• No results found

VU Research Portal

N/A
N/A
Protected

Academic year: 2021

Share "VU Research Portal"

Copied!
8
0
0

Bezig met laden.... (Bekijk nu de volledige tekst)

Hele tekst

(1)

Uterine artery embolization

de Bruijn, A.M.

2019

document version

Publisher's PDF, also known as Version of record

Link to publication in VU Research Portal

citation for published version (APA)

de Bruijn, A. M. (2019). Uterine artery embolization: for fibroids and adenomyosis.

General rights

Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain

• You may freely distribute the URL identifying the publication in the public portal ?

Take down policy

If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

E-mail address:

(2)

SUMMARY

7KLVWKHVLVDLPHGWRSRVLWLRQXWHULQHDUWHU\HPEROL]DWLRQ 8$( DVWUHDWPHQWRSWLRQ IRUXWHULQHÀEURLGVDQGDGHQRP\RVLV7KLVZDVSUHVHQWHGLQWZRSDUWVRIWKLVWKHVLV

PART I

7KLV SDUW RI WKLV WKHVLV HYDOXDWHG 8$( IRU XWHULQH ÀEURLGV ZKLFK KDV EHHQ DSSOLHGIRURYHU\HDUVRQHVWHSIXUWKHUE\ORRNLQJDWORQJWHUPRXWFRPHV LPSOHPHQWDWLRQLQWKH1HWKHUODQGVDQGLWVDSSOLFDWLRQVLQDQXQXVXDOLQGLFDWLRQ FHUYLFDOÀEURLGV ,QRUGHUWREHDEOHWRFRXQVHOSDWLHQWVRQORQJWHUPRXWFRPHV FRXQVHOLQJ LQIRUPDWLRQ IRU J\QHFRORJLVW DQG VWLPXODWH LPSOHPHQWDWLRQ LQWR GDLO\SUDFWLFHWKH\HDUIROORZXSRI(00<WULDOSDWLHQWVZDVFRQGXFWHG,Q DGGLWLRQDQ8$(LPSOHPHQWDWLRQLQYHQWRU\DQGSUHIHUHQFHVWXG\ZDVVHWXSWR DVVHVVLPSOHPHQWDWLRQRI8$(DQGLQYHVWLJDWHWKHKDPSHULQJRIIDFWRUVIRUWKH DSSOLFDWLRQRI8$(6LQFHZHQRWLFHGWKDW8$(HIÀFDF\DQGVDIHW\LQSDWLHQWV ZLWKV\PSWRPDWLFFHUYLFDOORFDWHGÀEURLGVZHUHQRW\HWHYDOXDWHGDFDVHVHULHV ZDVSXEOLVKHGWRLQLWLDWHIXUWKHUUHVHDUFKDQGSRVVLEO\H[SDQGWKHWKHUDSHXWLF DSSOLFDELOLW\RI8$( PART II 7KLVSDUWRIWKHWKHVLVPDNHVWKHÀ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uality of Life after Embolization vs Hysterectomy in Adenomyosis  7KLVLVDUDQGRPL]HGFRQWUROOHGWULDOFRPSDULQJXWHULQHDUWHU\HPEROL]DWLRQDQG K\VWHUHFWRP\LQWKHWUHDWPHQWRISDWLHQWVZLWKV\PSWRPDWLFDGHQRP\RVLV7KLV WKHVLVGHVFULEHVWKHGHVLJQRIWKLVWULDO7KHRXWFRPHVDUHQRWSDUWRIWKLVWKHVLV WKHWULDOLVVWLOOUHFUXLWLQJ 

'XULQJ WKH LQFOXVLRQ SHULRG RI WKH 48(67$ WULDO ZH QRWLFHG GLIÀFXOWLHV LQ GLDJQRVLQJDGHQRP\RVLV,WVHHPVDGHQRP\RVLVLVDIUHTXHQWO\XQUHFRJQL]HG EHQLJQGLVHDVHRUPLVWDNHQIRUXWHULQHÀEURLGGLVHDVH*\QHFRORJLVWVLQGLFDWHG ODFN RI NQRZOHGJH FRQFHUQLQJ WKH GLVHDVH LPDJLQJ FKDUDFWHULVWLFV DQG

SRVVLEOHWUHDWPHQWRSWLRQV6LQFHWUHDWPHQWPDQDJHPHQWLVRIWHQEDVHGRQDQ XOWUDVRQRJUDSKLFEDVHGGLDJQRVLVRIDGHQRP\RVLVRQO\DXQLIRUPUHSURGXFLEOH DQGFOLQLFDOO\UHOHYDQWUHSRUWLQJV\VWHPZDVGHYHORSHG

