宫腔镜手术分别联合屈螺酮炔雌醇片(Ⅱ)与LNG-IUS治疗子宫内膜息肉的疗效分析

Effective observation on hysteroscopic surgery combined with Drospiroone and Ethinylestradiol tablets Ⅱ and levonorgestrel intrauterine sustained release system in treatment of endometrial polyps

目的对比分析宫腔镜下子宫内膜息肉切除术分别联合屈螺酮炔雌醇片(Ⅱ)和左炔诺孕酮宫内缓释系统(levonorgestrel intrauterine sustained release system,LNG-IUS)的有效性及安全性,评估其在预防术后子宫内膜息肉复发的效果,为临床应用提供依据。方法对2018年5月—2020年5月间我院确诊的563例子宫内膜息肉病例进行回顾性研究,全部病例经宫腔镜下手术摘除子宫内膜息肉,包括182例(LNGIUS组)、203例(药物组)和178例(对照组),其中203例药物组接受屈螺酮炔雌醇片(Ⅱ)3个月的疗程。三组分别于术后3、6、12个月进行随访,对比不同干预措施在月经模式、预防息肉复发的疗效及不良反应发生的情况。结果所有患者的手术均顺利完成,术后经病理明确诊断为子宫内膜息肉。术后三组月经模式均较术前改善,经期时长缩短,血红蛋白水平上升,尤其是药物组与LNG-IUS组(P<0.05)。术后3月,三组均无息肉复发;但在术后6月、12月,药物组和LNG-IUS组息肉复发率明显低于对照组(P<0.05)。不良反应方面,药物组阴道点滴出血率低于LNG-IUS组和对照组(P<0.05),全程治疗和随访过程中,均未出现严重不良反应。结论宫腔镜分别联合应用屈螺酮炔雌醇和左炔诺孕酮宫内缓释系统,安全可行,能较好地防止息肉复发,且疗效相近。

Objective To compare the efficacy and safety of hysteroscopic endometrial polypectomy combined with Drospiroone and Ethinylestradiol tablets(Ⅱ)and levonorgestrel intrauterine sustained release system(LNG-IUS)in the treatment and prevention of postoperative polyp recurrence.Methods Clinical datas of 563 patients diagnosed with endometrial polyps in our hospital from May 2018 to May 2020 were retrospectively analyzed.All patients underwent hysteroscopic resection of the polyps,including 182 patients received treatment with levonorgestrel intrauterine sustained release system(LNG-IUS group),203 patients who received treatment with Drospirenone and Ethinylestradiol tablets(Ⅱ)(tablets group)and 178 cases with no tablets treatment(control group).Patients of the tablets group received Drospirenone and Ethinylestradiol tablets(Ⅱ)for 3 months,and the three groups were respectively followed up at 3,6 and 12 months after surgery.Compare the efficacy of different treatment groups in the menstrual pattern,preventing postoperative endometrial polyp recurrence and occurrence of adverse reactions.Results All patients were successfully operated,and endometrial polyp was diagnosed by pathological examination after operation.Postoperatively,the menstrual pattern was improved,the duration of menstruation was significantly reduced and the hemoglobin level was significantly increased in the three groups,especially in the tablets group and LNG-IUS group(P<0.05).3 months after surgery,no polyp recurrence was observed in any of the three groups.The recurrence rates of the tablets group and LNG-IUS group were significantly lower than that of the control group at 6 and 12 months after surgery(P<0.05).In terms of adverse reactions,the vaginal spotting rate in the tablets group was lower than the LNG-IUS group and control group(P<0.05),and no serious adverse reactions occurred during all the whole treatment and follow-up.Conclusion After hysteroscopic endometrial polyp resection,Drospiroone and Ethinylestradiol tabletsⅡand levonorgestrel intrauterine sustained release system can safely and effectively prevent the recurrence of polyps,and the effect is similar.