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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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.
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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.
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17.	黄梅香, 黄玉萍, 林秋玲. 热球子宫内膜去除术治疗异常子宫出血的远期疗效分析. 深圳中西医结合杂志, 2015, 25(3): 143-144.
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24.	叶淑珠. 诺舒子宫内膜切除术与经宫颈子宫内膜电切术治疗功能失调性子宫出血的比较. 实用医学杂志, 2016, 32(12): 2001-2003.
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30.	弋文娟, 陈煜岊, 米思倩, 等. 诺舒子宫内膜去除术与宫腔镜下子宫内膜电切术治疗异常子宫出血的疗效比较. 中国临床新医学, 2019, 12(1): 43-46.
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33.	董艳敏. NovaSure子宫内膜切除术对异常子宫出血的效果. 河南医学研究, 2019, 28(4): 620-621.
34.	王坤, 王逸菲, 李雅文. 诺舒阻抗控制子宫内膜切除术与宫腔镜子宫内膜切除术救治功能失调性子宫出血临床研究. 临床军医杂志, 2020, 48(11): 1304-1307.
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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.	万亚军, 王康. 热球系统与宫腔镜子宫内膜切除术治疗功能性子宫出血的比较. 中国内镜杂志, 2004, (6): 24-26.
42.	邱湘伊, 李晶华, 郑杰, 等. 热球系统、热水循环系统内膜去除术与经宫颈子宫内膜电切术治疗功能性子宫出血的比较. 腹腔镜外科杂志, 2008, (5): 436-439.
43.	Sesti F, Ruggeri V, Pietropolli A, et al. Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: a randomized study. J Obstet Gynaecol Res, 2011, 37(11): 1650-1657.
44.	罗银娟. 热球治疗功能失调性子宫出血的临床观察与护理配合. 母婴世界, 2020, (23): 135.
45.	Gannon MJ, Holt EM, Fairbank J, et al. A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia. BMJ, 1991, 303(6814): 1362-1364.
46.	Dwyer N, Hutton J, Stirrat GM. Randomised controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia. Br J Obstet Gynaecol, 1993, 100(3): 237-243.
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1. 中华医学会妇产科学分会妇科内分泌学组. 异常子宫出血诊断与治疗指南(2022更新版). 中华妇产科杂志, 2022, 57(7): 481-490.
2. 中华医学会妇产科学分会内分泌学组中华医学会妇产科学分会绝经学组. 功能失调性子宫出血临床诊断治疗指南(草案). 中华妇产科杂志, 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. 诺舒阻抗控制子宫内膜去除术治疗异常子宫出血的临床疗效及安全性探讨. 合肥: 安徽医科大学, 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. 宋凤英. 诺舒与热球子宫内膜去除术治疗异常子宫出血的疗效分析. 中国医药导刊, 2013, 15(8): 1418-1419.
17. 黄梅香, 黄玉萍, 林秋玲. 热球子宫内膜去除术治疗异常子宫出血的远期疗效分析. 深圳中西医结合杂志, 2015, 25(3): 143-144.
18. 高湘玲. 诺舒与热球子宫内膜去除术治疗异常子宫出血的效果对比. 中国实用医刊, 2016, 43(14): 74-76.
19. 杨斐涵. 分析热球子宫内膜去除术治疗异常子宫出血的远期疗效. 母婴世界, 2018, (7): 30, 32.
20. 夏琼, 蒋琼. 诺舒与热球子宫内膜去除术治疗异常子宫出血的临床效果. 中国计划生育学杂志, 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. 不同子宫内膜切除方案在月经过多患者中的疗效观察. 健康研究, 2016, 36(1): 85-86.
24. 叶淑珠. 诺舒子宫内膜切除术与经宫颈子宫内膜电切术治疗功能失调性子宫出血的比较. 实用医学杂志, 2016, 32(12): 2001-2003.
25. 赵雪芳, 李惠玲. 诺舒阻抗控制子宫内膜去除术在基层医院应用的临床评价. 包头医学院学报, 2016, 32(4): 21-23.
26. 梁双花. 诺舒子宫内膜去除系统与宫腔镜子宫内膜切除术治疗功能失调性子宫出血的疗效分析. 临床医学研究与实践, 2017, 2(33): 137-138.
27. 黄霞. NovaSure子宫内膜切除术与宫腔镜下子宫内膜电切术治疗异常子宫出血的临床研究. 中国当代医药, 2017, 24(5): 64-66.
28. 王琪. 诺舒阻抗控制子宫内膜切除系统治疗功能失调性子宫出血的疗效及安全性. 当代医学, 2018, 24(15): 113-115.
29. 胡慧, 王萍玲, 梁文通, 等. 诺舒手术治疗功能失调性子宫出血的有效性及安全性研究. 中国妇产科临床杂志, 2019, 20(2): 172-173.
30. 弋文娟, 陈煜岊, 米思倩, 等. 诺舒子宫内膜去除术与宫腔镜下子宫内膜电切术治疗异常子宫出血的疗效比较. 中国临床新医学, 2019, 12(1): 43-46.
31. 吴慧娴. 诺舒阻抗控制子宫内膜消融术与宫腔镜下子宫内膜电切术治疗异常子宫出血的疗效分析. 实用妇科内分泌电子杂志, 2019, 6(31): 78, 85.
32. 罗海华, 陈丽平, 吴伟瑛, 等. 诺舒阻抗子宫内膜切除系统治疗月经过多的临床效果. 中国当代医药, 2019, 26(19): 155-157.
33. 董艳敏. NovaSure子宫内膜切除术对异常子宫出血的效果. 河南医学研究, 2019, 28(4): 620-621.
34. 王坤, 王逸菲, 李雅文. 诺舒阻抗控制子宫内膜切除术与宫腔镜子宫内膜切除术救治功能失调性子宫出血临床研究. 临床军医杂志, 2020, 48(11): 1304-1307.
35. 郑敏旋. 诺舒子宫内膜消融术与经宫腔镜子宫内膜电切术在异常子宫出血中的治疗效果与安全性. 中国妇幼保健, 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. 万亚军, 王康. 热球系统与宫腔镜子宫内膜切除术治疗功能性子宫出血的比较. 中国内镜杂志, 2004, (6): 24-26.
42. 邱湘伊, 李晶华, 郑杰, 等. 热球系统、热水循环系统内膜去除术与经宫颈子宫内膜电切术治疗功能性子宫出血的比较. 腹腔镜外科杂志, 2008, (5): 436-439.
43. Sesti F, Ruggeri V, Pietropolli A, et al. Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: a randomized study. J Obstet Gynaecol Res, 2011, 37(11): 1650-1657.
44. 罗银娟. 热球治疗功能失调性子宫出血的临床观察与护理配合. 母婴世界, 2020, (23): 135.
45. Gannon MJ, Holt EM, Fairbank J, et al. A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia. BMJ, 1991, 303(6814): 1362-1364.
46. Dwyer N, Hutton J, Stirrat GM. Randomised controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia. Br J Obstet Gynaecol, 1993, 100(3): 237-243.
47. Pinion SB, Parkin DE, Abramovich DR, et al. Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding. BMJ, 1994, 309(6960): 979-983.
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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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