To investigate the clinical features of abnormal uterine bleeding of non-pregnancy women with liver cirrhosis and analyze the therapeutic effect of hysteroscopy.

Data of 152 non-pregnant patients with abnormal uterine bleeding treated in the Department of Obstetrics and Gynecology of Beijing Ditan Hospital, Capital Medical University from February 11st, 2014 to December 20th, 2020 were analyzed, retrospectively. The 152 patients were divided into cirrhosis group (22 cases), chronic hepatitis B group (67 cases) and control group (63 cases) according to the patients’ medical history, symptoms, etiological examination of hepatitis B virus, liver function, coagulation function and ultrasonic diagnosis results. The general clinical data of the three groups (length of preoperative bleeding, preoperative bleeding volume, hospitalization duration, hemostasis duration, ratio of cases with blood transfusion and acute bleeding), laboratory examination results [fibrinogen (FIB), prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), hemoglobin (Hb) and platelets (PLT)], pathology analysis and treatment effective of the three groups were analyzed, respectively. Comparison of every two groups for length of preoperative bleeding, preoperative bleeding volume, hospitalization duration, hemostasis duration and results of laboratory test were performed by t-test or Mann-Whitney test, and comparison between multiple groups for the above indexes were performed by analysis of ANOVA or KW test; the ratio of patients with acute bleeding and total treatment efficiency were calculated by Pearson Chi-square test, continuous correction Chi-square test or Fisher’s exact probability test.

The length of preoperative bleeding, hospitalization duration, hemostasis duration, ratio of cases with blood transfusion and acute bleeding of cirrhosis group, chronic hepatitis B group and control group were significantly different (F = 9.34, P < 0.001; F = 7.54, P < 0.001; F = 7.64, P = 0.01; F = 5.67, P = 0.02; χ² = 8.64, P = 0.01; χ² = 5.75, P = 0.02), and the above indicators of patients in cirrhosis group were significantly higher than those of chronic hepatitis B group (t = 6.01, P = 0.02; t = 7.44, P = 0.01; t = 5.90, P = 0.02; t = 11.23, P < 0.001; χ² = 10.45、P < 0.001; χ² = 11.32, P < 0.001). The levels of FIB, PT, TT, APTT, Hb and PLT of patients in cirrhosis group, chronic hepatitis B group and control group were significantly different (F = 11.36, P < 0.001; F = 8.35, P < 0.001; F = 8.33, P = 0.01; F = 15.64, P < 0.001; F = 7.34, P = 0.01; F = 10.36, P < 0.001). The incidence of endometrial atypical hyperplasia and endometrial cancer of patients in cirrhosis group (13.64% and 9.09%), chronic hepatitis B group (2.99% and 1.49%) and control group (3.17% and 0.00%) were significantly different (χ² = 4.97, P = 0.02; χ² = 8.61, P = 0.01). Total efficiency of the three groups were 90.48%, 89.55% and 90.91%, with no significant difference (χ² = 1.21, P = 0.32); the recurrence rate of abnormal uterine bleeding were 22.72%, 20.89% and 7.94% of patients in cirrhosis group, chronic hepatitis B and control group, with significant difference (χ² = 7.45, P = 0.01). There were no complications during or after hysteroscopic hysterotomy among the patients of the three group.

Liver cirrhosis could aggravate the symptoms of abnormal uterine bleeding during non-pregnancy. Hysteroscopic electrosurgical treatment of abnormal uterine bleeding for women with non-pregnancy cirrhosis is safe and effective, but with a certain risk of recurrence.