左炔诺孕酮宫内缓释系统和口服避孕药预防子宫内膜息肉术后复发的临床疗效比较

Comparison of the effect of levonorgestrel-releasing intrauterine system and oral contraceptive in preventing recurrence of endometrium polyps after hysteroscopic polypectomy

目的比较左炔诺孕酮宫内缓释系统（LNG-IUS）和121服避孕药预防子宫内膜息肉术后复发的临床疗效。方法选取2010年1月至2014年12月哈尔滨市第一医院收治的160例子宫内膜息肉手术切除患者，完全随机分为观察组与对照组，各80例。所有患者均行宫腔镜息肉电切除术，观察组术后月经来潮第3天放置LNG—IUS，对照组术后月经来潮第1天开始口服复方短效避孕药（炔雌醇30ug＋屈螺酮3mg），连服21d，周期服用，连续12个月经周期。术后3、6、12个月进行随访，比较2组患者子宫内膜息肉复发率、子宫内膜厚度、血红蛋白含量、月经情况（月经失血图评分）及不良反应发生情况。结果随访12个月后，观察组子宫内膜息肉复发率明显低于对照组[2．5％（2／80）比10．0％（8／80）]，差异有统计学意义（P〈0．05）。术前2组子宫内膜厚度比较，差异无统计学意义（P〉0．05）。术后3、6、12个月，观察组子宫内膜厚度均明显低于对照组[（0．48±0．12）cm比（0．58±0．08）em，（0．68±0．42）cm比（0．99±0．12）em，（0．784-0．12）em比（1．02±0．16）cm]，差异均有统计学意义（均P〈0．05）。2组患者术前血红蛋白水平及月经失血图评分比较，差异无统计学意义（P〉0．05），随访6个月后，2组患者血红蛋白水平均明显高于术前[对照组：（106±10）g／L比（97±5）g／L，观察组：（124±16）g／L比（97±5）g/L]，月经失血图评分均明显低于术前[对照组：（64±12）分比（125±21）分，观察组：（454-11）分比（123±22）分]，且观察组血红蛋白水平明显高于对照组，月经失血图评分明显低于对照组，差异均有统计学意义（均P〈0．05）。随访3个月时，观察组阴道点滴出血发生率明显高于对照组[50．0％（40／80）比20．O％（16／80）]，差异有统计学意义（P〈0．05）。随访12个月后，观察组与对照组阴道点滴出血发生率比较[6．2％（5／80）比7．5％（6／80）]，差异无统计学意义（P〉0．05）。对11例阴道点滴出血患者进行宫腔镜检查，子宫内膜均无异常。观察组未出现头晕、恶心、胃部不适等不良反应，对照组术后3个月出现头晕3例，恶心7例，12个月随访出现胃部不适2例。结论LNG．IUS在预防宫腔镜息肉电切除术后复发、降低子宫内膜增生厚度、改善月经情况和血红蛋白水平等方面，均优于口服避孕药，且不良反应少，创伤小。

Objective To compare the clinical effects of levonorgestrel-releasing intrauterine system （LNG-IUS） and oral contraceptive in preventing recurrence of endometrium polyps after hysteroscopic polypecto- my. Methods One hundred and sixty patients with endometrial polyp who underwent endometrial polyp curettage from January 2010 to December 2014 were randomly divided into observation group and control group （80 cases in each group）. After operation, LNG-IUS was used from the 3rd day after menstrual onset in observation group, and combined oral contraceptives （ethinylestradiol 30ug ＋ drospirenone 3 mg） were used from the 1 st day to the 21th day after menstrual onset in control group. The treatment lasted for 12 menstrual cycles. The patients were followed up 3, 6 and 12 months after operation. The recurrence rate, endometrial thickness, hemoglobin level, menstruation status [ pictorial blood assessment chart （PBAC） scores]and adverse reactions were compared between groups. Results The recurrence rate in observation group was significantly lower than that in control group 12 months after operation [2.5% （2/80） vs 10.0% （8/80） ] （P 〈0.05）. The endometrial thickness was not significantly different between groups before operation; 3, 6 and 12 months later, the endometrial thickness in observation group was significantly lower than that in control group [ （0.48 ± 0. 12） cm vs （0.58 ± 0.08 ） cm, （0.68± 0.42 ） cm vs （0.99 ±0.12） cm,（0.78 ±0. 12） cm vs （1.02 ±0.16） cm] （P 〈0. 05）. The hemoglobin level and PBAC score were not significantly different between groups before operation （P 〉 0. 05） ; 6 months after operation, the hemoglo- bin level was significantly increased and the PBAC score was significantly reduced compared with those before operation in both groups [ control group ： （ 106±10） g/L vs （97±5） g/L, （64 ± 12） scores vs （ 125± 21 ） scores; observation group （124±16） g/L vs （97 ±5） g/L, （45 ± 11） scores vs （123 ±22） scoresl, and they were significantly different between groups （P 〈 0.05）. After 3 months, the incidence of slight bleeding of vagina in observation group was significantly higher than that in control group [50.0% （40/80） vs 20.0% （16/80） ] （P 〈 0. 05）, but was not significantly different 12 months later [6. 2% （5/80） vs 7.5% （6/80） ] （P 〉0.05） ; all of the 11 cases with slight bleeding of vagina had normal endometrium confirmed by hysteroscopy. No adverse reactions occurred in observation group; 3 cases had dizziness and 7 cases had nausea 3 months after operation, 2 cases had stomach discomfort 12 months after operation. Conclusion LNG-IUS has better clinical effect than oral contraceptive in preventing polyp recurrence after endometrial polyp curettage, reducing endometrial thickness and improving hemoglobin level and menstruation, with less adverse effects.