诊断性刮宫术后应用左炔诺孕酮宫内缓释系统预防子宫内膜息肉复发的疗效分析

Clinical analysis of Mirena insertion for preventing recurrence after diagnostic dilation and curettage in women with endometrial polyps

目的:探讨诊断性刮宫术后应用左炔诺孕酮宫内缓释系统—曼月乐宫内节育器预防子宫内膜息肉复发的疗效和安全性。方法:回顾性分析120例子宫内膜息肉患者临床及随访资料,所有患者均在B超的监护指引下行息肉刮除术,并于术后将患者随机分为两组,治疗组为术后宫腔内放置曼月乐宫内节育器,对照组术后宫腔内未放置曼月乐宫内节育器,分别于术后6、12、24个月进行随访,对比两组预防子宫内膜息肉复发等疗效。结果:120例患者手术均顺利完成,术后经病理检查确诊为子宫内膜息肉。置入曼月乐宫内节育器治疗后妇女血红蛋白水平显著增加,术后各个时间点子宫内膜厚度均小于放置前,复发率均显著低于对照组(P均<0.05)。在治疗和随访过程中无严重不良反应发生。结论:B超监护指引下行息肉刮除术后放置曼月乐宫内节育器是一种较好的保守治疗方法,适用于没有宫腔镜诊疗设备的基层医疗单位。

Objective： To explore the clinical effects and safety of being inserted intrauterine device （Mirena） for preventing recurrence after diagnostic dilation and curettage for endometrial polyps. Methods： The clinical and follow - up data of 120 women with endometrial polyps were retrospectively analyzed. The diagnostic dilation and curettage of endometrial polyp guided by ultrasound was conducted. Women were divided into two groups randomly, the treatment group for being inserted Mirena and the control group without intrauterine device. The therapeutic effects of intrauterine device on preventing recur- rence of endometrial polyps in different groups were compared during 6, 12 and 24 months follow - up. Results ： The operation was successfully completed for all the patients. The postoperative pathological result was the endometrial polyp. The hemoglo- bin level significantly increased after Mirena insertion in the treatment group. And when compared with the control group, the endometrial thickness was significantly thinner and recurrence rates were significantly lower at three follow - up visits in the treatment group （P all 〈 0.05）. No obvious adverse reaction was found. Conclusion ： The insertion of intrauterine device （Mirena） after diagnostic dilation and curettage guided by ultrasound is an effective conservative therapy for endometrial pol- yps. It is suitable for primary health care institutions and family planning service stations where are lacking in hysteroscopy.