Clinical Analysis Of 34 Cases Of Abnormal Uterine Bleeding Treated By Nova Sure

Background and ObjectiveAbnormal uterine bleeding, is one of the most common gynecological diseases, can occur in menarche to menopausal women of any age. The normal menstrual cycle for 24-35 days, menstrual period lasts about 2-7 days, the amount of bleeding 20-60ml[1]. Any abnormal of menstrual cycle, menstrual period and the amount of menses, is belong to abnormal uterine bleeding(AUB). According to FIGO recommended the latest classification system of non-pregnant women of childbearing age, AUB etiology [2] which is divided into two categories: the presence of structural abnormality of the uterus and not in the structure, and the two major causes consist of nine types, which are known as PALM-COEIN:endometrial polyps caused AUB(AUB-P), adenomyosis due to AUB(AUB-A), uterine fibroids caused AUB(AUB-L), and atypical endometrial malignancy hyperplasia due to AUB(AUB-M), systemic coagulation related diseases caused AUB(AUB-C), ovulatory dysfunction related to the AUB(AUB-O), endometrium caused abnormal AUB(AUB-E), iatrogenic AUB(AUB-I), unclassified AUB(AUB-N). the reasons of AUB caused by structural abnormalities are complexd, and easy to repeated attacks, common in the uterine cavity lesions[3], such as submucosal uterine fibroids, endometrial polyps and endometrial cancer, and so common. The AUB of no structural abnormalities include ovulation disorders and complicated medical diseases.AUB is a longer duration, long-term diseases, resulting in varying degrees of impact on the patient’s physical and mental health, and therefore timely diagnosis and effective treatment is much more important. Drug therapy is the first line treatment for AUB, particularly adolescent reproductive endocrine abnormal uterine bleeding, hormone treatment is almost the only alternative [4]. But for inappropriate medication or the poor efficacy of drug therapy, especially patients of no fertility requirement who are not easy to follow, is more focused on operation treatment, including traditional hysterectomy and endometrial ablation(EA). Hysterectomy owns deficiency such as major surgical trauma, long operation time, more blood loss, more postoperative complications and long recovery time. Endometrial ablation: no abdominal hysterectomy, and small body injury, quick recovery, and replacing of hysterectomy for AUB to a certain extent. NovaSure is representative of the second generation of EA, has a unique design principle and mechanism of action, shorter operative time, less blood loss, postoperative amenorrhea rate and patient satisfaction rate of view were better than the first generation of EA. Particularly suitable for patients with severe medical conditions can not be implemented by traditional surgery or the patient can not disable the AUB anticoagulants.In this study, we carried out a retrospective analysis of 34 cases of abnormal uterine bleeding(AUB) patients by NovaSure, to analysis the clinical efficacy and significance of NovaSure-impedance controlled endometrial ablation treatment of abnormal uterine bleeding. Materials and Methods Research Object:From April 2013 to September 2015, 34 patients with AUB who were admitted into the Second Affiliated Hospital of Zhengzhou University, were treated by Nova Sure-impedance controlled endometrial ablation treatment. 34 patients have been birth, no-birth requirement. According to FIGO recommended the latest classification system of non-pregnant women of childbearing age, among the 34 cases objects, endometrial polyps(AUB-P) 4 cases, adenomyosis(AUB-A) 5 cases, systemic coagulation related diseases(AUB-C) 6 cases, ovulatory dysfunction(AUB-O) 13 cases, endometrial local anomaly(AUB-E) 2 cases, iatrogenic(AUB-I) 4 cases. In the 34 patients, 20 patients with abnormal uterine bleeding were followed severe medical illness, including blood diseases in 6 cases, 3 cases of kidney disease, heart disease in 4 cases, 4 cases of liver disease, 2 cases of cerebrovascular disease, systemic lupus erythematosus(SLE) with diabetes 1 case. 20 cases with severe medical illness included 18 cases of anemia, mild, moderate and severe anemia were: 5 cases, 10 cases, 3 cases. 