宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效观察

Clinical study of different forms of hystero scopic surgery for endometrial polyps

目的探讨宫腔镜下不同手术方式治疗子宫内膜息肉的疗效.方法对不同年龄和不同生育要求的子宫内膜息肉患者327例,分别行子宫内膜息肉切除＋子宫内膜汽化电切术（A组,53例）;子宫内膜息肉切除＋子宫内膜电切术（B组,175例）;子宫内膜息肉切除＋息肉旁浅层内膜切除术（C组,54例,要求保留生育功能者）;子宫内膜息肉切除＋子宫内膜电凝术（D组,45例,绝经后患者）.结果手术时间：A组（15.1±0.8）s, B组（19.7±0.7） s,C组（20.9±0.7） s,D组（22.1±0.8） s,A组平均手术时间与其他3组比较,差异有统计学意义（P〈0.01）;术后子宫内膜息肉复发率：A、D组为0,B组为1.7%（3/175）,C组为7.4%（4/54）,C组术后复发率与其他3组分别比较,差异均有统计学意义（P〈0.05）;C组术后无闭经者,但术后息肉复发率高于其他3组,C组中有14例术后5～23个月妊娠.结论宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效无明显差异,但子宫内膜息肉切除＋息肉旁浅层内膜切除术后复发率高;应根据患者年龄、生育要求等选择适宜的宫腔镜下手术方式.

Objective To investigate the curative effects of different types of hysteroseopic surgery for endometrial polyps. Methods A total of 327 cases by different ways of hysteroscopic surgery for endometrial polyps from Nov 1999 to Nov 2004 were followed up. The mean age was （40±61） years. The mean follow-up was （ 3.0±0. 6） years. Among 228 polyps patients in sexual maturity without desire of maintaining fertility, 53 （group A） underwent polypectomy with electrosurgical vaporization, and 175 cases （group B） did polypectomy with endometrial resection. Fifty-four （group C） cases （19 cases of infertility）, who desired future childbearing, did polypectomy with endometrial resection of superficial layer near the polyps. Forty-five postmenopausal patients（group D） did polypectomy with endometrial coagulation. Results The time of operation： group A （ 15.1±0. 8） second, group B （ 19. 7± 0. 7） second, group C （20. 9±0. 7 ） second, and group D （22. 1± 0. 8） second. None of polyps recurred for the patients of groups A and D after operation, and the recurrent rate of groups B and C was 1.7% and 7.4%. There were no cases with amenorrhea in group C, who hoped to keep the function of fertility, but the recurrent rate of polyps was higher than other three groups. Of 19 cases of infertility, 14 cases became pregnant after the surgery. Conclusion It is feasible to select different hysteroscopic surgery tor endometrial polyps, according to different ages and the desire of childbearing of the patients.