7KH DERYH PHQWLRQHG SHUIRUPHG VWXGLHV DV GHVFULEHG LQ WKLV WKHVLV ZLOO EH VXPPDUL]HGLQWKHQH[WSDUDJUDSKVWRJHWKHUZLOODJHQHUDOGLVFXVVLRQWKDW FRPSDUHVRXUUHVXOWVZLWKFXUUHQWOLWHUDWXUH7KHUHDIWHUWKHLPSOLFDWLRQRIWKLV WKHVLVZLOOEHPHQWLRQHGWRJHWKHUZLWKDQRYHUDOOFRQFOXVLRQDQGLQGLFDWLRQVIRU IXWXUHUHVHDUFK

RESULTS

MAIN FINDINGS PART I: UTERINE FIBROIDS

LONG TERM RESULTS OF UAE: THE RANDOMIZED EMMY TRIAL

(3)

IMPLEMENTATION OF UAE: AN INVENTORY AND PREFENRENCE STUDY

&KDSWHU  GHVFULEHV DQ LQYHQWRU\ DQG SUHIHUHQFH VWXG\ WKDW DLPHG WR ÀQG RXWLIWKHQDWLRQDOJXLGHOLQHKDGDQ\HIIHFWRQ8$(LPSOHPHQWDWLRQDQG WRDVVHVVWKHGLIIHUHQWDVSHFWVRI8$(FRXQVHOLQJSUHIHUHQFHGLIÀFXOWLHVDQG NQRZOHGJHDZDUHQHVVDPRQJJ\QHFRORJLVWV,QRUGHUWRREVHUYHWKHTXDQWLW\ RISHUIRUPHG8$(LQWKH1HWKHUODQGVWKHDQGDQQXDOUHSRUWVRI DOOKRVSLWDOVZHUHUHTXHVWHGDQGXVHGWRHVWDEOLVKWKHRYHUDOO8$(K\VWHUHFWRP\ UDWLR6HFRQGO\TXHVWLRQQDLUHVZHUHÀOOHGLQE\J\QHFRORJLVWVZRUNLQJDW8$( SHUIRUPLQJ 8$( DQGQRQ8$(SHUIRUPLQJ 8$( KRVSLWDOVUHVXOWLQJLQDJURXS FRPSDULVRQDQDO\VLV7KH8$(K\VWHUHFWRP\UDWLREHIRUH  DQGDIWHU   LQFRUSRUDWLRQLQWKHJXLGHOLQHUHPDLQHGORZDQGZHUHDQG UHVSHFWLYHO\2XWFRPHVRIWKHTXHVWLRQQDLUHVÀOOHGLQE\J\QHFRORJLVWVVKRZHG WKDWWKHDYDLODELOLW\RI8$(LQÁXHQFHVWKHIUHTXHQF\DQGW\SHRIFRXQVHOLQJ LQSDWLHQWVZLWKV\PSWRPDWLFXWHULQHÀEURLGV8$(KRVSLWDOVHVWLPDWHKLJKHU FRXQVHOLQJ QXPEHUV FRPSDUHG WR 8$( KRVSLWDOV $SSUR[LPDWHO\  RI J\QHFRORJLVWVZRUNLQJLQ8$(KRVSLWDOVLQGLFDWHGWKDWWKH\KDYHLQVXIÀFLHQW LQIRUPDWLRQ DERXW 8$( IRU DSSURSULDWH FRXQVHOLQJ DQG LQ WKH PDMRULW\ RI J\QHFRORJLVWVIURPERWKKRVSLWDOVWKH\RYHUHVWLPDWHWKHULVNRIUHLQWHUYHQWLRQ :HFRQFOXGHGWKDWLWPLJKWEHXVHIXOWRGHYHORSDQRSWLRQJULGRUGHFLVLRQ PDNLQJWRROLQRUGHUWRRIIHULQGHSHQGHQWFRXQVHOLQJDQGHQFRXUDJHVKDUHG GHFLVLRQPDNLQJ

UAE IN THE TREATMENT OF CERVICAL FIBROIDS.

In FKDSWHUZHSHUIRUPHGDQHYDOXDWLRQRQVDIHW\DQGHIÀFDF\RIXWHULQH DUWHU\HPEROL]DWLRQ 8$( LQWKHSDWLHQWVZLWKV\PSWRPDWLFFHUYLFDOÀ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ÀEURLGVLVHIIHFWLYHDQGVDIHZLWKVLJQLÀFDQW LPSURYHPHQWRIV\PSWRPVDQGTXDOLW\RIOLIH,WVHHPVDYDOXDEOHRSWLRQIRU ZRPHQVHHNLQJDQRQVXUJLFDOVROXWLRQRUZKHQRSHUDWLYHLQWHUYHQWLRQLVWRR GDQJHURXV

