不同孕激素预防子宫内膜息肉术后复发的临床疗效

Effects of Dydrogesterone and Levonorgestrel on the Preventing Recurrence of Endometrium Polyps after Hysteroscopic Polypectomy

目的:观察口服孕激素和宫腔内放置左炔诺孕酮宫内缓释系统(LNG-IUS,商品名曼月乐)对预防子宫内膜息肉术后复发的临床疗效。方法:系统回顾对比研究73例子宫内膜息肉宫腔镜电切术后使用孕激素预防复发的患者,包括周期口服地屈孕酮片的对照组(40例)和宫内放置LNG-IUS的试验组(33例)。比较2组月经量、子宫内膜厚度改变、复发和不良反应情况。结果:2组患者治疗后月经量较术前均明显减少,子宫内膜明显变薄,试验组效果更显著(P=0.000)。随访6个月时试验组点滴出血发生率高于对照组(P=0.000),12个月时2组间差异无统计学意义(P=0.809)。对照组的不良反应发生率高于试验组。对照组有2例复发,试验组无复发。结论:孕激素治疗对预防子宫内膜息肉术后复发有效,LNG-IUS预防子宫内膜息肉术后复发使用方便、见效快,不良反应少。

Objective ：To compare the clinical effects of dydrogesterone and levonorgestrel intrauterine system on the prevention of endometrium polyps recurrence after hysteroscopic polypectomy. Methods：It was a retrospective study with 73 cases who treated with two progestin in preventing endometrium polyps recurrence after hysteroscopic resection. Those patients were divided into two groups. 33 cases in the test group were treated with LNG-IUS （Mirena）, and 40 patients in control group with cyclic dydrogesterone. The menstrual quantity, thickness of endometrium, recurrence rate, and adverse reactions were compared. Results：The endometrium thickness and menstrual quantity in both groups were significantly decreased after treatment within 6 months, while two values in the test group after treatment were significantly lower than those in the control group （P= 0.000）. The risk of dotted bleeding in the test group was significantly higher than that in the control group at 6 months （P=0.000）, but the difference was not significant between two groups at 12 months （P=0.809）. The incidence of nausea was lower in the group at any time after treatment. There were 2 cases relapsed in the control group, no one case recurred in the test group. Conclusions：Progestin therapy is safe and effective to prevent polyp recurrence. Compared with dydrogesterone, LNG-IUS can be encouraged with the more convenience, lower rate of recurrence, and lower risk of adverse effects.