Efficacy and safety of bipolar radiofrequency ablation<i> versus</i> hysterectomy in abnormal uterine bleeding: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZU Enqing ^1,2 , WANG Baoyue ^1,2 , ZHANG Jianfeng ³ ,  ZHOU Ping ^1,2 , CAI Meiyu ³

1. School of Public Health, Fudan University, Shanghai 200032, P. R. China;
2. NHC Key Lab of Health Technology Assessment (Fudan University), Shanghai 200032, P. R. China;
3. Fudan University Obstetrics and Gynecology Hospital, Shanghai 200011, P. R. China;

Corresponding?author：

ZHOU Ping, Email: zhouping@fudan.edu.cn

Keywords：

Abnormal uterine bleeding; Bipolar radiofrequency ablation; Hysterectomy; Network meta-analysis; Systematic review

DOI：

10.7507/1672-2531.202212045

Video：

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Objective To indirectly compare the efficacy and safety of bipolar radiofrequency ablation versus hysterectomy in abnormal uterine bleeding by using network meta-analysis. Methods The PubMed, EMbase, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of different surgical methods in abnormal uterine bleeding from inception to May 20, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using Stata 16.0 software. Results A total of 39 RCTs involving 3 307 patients were included. The results of network meta-analysis showed that hysterectomy was superior to bipolar radiofrequency ablation in terms of amenorrhea rate and reintervention rate, while the hospital stay and patient satisfaction rate were opposite. Conclusion Current evidence shows that bipolar radiofrequency ablation has more advantages in terms of hospital stay and satisfaction rate, while hysterectomy has more advantages in terms of amenorrhea rate and reintervention rate. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： ZU Enqing, WANG Baoyue, ZHANG Jianfeng, ZHOU Ping, CAI Meiyu. Efficacy and safety of bipolar radiofrequency ablation versus hysterectomy in abnormal uterine bleeding: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(5): 522-527. doi: 10.7507/1672-2531.202212045 Copy

