3种不同宫腔镜手术方式治疗子宫内膜息肉的临床效果分析

Analysis on clinical effects of three different hysteroscopic methods in treatment of endometrial polyps

目的比较3种不同宫腔镜手术方式治疗子宫内膜息肉(EP)的临床疗效。方法回顾性分析2015年1月-2017年2月期间经宫腔镜检查或阴道超声诊断为子宫内膜息肉的患者135例,按年龄和生育要求随机分3组。A组:42例,行宫腔镜下子宫内膜息肉电切术;B组:47例,行宫腔镜下子宫内膜息肉电切+部分内膜电切术;C组:46例,行宫腔镜下子宫内膜切除术。术毕均放置T型环1枚,术后2月取出。术后随访1年,评价不同手术方式的治疗效果。结果135例患者均顺利完成手术,术后病理证实为子宫内膜息肉。3组的手术时间和术中出血量比较,差异有统计学意义(P<0.05)。术后6、12个月3组血红蛋白比较,差异有统计学意义(P<0.05)。随访12个月结束C组无复发,3组复发率差异有统计学意义(P<0.05)。3组月经症状的改善情况比较,差异有统计学意义(P<0.05)。结论宫腔镜子宫内膜切除术(包括部分切除)均可明显提高血红蛋白,改善月经症状,复发率低,对症状严重及无生育要求的患者尤为适合。

Objective To compare the clinical effects of three different hysteroscopic methods in treatment of endometrial polyps ( EP) .Methods From January 2015 to February 2017,135 patients diagnosed as endometrial polyps by hysteroscopy or vaginal ultrasonography were analyzed retrospectively,then they were randomly divided into three groups according to age and fertility,42 patients in group A were treated by hysteroscopic endometrium polyp electrotomy,47 patients in group B were treated by hysteroscopic endometrium polyp electrotomy and partial endometrial electrotomy,46 patients in group C were treated by hysteroscopic endometrial hysterectomy.After surgery,T ring was placed,then it was removed after 2 months.All the patients were followed up for one year after surgery,the curative effects in the three groups were evaluated.Results The operation was completed successfully in all the 135 patients,and all the patients were diagnosed as endometrial polyps definitely by postoperative pathological examination.There were statistically significant differences in operation time and the amount of intraoperative blood loss among the three groups ( P<0.05) .At 6 and 12 months after surgery,there were statistically significant differences in hemoglobin level among the three groups ( P<0.05) .After follow-up for 12 months,there was no recurrence in group C,there were statistically significant differences in the recurrence rate among the three groups ( P<0.05) .There were statistically significant differences in improvement of menstrual symptoms among the three groups ( P<0.05) .Conclusion Hysteroscopic endometrial hysterectomy ( including partial endometrial hysterectomy) can significantly improve hemoglobin level and menstrual symptoms with low recurrence rate,which is suitable for patients with severe symptoms and without fertility requirements.