宫腔镜手术治疗年轻、未育的子宫内膜增殖症临床分析

Analysis on the surgical and reproductive outcomes of endometrial hyperplasia with hysteroscopic surgery

目的研究宫腔镜手术治疗年轻、未育、刮宫和药物治疗效果不佳的子宫内膜增殖症的临床效果及生殖预后。方法 30例年轻、未育女性,经超声及宫腔镜检查+诊刮诊断为子宫内膜增殖症,在超声监护下行宫腔镜子宫内膜功能层电切术,保留基底层内膜。根据术后病理选择辅助药物治疗,随访治疗后月经改善情况、妊娠率、活产率。结果 30例患者,术前内膜诊刮对复杂型增生和非典型增生的漏诊率达50.0%。平均随访(31.7±11.0)个月,术后月经改善率为26.7%(8/30),24例有生育要求的患者中5例术后经常规促排卵治疗妊娠,1例行辅助生育获得妊娠,术后妊娠率及活产率均为25.0%(6/24)。结论宫腔镜手术切除功能层子宫内膜治疗药物及刮宫治疗效果不佳的子宫内膜增殖症,去除病灶后联合药物治疗,可改善月经情况,保留子宫,保留患者生育力。

[ Objective ] To analyze the surgical and reproductive outcomes of endometrial hyperplasia with hys- teroscopic functional resection of endometrium. [ Methods ] 30 young infertile women suffered from abnormal uterine bleeding were diagnosed as endometrial hyperplasia by ultrasonography and diagnostic hysteroseopy combined with D＆C, hysteroscopic endometrium resection were performed under the guidance of ultrasound to excise only function- al layer of endometrium, while leaving basal layer of endometrium in place, medical treatment was given according to postoperative endometrial pathology report. Menstrual condition, conception, and pregnancy outcome were followed up. [Results] Among the total 30 patients, preoperative D＆C failed to identify some cases of either endometriai complex hyperplasia or atypical hyperplasia,the rate of missed diagnosis was 50.0%. A normal amount of menstrua- tion was restored in 26.7% （8/30） patients. 24 patients who wished to conceive had6 successful conceptions with o- varian induction c^r IVF-ET （in vitro fertilization and embryo transfer）, the postoperative pregnancy rate and live birth rate was 25.0% （6/24）. [ Conclusion ] Young infertile women with endometrial hyperplasia failed with medical and D＆C treatment, can be treated by hysteroseopic functional endometrium resection combined with postoperative medical treatment, which have the benefits of improving menstruation, preserving the uterus successfully and improv- ing reproductive outcomes.