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40.	Brun JL, Raynal J, Burlet G, et al. Cavaterm thermal balloon endometrial ablation versus hysteroscopic endometrial resection to treat menorrhagia: the French, multicenter, randomized study. J Minim Invasive Gynecol, 2006, 13(5): 424-430.
41.	萬亞軍, 王康. 熱球系統與宮腔鏡子宮內膜切除術治療功能性子宮出血的比較. 中國內鏡雜志, 2004, (6): 24-26.
42.	邱湘伊, 李晶華, 鄭杰, 等. 熱球系統、熱水循環系統內膜去除術與經宮頸子宮內膜電切術治療功能性子宮出血的比較. 腹腔鏡外科雜志, 2008, (5): 436-439.
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1. 中華醫學會婦產科學分會婦科內分泌學組. 異常子宮出血診斷與治療指南(2022更新版). 中華婦產科雜志, 2022, 57(7): 481-490.
2. 中華醫學會婦產科學分會內分泌學組中華醫學會婦產科學分會絕經學組. 功能失調性子宮出血臨床診斷治療指南(草案). 中華婦產科雜志, 2009, 44(3): 234-236.
3. Munro MG, Critchley HO, Fraser IS, et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril, 2011, 95(7): 2204-2208.
4. Munro MG, Critchley HOD, Fraser IS, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet, 2018, 143(3): 393-408.
5. Shazly SA, Famuyide AO, El-Nashar SA, et al. Intraoperative predictors of long-term outcomes after radiofrequency endometrial ablation. J Minim Invasive Gynecol, 2016, 23(4): 582-589.
6. 王中正. 諾舒阻抗控制子宮內膜去除術治療異常子宮出血的臨床療效及安全性探討. 合肥: 安徽醫科大學, 2020.
7. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions.
8. Salanti G, Del Giovane C, Chaimani A, et al. Evaluating the quality of evidence from a network meta-analysis. PLoS One, 2014, 9(7): e99682.
9. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ, 2011, 342: d549.
10. Higgins JP, Jackson D, Barrett JK, et al. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods, 2012, 3(2): 98-110.
11. Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med, 2010, 29(7-8): 932-944.
12. Abbott J, Hawe J, Hunter D, et al. A double-blind randomized trial comparing the Cavaterm and the NovaSure endometrial ablation systems for the treatment of dysfunctional uterine bleeding. Fertil Steril, 2003, 80(1): 203-208.
13. Bongers MY, Bourdrez P, Mol BW, et al. Randomised controlled trial of bipolar radio-frequency endometrial ablation and balloon endometrial ablation. BJOG, 2004, 111(10): 1095-1102.
14. Clark TJ, Samuels N, Malick S, et al. Bipolar radiofrequency compared with thermal balloon endometrial ablation in the office: a randomized controlled trial. Obstet Gynecol, 2011, 117(5): 1228.
15. Penninx JP, Herman MC, Kruitwagen RF, et al. Bipolar versus balloon endometrial ablation in the office: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol, 2016, 196: 52-56.
16. 宋鳳英. 諾舒與熱球子宮內膜去除術治療異常子宮出血的療效分析. 中國醫藥導刊, 2013, 15(8): 1418-1419.
17. 黃梅香, 黃玉萍, 林秋玲. 熱球子宮內膜去除術治療異常子宮出血的遠期療效分析. 深圳中西醫結合雜志, 2015, 25(3): 143-144.
18. 高湘玲. 諾舒與熱球子宮內膜去除術治療異常子宮出血的效果對比. 中國實用醫刊, 2016, 43(14): 74-76.
19. 楊斐涵. 分析熱球子宮內膜去除術治療異常子宮出血的遠期療效. 母嬰世界, 2018, (7): 30, 32.
20. 夏瓊, 蔣瓊. 諾舒與熱球子宮內膜去除術治療異常子宮出血的臨床效果. 中國計劃生育學雜志, 2019, 27(7): 908-911.
21. Cooper J, Gimpelson R, Laberge P, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc, 2002, 9(4): 418-428.
22. Ghazizadeh S, Panahi Z, Ghanbari Z, et al. Comparative efficacy of novasure, the levonorgestrel-releasing intrauterine system, and hysteroscopic endometrial resection in the treatment of menorrhagia: a randomized clinical trial. J Gynecol Surg, 2014, 30(4): 215-218.
23. 尹玲玲. 不同子宮內膜切除方案在月經過多患者中的療效觀察. 健康研究, 2016, 36(1): 85-86.
24. 葉淑珠. 諾舒子宮內膜切除術與經宮頸子宮內膜電切術治療功能失調性子宮出血的比較. 實用醫學雜志, 2016, 32(12): 2001-2003.
25. 趙雪芳, 李惠玲. 諾舒阻抗控制子宮內膜去除術在基層醫院應用的臨床評價. 包頭醫學院學報, 2016, 32(4): 21-23.
26. 梁雙花. 諾舒子宮內膜去除系統與宮腔鏡子宮內膜切除術治療功能失調性子宮出血的療效分析. 臨床醫學研究與實踐, 2017, 2(33): 137-138.
27. 黃霞. NovaSure子宮內膜切除術與宮腔鏡下子宮內膜電切術治療異常子宮出血的臨床研究. 中國當代醫藥, 2017, 24(5): 64-66.
28. 王琪. 諾舒阻抗控制子宮內膜切除系統治療功能失調性子宮出血的療效及安全性. 當代醫學, 2018, 24(15): 113-115.
29. 胡慧, 王萍玲, 梁文通, 等. 諾舒手術治療功能失調性子宮出血的有效性及安全性研究. 中國婦產科臨床雜志, 2019, 20(2): 172-173.
30. 弋文娟, 陳煜岊, 米思倩, 等. 諾舒子宮內膜去除術與宮腔鏡下子宮內膜電切術治療異常子宮出血的療效比較. 中國臨床新醫學, 2019, 12(1): 43-46.
31. 吳慧嫻. 諾舒阻抗控制子宮內膜消融術與宮腔鏡下子宮內膜電切術治療異常子宮出血的療效分析. 實用婦科內分泌電子雜志, 2019, 6(31): 78, 85.
32. 羅海華, 陳麗平, 吳偉瑛, 等. 諾舒阻抗子宮內膜切除系統治療月經過多的臨床效果. 中國當代醫藥, 2019, 26(19): 155-157.
33. 董艷敏. NovaSure子宮內膜切除術對異常子宮出血的效果. 河南醫學研究, 2019, 28(4): 620-621.
34. 王坤, 王逸菲, 李雅文. 諾舒阻抗控制子宮內膜切除術與宮腔鏡子宮內膜切除術救治功能失調性子宮出血臨床研究. 臨床軍醫雜志, 2020, 48(11): 1304-1307.
35. 鄭敏旋. 諾舒子宮內膜消融術與經宮腔鏡子宮內膜電切術在異常子宮出血中的治療效果與安全性. 中國婦幼保健, 2021, 36(21): 4884-4887.
36. Meyer WR, Walsh BW, Grainger DA, et al. Thermal balloon and rollerball ablation to treat menorrhagia: a multicenter comparison. Obstet Gynecol, 1998, 92(1): 98-103.
37. Pellicano M, Guida M, Acunzo G, et al. Hysteroscopic transcervical endometrial resection versus thermal destruction for menorrhagia: a prospective randomized trial on satisfaction rate. Am J Obstet Gynecol, 2002, 187(3): 545-550.
38. Hawe J, Abbott J, Hunter D, et al. A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd: YAG laser for the treatment of dysfunctional uterine bleeding. BJOG:an international J Obstet Gynaecol, 2003, 110(4): 350-357.
39. van Zon-Rabelink IA, Vleugels MP, Merkus HM, et al. Endometrial ablation by rollerball electrocoagulation compared to uterine balloon thermal ablation: technical and safety aspects. Eur J Obstet Gynecol Reprod Biol, 2003, 110(2): 220-223.
40. Brun JL, Raynal J, Burlet G, et al. Cavaterm thermal balloon endometrial ablation versus hysteroscopic endometrial resection to treat menorrhagia: the French, multicenter, randomized study. J Minim Invasive Gynecol, 2006, 13(5): 424-430.
41. 萬亞軍, 王康. 熱球系統與宮腔鏡子宮內膜切除術治療功能性子宮出血的比較. 中國內鏡雜志, 2004, (6): 24-26.
42. 邱湘伊, 李晶華, 鄭杰, 等. 熱球系統、熱水循環系統內膜去除術與經宮頸子宮內膜電切術治療功能性子宮出血的比較. 腹腔鏡外科雜志, 2008, (5): 436-439.
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Chinese Journal of Evidence-Based Medicine

Efficacy and safety of bipolar radiofrequency ablation versus hysterectomy in abnormal uterine bleeding: a network meta-analysis

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