A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years. Aberdeen Endometrial Ablation Trials Group.

摘要

OBJECTIVE: To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. DESIGN: Long term follow up of randomised cohorts of women. SETTING: Gynaecology department of a large teaching hospital. SAMPLE: Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously. METHODS: Postal questionnaire and casenote review. MAIN OUTCOME MEASURES: Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up. RESULTS: Further surgical treatment was received by 39 (38%) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36% and by hysterectomy was 24% (compared with 29% and 14% respectively at one year). Satisfaction rates were high (80% ablation group vs 89% hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (pound sterling 1231 vs pound sterling 1332). CONCLUSIONS: While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76% of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.