MAIN FINDINGS PART II: ADENOMYOSIS

7 YEAR FOLLOW-UP OF UAE IN PATIENTS WITH ADENOMYOSIS

In FKDSWHUZHDVVHVVHGFOLQLFDORXWFRPHVVHYHQ\HDUVDIWHUXWHULQHDUWHU\ HPEROL]DWLRQLQWKHWUHDWPHQWRIV\PSWRPVFDXVHGE\V\PSWRPDWLFDGHQRP\RVLV 7KHVHYHQ\HDUSRVWLQWHUYHQWLRQRXWFRPHVZHUHKHDOWKUHODWHGTXDOLW\RIOLIH +542/ V\PSWRPVHYHULW\VFRUHV 666 SDWLHQWVDWLVIDFWLRQPHQRSDXVHDQGUH LQWHUYHQWLRQUDWHVZKLFKZHUHDVVHVVHGZLWKVWDQGDUGL]HGTXHVWLRQQDLUHV7ZHQW\ QLQHSDWLHQWVZLWKDGHQRP\RVLV LQFRPELQDWLRQZLWKÀEURLGV ZHUHLQFOXGHG DQGWUHDWHGZLWK8$(EHWZHHQ6HSWHPEHUDQG-DQXDU\3UHYLRXVO\ UHVXOWVZHUHSXEOLVKHG\HDUVDIWHUWUHDWPHQW6HYHQ\HDUVDIWHUWUHDWPHQWRI SDWLHQWV  KDGDVHFRQGDU\K\VWHUHFWRP\GXHWRSHUVLVWLQJFRPSODLQWV7KH LQLWLDOO\VLJQLÀFDQWO\LPSURYHG+542/DIWHU8$(UHPDLQHGVWDEOHWKURXJKRXWWKH \HDUVXSXQWRVHYHQ\HDUV7KH666VKRZHGDVPDOOVWDWLVWLFDOVLJQLÀFDQWGLIIHUHQFH LQIDYRURIWKHDGHQRP\RVLVLQFRPELQDWLRQZLWKÀEURLGVJURXSFRPSDUHGWRWKH SXUHDGHQRP\RVLVJURXS:HFRQFOXGHGWKDWLQRISDWLHQWV8$(UHVXOWVLQ SUHVHUYDWLRQRIWKHXWHUXVRISDWLHQWVDUHVDWLVÀHGDQGWZRWKLUGVHHPWR UHVSRQGZHOOWR8$(LQWHUPVRILPSURYHPHQWRI+542/DQG666

A SYSTEMATIC REVIEW AND METANALYSIS ON UAE IN THE TREATMENT OF ADENOMYSOSIS

(4)

QUESTA TRIAL STUDY PROTOCOL

In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

SONOGRAPHIC CLASSIFICATION AND REPORTING FOR ADENOMYOSIS.

&KDSWHUSUHVHQWVDXQLIRUPFODVVLÀFDWLRQDQGVWDQGDUGL]HGUHSRUWLQJV\VWHPRI XOWUDVRXQGÀQGLQJVRIDGHQRP\RVLVXVLQJWKH0RUSKRORJLFDO8WHUXV6RQRJUDSKLF $VVHVVPHQW 086$ FULWHULD7KLVFODVVLÀFDWLRQDQGUHSRUWLQJV\VWHPZDVEXLOW EDVHGRQDWKRURXJKGLVFXVVLRQDPRQJDOODXWKRUVLQFOXGLQJD'HOSKLSURFHGXUH 6HOHFWHGLPDJHVDQGYLGHRVRIW\SLFDOFDVHVRIWKHGLIIHUHQWPRUSKRORJLFDO YDULDWLRQVRIDGHQRP\RVLVZHUHXVHGLQWKHGHEDWHV 7KLVV\VWHPLQFOXGHV  LGHQWLÀFDWLRQRIDGHQRP\RVLVEDVHGRQ086$FULWHULD   GLVHDVHORFDWLRQ  FODVVLÀFDWLRQRIWKHOHVLRQVDVIRFDORUGLIIXVH  SUHVHQFH RUDEVHQFHRILQWUDOHVLRQDOF\VWV  P\RPHWULDOOD\HULQYROYHPHQW MXQFWLRQDO ]RQHP\RPHWULXPVHURVDOLQYROYHPHQW   GLVHDVHH[WHQWDQG  OHVLRQVL]H7KH SURSRVHGFODVVLÀFDWLRQPLJKWQHHGWREHDPHQGHGDIWHUH[WHUQDOYDOLGDWLRQDQG EDVHGRQWKHUHVXOWRIIXWXUHVWXGLHVHYDOXDWLQJWKHUHODWLRQEHWZHHQXOWUDVRXQG IHDWXUHVFOLQLFDOV\PSWRPVKLVWRORJLFDOÀQGLQJDQGSRVVLEO\DOVR05,ÀQGLQJV

GENERAL DISCUSSION

UAE IN THE TREATMENT OF FIBROIDS.

