宫腔镜子宫内膜息肉切除术后口服避孕药或放置左炔诺孕酮宫内缓释系统对预防复发的作用

Efficacy of Oral Contraceptive or Levonorgestrel-releasing Intrauterine System after Hysteroscopic Endometrial Polypectomy in Preventing Recurrence

目的探讨子宫内膜息肉宫腔镜手术后口服避孕药或放置左炔诺孕酮宫内缓释系统(曼月乐)对预防复发的效果。方法 2009年1月～2011年10月门诊宫腔镜子宫内膜息肉切除术且病理证实为子宫内膜息肉116例,由患者知情选择术后处理方法。34例宫腔镜手术后1个月开始应用复方短效口服避孕药12个月(避孕药组),39例宫腔镜术后1个月放置曼月乐(曼月乐组),43例仅行宫腔镜手术切除息肉(对照组)。术后3、6、12个月随访,比较3组复发率,以及月经和血红蛋白情况。结果术后均完成12个月随访。复发率避孕药组2.9%(1/34),曼月乐组2.6%(1/39),对照组18.6%(8/43),3组间复发率差异有显著性(χ2=8.649,P=0.013),对照组复发率是另外2组的6倍。术后3、6、12个月避孕药组和曼月乐组月经量少的构成比均明显高于对照组(P=0.000)。术后12个月避孕药组和曼月乐组血红蛋白明显高于对照组(P<0.05)。结论宫腔镜术后应用复方短效口服避孕药或左炔诺孕酮宫内缓释系统可以降低子宫内膜息肉复发率,不良反应轻,创伤小,值得临床推广。

Objective To investigate the recurrence-prevention effect of oral contraceptive or levonorgestrel-releasing intrauterine system （Mirena） after hysteroscopic endometrial polypectomy. Methods Totally 116 patients, who received hysteroscopic endometrial polypectomy and were confirmed with endometrial polyp by postoperative pathological examination during January 2009 and October 2011 in our hospital, were enrolled into this study. The patients were divided into three groups： oral contraceptive group （n = 34） was given combined oral contraceptive since one month until 12 months after the operation; Mirena group （ n = 39 ） received levonorgestrel-releasing intrauterine system since one month after the operation ; and control group （ n = 43 ） received no treatment after hysteroscopic endometrial polypeetomy. The three groups were followed up at 3, 6, and 12 months after the procedure, and the recurrence rate, menstruation, and level of hemoglobin were compared among the groups. Results No patients were lost during a 12-month follow-up. The control group showed significantly higher recurrence rate, lower proportion of low menstruation volume and lower level of hemoglobin than the oral contraceptive and Mirena groups [ 18.6% （8/43） vs. 2.9% （1/34） and 2.6% （1/39） , X2 = 8. 649, P = 0. 013 ; P = 0. 000; and P 〈 0. 05, respectively ]. Conclusion Oral contraceptive or levonorgestrel-releasing intrauterine system after hysteroscopy for endometrial polyps significantly decreases recurrence rate and adverse reaction, and we recommend it to be widely used.