宫腔镜治疗子宫内膜息肉的手术体会

Hysteroscopic surgical treatment for endometrial polyps

目的探讨宫腔镜治疗子宫内膜息肉的方法和效果。方法收集2008年10月至2012年3月在江苏省扬州市妇幼保健院宫腔镜下诊断为子宫内膜息肉的病例共123例,根据病史、宫腔镜检查结果及患者是否有生育要求分别行宫腔镜定位下息肉摘除术(组)、电切术(组)和吸刮后电切术(组),观察随访3组患者的术中术后情况。结果 123例患者均顺利完成手术,无术后感染、大出血及子宫穿孔发生。3组病例术中出血量比较无统计学差异;平均手术时间吸刮后电切术组最长,有统计学意义(F=109.89,P<0.05);术后随访一年,异常子宫出血患者症状改善率吸刮后电切术组最高(x^2=65.45,P<0.05),合并不育患者的妊娠率息肉摘除术组最高(x^2=65.45,P<0.05),3种手术方式中摘除术组复发率最高(x^2=3.48,P<0.05),均有统计学意义。结论宫腔镜下治疗子宫内膜息肉的3种手术方式均切实可行,而对不同症状、不同年龄、不同生育要求的患者选择不同手术方式进行治疗,是手术成功的关键。

Objective To explore the methods and efficacy of hysteroscopic surgical treatment for endometrial polyps .Methods Totally 123 patients were diagnosed with endometrial polyps under hysteroscopy in Yangzhou Municipal Maternal and Child Health Hospital from October 2008 to March 2012.Hysteroscopic localization （ hysteroscopic localization group ）, electrocision （ electrocision group ） or electrocision after suction and curettage （ electrocision after suction and curettage group ） was performed according to patients ＇ medical history, hysteroscopic examination and fertility requirements .The intraoperative and postoperative conditions of the patients were followed up.Results All of 123 patients underwent surgery successfully .No complication , hemorrhage or uterine perforation occurred after operation.Intraoperative blood loss of three groups was not significantly different .However, the mean operative time for electrocision after suction and curettage group was longest in three groups （F=109.89,P〈0.05）, and the improvement rate of abnormal uterine hemorrhage in patients undergoing electrocision after suction and curettage was highest （χ^2 =65.45,P〈0.05） after one year follow-up.The highest pregnant rate was found in infertile patients undergoing hysteroscopic localization （χ^2 =65.45, P 〈0.05 ）.The recurrence rate in hysteroscopic localization group was highest among three groups （χ^2 =3.48,P〈0.05）.There were statistically significant differences . Conclusion All of the operational methods are effective .It is important to take different approach according to different symptoms , age or fertility requirments in the treatment of endometrial polyps .