术的妇女在出血方面有更大的改善（P<0.05）。盆腔疼痛（P<. 01）。下腰痛（P=. 01）。02）、乳房疼痛（P=. 01）、尿频（P=. 01）、紧迫性（P=. 02）。然而，他们也经历了更多的工作或日常活动（P<. 01)卧床天数明显增多（P<. 01)结论：对于醋酸甲羟孕酮难治性异常子宫出血患者，子宫切除术上级口服药物缓解临床症状的扩大努力，但可能导致更多的日子限制activity. Level的证据：IHysterectomy上级口服药物缓解异常子宫出血的扩大努力，但可能导致更多的日子限制活动。
OBJECTIVE:To compare clinical outcomes after randomization to hysterectomy versus medical treatment in patients with chronic abnormal uterine bleeding refractory to medroxyprogesterone acetate.METHODS:We randomly assigned 63 premenopausal women with abnormal uterine bleeding refractory to cyclic medroxyprogesterone acetate treatment to receive either a hysterectomy or expanded medical treatment. Within each randomized group, the specific treatment approach was determined by patient and provider preference. The primary analysis compared changes in clinical outcomes at 6 and 24 months by using an intention-to-treat approach. Secondary as-treated analyses after adjustment for baseline covariates compared participants randomly assigned to medical treatment who continued the medical approach with those who crossed over to hysterectomy.RESULTS:The intention-to-treat analyses at 6 months revealed greater symptom improvement in the hysterectomy group than in the medicine group for pelvic pain (P<. 01), urinary urgency (P=. 03), incomplete bladder emptying (P=. 03), breast pain (P=. 02), and cessation of vaginal bleeding (87% versus 11%, P<. 001). Seventeen of 32 women assigned to medicine (53%) eventually crossed over and received a hysterectomy, and by 24 months the statistically significant differences by intention-to-treat were limited to greater improvement in hot flushes (P<. 01) and cessation of vaginal bleeding (P<. 01). Within-group analyses at year 2 showed statistically significant improvements from baseline on most symptoms for women who had a hysterectomy, whether through randomization or crossover. Women remaining on medical treatments had statistically significant improvements in pelvic pain, pelvic/bladder pressure, and stress incontinence. In a nonrandomized comparison with women who remained on medical treatments through year 2, those crossing over to hysterectomy experienced greater improvements in bleeding (P<. 01), pelvic pain (P<. 01), low back pain (P=. 02), breast pain (P=. 01), urinary frequency (P=. 01), and urgency (P=. 02). However, they also experienced more days off from work or usual activities (P<. 01) and more days spent in bed (P<. 01) than those who remained on medicine.CONCLUSION:For patients with abnormal uterine bleeding refractory to medroxyprogesterone acetate, hysterectomy is superior to expanded efforts with oral medications for alleviating clinical symptoms but may lead to more days of restricted activity.LEVEL OF EVIDENCE:IHysterectomy is superior to expanded efforts with oral medications for alleviating abnormal uterine bleeding but may lead to more days of restricted activity.