(5)

V\PSWRPDWLFFHUYLFDOÀEURLGVZDVFRQGXFWHG:HFRQFOXGHGWKDW8$(LQWKHVH SDWLHQWVVHHPVHIIHFWLYHDQGVDIHZLWKVLJQLÀFDQWLPSURYHPHQWLQV\PSWRPVDQG TXDOLW\RIOLIHKRZHYHULWZDVDYHU\VPDOOVDPSOHVL]H Q  &RPSDUHGWRWKH RQO\RWKHUVPDOOUHWURVSHFWLYHVWXG\ZHUHSRUWHGDKLJKHUVXFFHVVUDWHKRZHYHU WKH\GLGQRWXVHYDOLGDWHGTXHVWLRQQDLUHV7KHGLIIHUHQFHLQRXWFRPHPLJKWEH H[SODLQHGE\YDVFXODULW\YDULHW\VPDOOHUÀEURLGVDQGWKXVOHVVLQIDUFWLRQLQWKHLU SRSXODWLRQRUDGLIIHUHQWFDWKHWHUL]DWLRQWHFKQLTXH6LQFHRQO\WKHVHWZRUHSRUWV DUHDYDLODEOHLPSOHPHQWDWLRQRI8$(LQWKHWUHDWPHQWRIFHUYLFDOÀEURLGVLVWRR SUHOLPLQDU\/DUJHUKLJKTXDOLW\WULDOVVKRXOGLGHDOO\EHFRQGXFWHGWRFRQÀUP RXUUHVXOWV+RZHYHUWKLVFRQGLWLRQLVUDUHVRODUJHSURVSHFWLYHVWXGLHVLQWKH IXWXUHVHHPXQOLNHO\6LQFHVXUJHU\FDQEHULVN\ZLWKFHUYLFDOÀEURLGVZHKRSH RXUUHSRUWFRQWULEXWHGWRWDNLQJ8$(DVDWUHDWPHQWRSWLRQIRUWKHVHÀEURLGVLQWR DFFRXQW

UAE IN THE TREATMENT OF ADENOMYOSIS.

3XEOLFDWLRQVRQWKHUHVXOWVDIWHU8$(LQWKHWUHDWPHQWRIDGHQRP\RVLVLQFUHDVHG LQWKHODVW\HDUVEXWHYLGHQFHLVVWLOOOLPLWHG2QO\VPDOOXQFRQWUROOHGFDVH VHULHVZHUHDYDLODEOHZKHQZHVWDUWHGWKHHYDOXDWLRQRIWKH\HDUIROORZXSRI 8$(LQWKHWUHDWPHQWRISDWLHQWVZLWKV\PSWRPDWLFDGHQRP\RVLV7KHVHFDVH VHULHVVKRZHGVXEVWDQWLDOLPSURYHPHQWRIV\PSWRPV KHDY\PHQVWUXDOEOHHGLQJ G\VPHQRUUKHDDQGEXONUHODWHGV\PSWRPV DIWHU8$($FFRUGLQJWRWKHVH XQFRQWUROOHGVHULHVFOLQLFDOHIIHFWLYHQHVVGHÀQHGDVLPSURYHPHQWRIKHDY\ PHQVWUXDOEOHHGLQJG\VPHQRUUKHDDQGEXONUHODWHGV\PSWRPVDYHUDJHG 7KHORQJHVWIROORZXSDPRQJRQHRIWKHVHFDVHVHULHVZDVPRQWKV,WMXVWLÀHG WKHHYDOXDWLRQRIORQJHUIROORZXSDQGDVIDUDVZHDUHDZDUHRIRXUSURVSHFWLYH FRKRUWLVWKHORQJHVWIROORZXSDYDLODEOHVRIDU7KHPRVWQRWLFHDEOHLPSURYHPHQW RI+542/LQSDWLHQWVZLWKSXUHDGHQRP\RVLVDQGLQDGHQRP\RVLVZLWKÀEURLGV RFFXUUHGLQWKHÀUVWPRQWKVDIWHU8$(DQGUHPDLQHGVWDEOHRYHUWLPHZLWKRXW GLIIHUHQFHVEHWZHHQWKHWZRJURXSV$WIROORZXSWKHV\PSWRPVVHYHULW\VFRUH VKRZHGFRPSDUDEOHVWDEOHLPSURYHPHQWZLWKDVPDOOVWDWLVWLFDOGLIIHUHQFHLQ IDYRURIWKHDGHQRP\RVLVFRPELQHGZLWKÀEURLGVJURXSDWDQGPRQWKV 7KLVÀQGLQJLVFRQFRUGDQWZLWKRXUV\VWHPDWLFUHYLHZDQGPHWDDQDO\VLVEXW FRXOGDOVREHH[SODLQHGE\WKHLQLWLDOVHOHFWLRQELDVZKHUHSDWLHQWVZLWKSXUH DGHQRP\RVLVKDGZRUVHV\PSWRPVFRPSDUHGWRWKHSDWLHQWVZLWKDGHQRP\RVLV DQGÀEURLGV$WRWDORIÀYHSDWLHQWVXQGHUZHQWDVHFRQGDU\K\VWHUHFWRP\   )RXURIWKHVHÀ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ÀEURLGV7KHLQFOXGHGVWXGLHVUHSRUWHGLPSURYHPHQWRIFOLQLFDO V\PSWRPVGHÀQHGDVLPSURYHPHQWRIKHDY\PHQVWUXDOEOHHGLQJG\VPHQRUUKHD DQG EXON UHODWHG V\PSWRPV LQ   RI   RI SDWLHQWV *UHDWHU -= WKLFNQHVV !PP DQGORZLQIDUFWLRQUDWHV  KDYHEHHQDVVRFLDWHGZLWK GHFUHDVHGHIIHFWLYHQHVVIRU8$(LQWUHDWLQJDGHQRP\RVLV:KDWKDPSHUHGWKLV UHYLHZZDVWKHKHWHURJHQHLW\RIVWXGLHVQRDYDLODEOH UDQGRPL]HG FRQWUROOHG WULDOVVPDOOVDPSOHVL]HDQGXQGHUUHSRUWLQJRIH[FOXGHGSDWLHQWRUSDWLHQWVORVW WRIROORZXSWKHUHIRUHVHOHFWLRQELDVDQGSXEOLFDWLRQELDVFRXOGQRWEHUXOHG RXW,QDGGLWLRQQRYDOLGDWHGDGHQRP\RVLVVSHFLÀFTXHVWLRQQDLUHVDYDLODEOH $VDUHVXOWRIWKHVHOLPLWDWLRQVWKLVUHYLHZGRHVQRWVXSSRUWWRRVWURQJFOLQLFDO FRQFOXVLRQVUHJDUGLQJ8$(LQWKHWUHDWPHQWRIV\PSWRPDWLFDGHQRP\RVLV,W QHHGHGWREHFRQÀUPHGLQFRPSDUDWLYH SUHIHUDEO\UDQGRPL]HG WULDOVEHIRUH LPSOHPHQWDWLRQLQGDLO\SUDFWLFH