14 cases of AUB with no serious medical illness included 12 cases of anemia, mild anemia in 4 cases, 8 cases of moderate anemia, severe anemia none. 34 patients adopted NovaSure--Impedance controlled endometrial ablation treatment, postoperative follow-up of patients were carried out, included asking in detail about whether vaginal discharge, periodic abdominal pain and so on, whether menstruation recovery and menstrual condition. When one month, three-month after operation,review blood routine to know hemoglobin level, and the clinical efficacy was followed up. Inclusion criteria:(1) There are indications for surgery, no fertility requirements but asking to retain the uterus;(2) Drug treatment is poor;(3) With severe medical illness can not tolerate conventional surgery;(4) Preoperative pathology has been ruled out cancer and precancerous lesions;(5) Preoperative improve the relevant examination can tolerate surgery. Exclusion criteria:(1) Patients with pregnancy or fertility requirements;(2) With severe medical illness can not tolerate surgery;(3) Weak presence of the uterine muscle wall of the anatomy or pathological conditions, such as classical cesarean section or patients had permeable wall myomectomy;(4) Small Cervical, it can not be set by NovaSure disposable ablator;(5) Severe uterine malformations, such as double uterine horn or mediastinal uterus;(6) Uterine cavity depth of less than 4cm, more than 6.5cm, measured with uterine ablation width <2.5cm;(7) Endometrial cancer or precancerous prompted by pathology;(8) Acute pelvic inflammatory disease;(9) Acute genital tract or urinary tract infections. Surgical approach:34 cases of abnormal uterine bleeding patients were under general anesthesia NovaSure impedance controlled endometrial ablation. Specific surgical procedures:After anesthesia is reached, bladder lithotomy position, disinfection, shop towels, with the speculum open the vagina, cervical length measurement, measuring a total length of the uterus, uterine cavity depth is the uterine full-length minus the length of the tube. Intrauterine set Runuo Shu disposable ablation intrauterine, expand it to measure the width of the uterine cavity, and then enter depth and width of the the uterine on the controller, the system will automatically output the required power level. Then start checking the integrity of the uterus, automatically determine if there is any uterine perforation. The detection process takes an average of 8 seconds. If there is an uterine perforation, the system does not transmit radio frequency energy. Endometrial resection start after the assessment, costs average 90 seconds. When it is over, closing the ablation device and remove it. Postoperative hysteroscopy of the uterine walls and corners shows the intima brown-like, no significant active bleeding points within the uterine cavity, and cervical mucosa integrity, back mirror, surgery over. Results1. 34 AUB patients accepted routine NovaSure surgery were successfully completed, blood loss: 5-20 ml, average blood loss was 11.76+5.89ml; electrocautery time: 39-120 s, the average electrocautery time was 89.85+24.84 s. Postoperative hospital stay was 1-3 days, with an average 1.71+0.63 days.2. Preoperative and postoperative 1 month, 3 months in patients with hemoglobin, those owned the normal hematopoietic function, the mean preoperative hemoglobin was 92.13+18.97 g/L, after one month, three months later hemoglobin with an average of 104.17+15.44 g / L, 121.57+9.18 g / L, those with hematopoietic dysfunction, mean preoperative hemoglobin was 72.20+16.71 g / L, after 1 month, 3-month later average hemoglobin was respectively: 76.00+16.39 g / L, 75.90+18.35 g / L.3. They were followed up a minimum of six months up to 2 years, and 1 of 34 patients were lost. Up to 2015.09, Follow-up of 33 cases of patients 1,3,6,12,24 months amenorrhea rates were: 60.6%, 60.6%, 66.6%, 80%, 85%. The postoperative menstrual flow was significantly reduced compared with preoperative, the total effective rate was 100%.4. Postoperative follow-up of patients had a small amount of vaginal discharge, ranging from 7-30 days duration. Mild lower abdominal pain(3 cases). Have no serious complications during and after operation. Conclusion1.NovaSure treatment is safer, shorter operative time, less bleeding, faster recovery and less postoperative complications2.NovaSure surgery is high rate of amenorrhea which can reached to 100%.3.For AUB patients with severe medical conditions who can not be implemented by traditional surgery and coagulation abnormalities or needing to oral anticoagulants without stopping, NovaSure is a safe, effective treatment.