宫腔镜术后子宫内膜息肉复发的多因素分析

Multiplicity analysis on the recurrence of endometrial polyps after hysteroscopic surgery

目的探讨宫腔镜联合药物治疗子宫内膜息肉患者的复发因素。方法收集我院2006年10月至2008年10月经宫腔镜和病理诊断为子宫内膜息肉的患者168例,分为四组,A组:52例,为初发息肉,术后未用药;B组:36例,术后炔诺酮治疗3个月;C组:26例,为复发息肉,术后未用药;D组:54例,术后炔诺酮治疗3～6个月。比较四组术后复发率并用Logistic回归法分析与复发可能的相关因素。结果总复发率为11.3%。四组复发率差异具有统计学意义,B组复发率最低,C组复发率最高(P<0.05)。息肉多发、腺肌瘤型息肉、乳腺癌tamoxifen治疗病史和既往内膜息肉病史与高复发率有关,术后药物治疗和术后妊娠与低复发率有关。结论子宫内膜息肉患者行宫腔镜监测下诊刮或息肉摘除术,术后加用炔诺酮治疗及术后妊娠对降低复发率有重要作用,是经济有效的治疗方法,值得推广。

Objective To investigate prognostic factors for endometrial polyps recurrence after complete hysteroscopy excision of polyps combined with medical treatment.Methods 168 patients with endometrial polyps after hysterscopic excision were collected and divided into four groups：group A（52 cases） was primary polyps,which was not given any treatment after operation;group B（36 cases） was primary polyps,which was given norethisterone for 3 months after operation;group C（26 cases） was recurrence polyps,which was not given any treatment after operation;group D（54 cases） was recurrence polyps,which was given norethisterone for 3-6 months after operation.Logistic regression analysis was used to assess the factors on recurrence.Results The overall rate of recurrence was 11.3%.There was a significant difference among four groups（P〈0.05）,the recurrence of group B was the lowest and group C was the highest.Polyps number,polyps pathologic type,breast cancer patients with tamoxifen and previous polyps were independently associated with higher recurrence.Post-operative pregnancy and medical treatment were pr otective effcets.Conclusion Pregnancy and drugs have a protective effect on disease recurrence of endometrial polyps