5HVXOWLQJLQWKHGHYHORSPHQWRIWKH48(67$ 4uality of Life after Embolization

vs Hysterectomy in Adenomyosis  WR HYDOXDWH WKH WUXH HIIHFWLYHQHVV RI 8$(

LQFRPSDULVRQWRK\VWHUHFWRP\KRZHYHUGXULQJWKHLQFOXVLRQSHULRGSDWLHQW LQFOXVLRQ ZDV GLIÀFXOW ,W PRVWO\ VHHPHG KDPSHUHG E\ SRRU UHFRJQLWLRQ RI DGHQRP\RVLVRQXOWUDVRXQG7KHUHIRUHDXQLIRUPUHSURGXFLEOHDQGFOLQLFDOO\ UHOHYDQWUHSRUWLQJV\VWHPZDVGHYHORSHG

SONOGRAPHIC IMAGING IN DIAGNOSING ADENOMYOSIS

(6)

RIDUHFHQWFRQVHQVXVVWDWHPHQWGHVFULELQJWHUPVGHÀQLWLRQVDQGPHDVXUHPHQWV WKDWPD\EHXVHGLQWKHXOWUDVRQRJUDSKLFGHVFULSWLRQRIDGHQRP\RVLVWKHH[WHQW RIFULWHULDDQGPHWKRGVXVHGIRUGLDJQRVLQJDGHQRP\RVLVRQXOWUDVRQRJUDSK\ XVHG WR YDU\ EHWZHHQ VWXGLHV 7KLV FRQVHQVXV VWDWHPHQW LV D SRVLWLYH VWHS

WRZDUGDXQLÀHGQRPHQFODWXUHIRUUHVHDUFKDQGFODVVLÀ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ÀFDWLRQDQG UHSRUWLQJV\VWHPDVGHVFULEHGLQWKLVWKHVLVZDVFRQGXFWHG,WVKRXOGIDFLOLWDWH FRQVLVWHQW UHSRUWLQJ DQG D JXLGHOLQH IRU FODVVLI\LQJ WKH DERYH PHQWLRQHG XOWUDVRQRJUDSKLFIHDWXUHV+RZHYHULWQHHGVWREHYDOLGDWHGDQGUHÀQHGDIWHU IXWXUHVWXGLHV6RPHLVVXHVKDYHULVHQGXULQJWKHGHYHORSPHQWRIWKHFODVVLÀ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ÀFDWLRQZH KDYHVXJJHVWHGFDQQRWEHXVHGRQLWVRZQWRGHFLGHRQWUHDWPHQWEXWQHHGV WREHYDOLGDWHGÀUVW

