宫腔镜在子宫内膜息肉诊治中的作用

Role of hysteroscopy in diagnosis and treatment of endometrial polyp

目的探讨宫腔镜在改善子宫内膜息肉(EMP)的检出率和摘除率中的作用.方法将2002年4～11月由A医生行宫腔镜检查发现的EMP患者59例随机分成两组,A组31例,由A医生行刮宫术后再用卵圆钳钳夹息肉;B组28例,由不知宫腔镜检查结果的B医生行刮宫术.随后由A医生再行宫腔镜检查并作出处理.结果取出的组织物中A组19例发现息肉,明显多于B组的9例(P＜0.05).第2次镜检见A组息肉完全摘除16例,B组5例,两者间差异有统计学意义(P＜0.01).38例残余息肉患者中29例即于镜下用活检钳自根部摘除,9例行宫腔镜电切术.59例均无发生并发症.结论当异常子宫出血、不孕、宫颈息肉、B超提示宫腔异常等应行宫腔镜检查,宫腔镜可明显提高EMP检出率.镜下定位后行全面刮宫及卵圆钳钳夹仍有息肉遗留时,宫腔镜直视下摘除息肉能达到完全清除的目的,预防息肉持续存在及复发.

Objective To explore the function of hysteroscopy in improving the detection and extraction of endom- etrial polyps（EMP）. Methods A total of 59 cases with EMP were randomly divided into Group A（n=31） and Group B （n=28）. Hysteroscopies were performed by Dr. A before and after curettage in all patients. In addition to curettages, the ovum forceps were used to extract EMP by Dr. A in Group A. In Group B, curettages were performed by Dr. B who did not know the results of hysteroscopy. Results Polyps were diagnosed by curettages and ovum forceps in 19 of 31 cases,which was significantly more than 9 of 28 cases （P〈0.05）. Polyps in 16 of 31 cases were extracted completely ,which was significantly more than 5 of 28 cases （P〈0.01）. In 38 cases remnant of ployps were extracted by hysteroscopy. Conclusion Hysteroscopy reveals polyp directly. With curettage and ovum forceps complete extraction of polyps is not achieved in a number of cases. Hysteroscopy-controlled extraction is superior, which avoides polyps continual existence and recurrence.