英国诺丁汉大学Jane P. Daniels团队比较了子宫肌瘤切除术和子宫动脉栓塞术治疗子宫肌瘤的效果。相关论文于2020年7月30日发表在《新英格兰医学杂志》上。

子宫肌瘤是育龄妇女中最常见的一类肿瘤，与月经大出血、腹部不适、不育和生活质量下降有关。对于希望保留子宫且对药物治疗无反应的女性，子宫肌瘤切除术和子宫动脉栓塞术是理想的治疗选择。

研究组进行了一项多中心、随机、开放标签试验，在英国的29家医院招募了254名患有症状性子宫肌瘤且不想进行子宫切除术的女性，将其随机分组，其中127名接受子宫肌瘤切除术，127名接受子宫动脉栓塞术。主要结局是子宫肌瘤相关的生活质量，通过子宫肌瘤症状和健康相关生活质量问卷（UFS-QOL）进行评分，0-100分，分数越高生活质量越好。

共有206名女性（81％）获得了主要结局数据。随访2年后，在意向治疗分析中，子宫肌瘤切除组的UFS-QOL健康相关生活质量得分为84.6±21.5分，显著高于子宫动脉栓塞组（80.0±22.0分）。子宫肌瘤切除组中29％的女性和子宫动脉栓塞组中24％的女性发生了所有初始手术的围手术期和术后并发症，无论其是否遵循指定程序。

总之，对于症状性子宫肌瘤的女性，接受子宫肌瘤切除术2年后的子宫肌瘤相关生活质量优于子宫动脉栓塞术。

附：英文原文

Title: Uterine-Artery Embolization or Myomectomy for Uterine Fibroids

Author: Isaac Manyonda, Ph.D.,, Anna-Maria Belli, F.R.C.R.,, Mary-Ann Lumsden, M.D.,, Jonathan Moss, M.B., Ch.B.,, William McKinnon, Ph.D.,, Lee J. Middleton, M.Sc.,, Versha Cheed, M.Sc.,, Olivia Wu, Ph.D.,, Fusun Sirkeci, M.D.,, Jane P. Daniels, Ph.D.,, and Klim McPherson, Ph.D.

Issue&Volume: 2020-07-29

Abstract: Abstract

Background

Uterine fibroids, the most common type of tumor among women of reproductive age, are associated with heavy menstrual bleeding, abdominal discomfort, subfertility, and a reduced quality of life. For women who wish to preserve their uterus and who have not had a response to medical treatment, myomectomy and uterine-artery embolization are therapeutic options.

Methods

We conducted a multicenter, randomized, open-label trial to evaluate myomectomy, as compared with uterine-artery embolization, in women who had symptomatic uterine fibroids and did not want to undergo hysterectomy. Procedural options included open abdominal, laparoscopic, or hysteroscopic myomectomy. The primary outcome was fibroid-related quality of life, as assessed by the score on the health-related quality-of-life domain of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire (scores range from 0 to 100, with higher scores indicating a better quality of life) at 2 years; adjustment was made for the baseline score.

Results

A total of 254 women, recruited at 29 hospitals in the United Kingdom, were randomly assigned: 127 to the myomectomy group (of whom 105 underwent myomectomy) and 127 to the uterine-artery embolization group (of whom 98 underwent embolization). Data on the primary outcome were available for 206 women (81%). In the intention-to-treat analysis, the mean (±SD) score on the health-related quality-of-life domain of the UFS-QOL questionnaire at 2 years was 84.6±21.5 in the myomectomy group and 80.0±22.0 in the uterine-artery embolization group (mean adjusted difference with complete case analysis, 8.0 points; 95% confidence interval [CI], 1.8 to 14.1; P=0.01; mean adjusted difference with missing responses imputed, 6.5 points; 95% CI, 1.1 to 11.9). Perioperative and postoperative complications from all initial procedures, irrespective of adherence to the assigned procedure, occurred in 29% of the women in the myomectomy group and in 24% of the women in the uterine-artery embolization group.

Conclusions

Among women with symptomatic uterine fibroids, those who underwent myomectomy had a better fibroid-related quality of life at 2 years than those who underwent uterine-artery embolization.

DOI: NJ202007303830511

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1914735