FUTURE RESEARCH

7KH HPEROL]DWLRQ LPSOHPHQWDWLRQ SURFHVV WKH XVH DQG FRPSOLDQFH RI WKH KHDY\PHQVWUXDOEOHHGLQJJXLGHOLQH ZDVWHVWHGE\WKHXVHRIHPEROL]DWLRQ K\VWHUHFWRP\UDWLR·VLQZRPHQZLWKV\PSWRPDWLFÀEURLGV,WVKRZVWKDWLWPLJKW EHXVHIXOWRGHYHORSDQRSWLRQJULGRUGHFLVLRQPDNLQJWRROLQRUGHUWRRIIHU LQGHSHQGHQWFRXQVHOLQJHQFRXUDJHVKDUHGGHFLVLRQPDNLQJDQGLQFUHDVH

LPSOHPHQWDWLRQ RI 8$( 7KLV HYDOXDWLRQ ZDV SDUW LQ WKH VRFDOOHG ¶FLUFOH RI TXDOLW\· ¶NZDOLWHLWVFLUNHO LQ 'XWFK  DV GHVLJQHG E\ WKH (00< WULDO JURXS )XUWKHUPRUHWKHJXLGHOLQHVKRXOGEHXSGDWHGZLWKWKHQHZHYLGHQFHRI8$( YHUVXVK\VWHUHFWRP\DIWHU\HDUV

,QWKLVWKHVLVZHGHVFULEHWKHVWLOORQJRLQJUDQGRPL]HGFRQWUROOHG48(67$WULDO 4uality of Life after Embolization vs Hysterectomy in Adenomyosis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ÀFDWLRQDQG UHSRUWLQJV\VWHPLQGLDJQRVLQJDGHQRP\RVLV$IWHUYDOLGDWLRQDQGRSWLPL]DWLRQ RIWKHSURSRVHGFODVVLÀFDWLRQE\PHDQVRIDLQWHUDQGLQWUDREVHUYHUYDOLGDWLRQ VWXG\ LW ZRXOG EH UHDVRQDEOH WR GHYHORS DQ HOHDUQLQJ SURJUDP IRU OHVV H[SHULHQFHGXOWUDVRQRJUDSKHUV

)XUWKHUPRUH WKH FODVVLÀFDWLRQ DOVR QHHGV WR EH DPHQGHG DIWHU H[WHUQDO YDOLGDWLRQEDVHGRQWKHUHVXOWVRIIXWXUHVWXGLHVHYDOXDWLQJWKHUHODWLRQEHWZHHQ XOWUDVRXQGIHDWXUHVFOLQLFDOV\PSWRPVKLVWRORJLFDOÀQGLQJVDQGSRVVLEO\DOVR 05,ÀQGLQJV

CONCLUSION

(7)

8$(LQWKHWUHDWPHQWRIDGHQRP\RVLVVHHPVSURPLVLQJKRZHYHULWVWLOOKDVWREH FRQÀUPHGLQZHOOVHWXSDQGJRRGTXDOLW\WULDOVEHIRUHLPSOHPHQWDWLRQLQGDLO\ SUDFWLFH 8OWUDVRQRJUDSKLFGLDJQRVLVRIDGHQRP\RVLVVHHPVFKDOOHQJLQJGXHWRODFNRI WUDLQLQJDQGUHFRJQLWLRQRIWKHUHODWLYHO\QHZSXEOLVKHGFULWHULDIRUDGHQRP\RVLV 7KHXQLIRUPUHSRUWLQJDQGFODVVLÀFDWLRQV\VWHPDVGHVFULEHGLQWKLVWKHVLVVKRXOG VXSSRUWFRQVLVWHQWUHSRUWLQJ

REFERENCES

 -+5DYLQD'+HUEUHWHDX1&LUDUX9LJQHURQ-0%RXUHW(+RXGDUW$$\PDUG DQG--0HUODQG$UWHULDOHPEROLVDWLRQWRWUHDWXWHULQHP\RPDWDLancet    -.*XSWD$6LQKD0$/XPVGHQDQG0+LFNH\8WHULQHDUWHU\HPEROL]DWLRQIRU V\PSWRPDWLFXWHULQHÀEURLGVCochraneDatabaseSystRev &'  $0GH%UXLMQ:0$QNXP-$5HHNHUV(%LUQLH60YDQGHU.RRLM1$9RONHUV DQG:-+HKHQNDPS8WHULQHDUWHU\HPEROL]DWLRQYVK\VWHUHFWRP\LQWKHWUHDWPHQW RIV\PSWRPDWLFXWHULQHÀEURLGV\HDURXWFRPHVIURPWKHUDQGRPL]HG(00<WULDO Am J Obstet Gynecol HH  1$9RONHUV:-+HKHQNDPS(%LUQLH:0$QNXPDQG-$5HHNHUV8WHULQHDUWHU\ HPEROL]DWLRQYHUVXVK\VWHUHFWRP\LQWKHWUHDWPHQWRIV\PSWRPDWLFXWHULQHÀEURLGV \HDUV·RXWFRPHIURPWKHUDQGRPL]HG(00<WULDOAmJObstetGynecol    60YDQGHU.RRLM:-+HKHQNDPS1$9RONHUV(%LUQLH:0$QNXPDQG-$ 5HHNHUV8WHULQHDUWHU\HPEROL]DWLRQYVK\VWHUHFWRP\LQWKHWUHDWPHQWRIV\PSWRPDWLF XWHULQHÀEURLGV\HDURXWFRPHIURPWKHUDQGRPL]HG(00<WULDOAmJObstetGynecol   -*0RVV.*&RRSHU$.KDXQG/60XUUD\*'0XUUD\2:X/(&UDLJDQG 0$/XPVGHQ5DQGRPLVHGFRPSDULVRQRIXWHULQHDUWHU\HPEROLVDWLRQ 8$( ZLWK VXUJLFDOWUHDWPHQWLQSDWLHQWVZLWKV\PSWRPDWLFXWHULQHÀEURLGV 5(67WULDO \HDU UHVXOWVBJOG   60YDQGHU.RRLM(.OLQW:-+HKHQNDPS6%LSDW:0$QNXPDQG-$5HHNHUV ,PSOHPHQWDWLRQRIXWHULQHDUWHU\HPEROLVDWLRQIRUV\PSWRPDWLFXWHULQHÀEURLGVDQ LQYHQWRU\Neth J Med   192*+HDY\PHQVWUXDOEOHHGLQJ  $0GH%UXLMQ+XLVPDQ-+HKHQNDPS-./RKOH3105HHNHU-$7LPPHUPDQV$ 7ZLMQVWUD$5+,PSOHPHQWDWLRQRIXWHULQHDUWHU\HPEROL]DWLRQIRUV\PSWRPDWLFÀEURLGV LQWKH1HWKHUODQGVDQLQYHQWRU\DQGSUHIHUHQFHVWXG\Cardiovascular interventional radiology  $0$6609%UXLMQGH$+HKHQNDPS:-.6PHHWV$-/RSH]$+XLUQH-$)/RKOH 3108WHULQHDUWHU\HPEROL]DWLRQLQZRPHQZLWKV\PSWRPDWLFFHUYLFDOOHLRP\RPD HIÀFDF\DQGVDIHW\Journal of cardiovascular interventional radiology 

 0'.LP0/HH'&-XQJ6,3DUN06/HH-<:RQ'</HHDQG.+/HH /LPLWHGHIÀFDF\RIXWHULQHDUWHU\HPEROL]DWLRQIRUFHUYLFDOOHLRP\RPDVJ Vasc Interv Radiol 

 0 3RSRYLF 6 3XFKQHU ' %HU]DF]\ - /DPPHU DQG 5 $ %XFHN 8WHULQH DUWHU\ HPEROL]DWLRQIRUWKHWUHDWPHQWRIDGHQRP\RVLVDUHYLHZJVascIntervRadiol  

$0GH%UXLMQ06PLQN310/RKOH-$)+XLUQH-:57ZLVN&:RQJ/ 6FKRRQPDGHDQG:-.+HKHQNDPS8WHULQH$UWHU\(PEROL]DWLRQIRUWKH7UHDWPHQW RI$GHQRP\RVLV$6\VWHPDWLF5HYLHZDQG0HWD$QDO\VLVJ Vasc Interv Radiol  H

9

O\

(8)

5-1LMHQKXLV$-6PHHWV00RUSXUJR3)%RHNNRRL3-5HXZHU06PLQN:- YDQ5RRLMDQG31/RKOH8WHULQHDUWHU\HPEROLVDWLRQIRUV\PSWRPDWLFDGHQRP\RVLV ZLWKSRO\]HQH)FRDWHGK\GURJHOPLFURVSKHUHVWKUHH\HDUFOLQLFDOIROORZXSXVLQJ 8)64R/TXHVWLRQQDLUHCardiovasc Intervent Radiol 

 6+%DH0'.LP*0.LP6-/HH6,3DUN-<:RQDQG</HHGR8WHULQH $UWHU\(PEROL]DWLRQIRU$GHQRP\RVLV3HUFHQWDJHRI1HFURVLV3UHGLFWV0LGWHUP&OLQLFDO 5HFXUUHQFHJ Vasc Interv Radiol H

 9 )URHOLQJ & 6FKHXULJ0XHQNOHU % +DPP DQG 7 - .URHQFNH 8WHULQH DUWHU\ HPEROL]DWLRQ WR WUHDW XWHULQH DGHQRP\RVLV ZLWK RU ZLWKRXW XWHULQH OHLRP\RPDWD UHVXOWVRIV\PSWRPFRQWURODQGKHDOWKUHODWHGTXDOLW\RIOLIHPRQWKVDIWHUWUHDWPHQW Cardiovasc Intervent Radiol 

 5 . &XQQLQJKDP 0 0 +RUURZ 5 - 6PLWK DQG - 6SULQJHU $GHQRP\RVLV $ 6RQRJUDSKLF'LDJQRVLVRadiographics 

-1DIWDOLQ:+RR11XQHV7+ROODQG'0DYUHORVDQG'-XUNRYLF$VVRFLDWLRQ EHWZHHQ XOWUDVRXQG IHDWXUHV RI DGHQRP\RVLV DQG VHYHULW\ RI PHQVWUXDO SDLQ Ultrasound Obstet Gynecol 

 79DQGHQ%RVFK0'XHKROP)3/HRQH/9DOHQWLQ&.5DVPXVVHQ$9RWLQR' 9DQ6FKRXEURHFN&/DQGROIR$-,QVWDOOH6*XHUULHUR&([DFRXVWRV6*RUGWV% %HQDFHUUDI7'·+RRJKH%'H0RRU+%UROPDQQ6*ROGVWHLQ((SVWHLQ7%RXUQHDQG '7LPPHUPDQ7HUPVGHÀQLWLRQVDQGPHDVXUHPHQWVWRGHVFULEHVRQRJUDSKLFIHDWXUHV RIP\RPHWULXPDQGXWHULQHPDVVHVDFRQVHQVXVRSLQLRQIURPWKH0RUSKRORJLFDO 8WHUXV6RQRJUDSKLF$VVHVVPHQW 086$ JURXSUltrasound Obstet Gynecol  

79DQGHQ%RVFK$0GH%UXLMQ5$GH/HHXZ0'XHKROP&([DFRXVWRV/ 9DOHQWLQ7%RXUQH'7LPPHUPDQDQG-$)+XLUQH$VRQRJUDSKLFFODVVLÀFDWLRQ DQGUHSRUWLQJV\VWHPIRUGLDJQRVLQJDGHQRP\RVLVUltrasound Obstet Gynecol   &$9DQGHUPHXOHQ/.MDHUJDDUG5DVPXVVHQ&7LPPHUPDQ'9DQGHQ%RVFK7 *XLGLQJKLVWRORJLFDODVVHVVPHQWRIXWHULQHOHVLRQVXVLQJ'LQYLWURXOWUDVRQRJUDSK\ DQGVWHUHRWD[LV/)DFWV9LHZV9LV2EJ\Q   '0DYUHORV7.+ROODQG22·'RQRYDQ0.KDOLO*3ORXPSLGLV'-XUNRYLFDQG< .KDODI7KHLPSDFWRIDGHQRP\RVLVRQWKHRXWFRPHRI,9)HPEU\RWUDQVIHUReprod Biomed Online  -1DIWDOLQ:+RR.3DWHPDQ'0DYUHORV;)RRDQG'-XUNRYLF,VDGHQRP\RVLV DVVRFLDWHGZLWKPHQRUUKDJLD"Hum Reprod 

Referenties

GERELATEERDE DOCUMENTEN

, FRQFOXGH WKDW KLJK EORRG SUHVVXUH LV QRW UHODWHG ZLWK H[FHVV PRUWDOLW\ DW DJH.  \HDUV DQG RYHU +LJK EORRG SUHVVXUH KDV D SUHVHUYDWLYH HIIHFW

80 procent gaat goed Aan de deelnemers aan de ronde tafel is gevraagd naar het percen- tage collega’s dat niet meewerkt aan het invoeren van arbomaatre- gelen op basis van

SURFHGXUH DQG DW  \HDUV· IROORZXS WKH DOOFDXVH PRUWDOLW\ DQG KRVSLWDOL]DWLRQV IRU. +) ZHUH UHFRUGHG )LQDOO\ EDVHOLQH DQG  PRQWKV· IROORZXS FKDQJHV

VS was also not correlated with VSHHFKUHFRJQLWLRQVFRUHV7KLVFRUUHVSRQGVWRÀQGLQJVRIIRULQVWDQFH+H\GHEUDQGHWDO

7KH VHFRQG ZD\ WR DYRLG RYHUJHQHUDOL]LQJ LV WR EH FRQVHUYDWLYH ,I WZR IRUPV RFFXU IUHTXHQWO\ ZLWKLQ  ZRUGV RI HDFK RWKHU WKHUH PD\ EH PDQ\ H[SODQDWLRQV IRU WKLV VLWXDWLRQ ZKLFK

 DWDERYHFKDQFHOHYHOIRUGLFWDWHGZRUGVVKRZLQJWKDWWKHWDVNRIZULWLQJODEHOV

GHYHORSPHQWRIYHQRXVWKURPERHPEROLVP 97( LQ  36GHILFLHQF\KDVEHHQZHOO HVWDEOLVKHGDVDULVNIDFWRUIRU 97(VLQFHWKHQ  36LVDYLWDPLQ

:K\GLGKRXVHKROGVLQ0XSIXUXG]LUHFHLYHOHVVIRRGDLGFRPSDUHGWRKRXVHKROGVLQ 0XWDQGD" 7KH\ IDFHG VLPLODU SURGXFWLRQ GHILFLWV DQG DOVR DSSOLHG IRU VLPLODU TXDQWLWLHV RI IRRG DLG 7KH