宫腔镜下电切术治疗子宫内膜息肉的疗效分析

The clinical effect of hysteroscopic electrocision in treating endometrial polyps

目的探讨3种不同宫腔镜电切术治疗子宫内膜息肉(endometrial polyps,EMP)的临床疗效和复发率。方法回顾性分析2015~2016年143例在广安市人民医院进行宫腔镜电切术治疗的EMP患者的临床资料,根据年龄和生育要求,分为宫腔镜子宫内膜息肉电切术(transcervical resection of endometrial polyps,TCRP)组(63例),TCRP+部分宫腔镜子宫内膜电切术(transcervical resection of endometrium,TCRE)组(49例)和TCRP+宫腔镜下滚球电极电凝去内膜术(roller-boll endometrial ablation,REA)组(31例)。随访1~12个月,详细记录患者月经情况,复发情况以及妊娠情况。结果与其他两组比较,TCRP组患者手术时间最短,术中失血量最少(P<0.05);所有患者顺利完成手术,术中未发生严重并发症。术后,TCRP组2例患者出现轻度头晕,其余两组各有1例患者发生一过性体温升高;99例月经紊乱患者术后月经情况得到显著改善;术后复查结果显示,3组患者术后症状改善率均较高,差异无统计学意义(P>0.05)。TCRP组有3例(4.76%)患者复发;TCRP+部分TCRE组有1例患者复发,而TCRP+REA组无患者复发。术前,TCRP组有13例有生育要求的患者不孕,随访1年,有7例患者自然受孕,妊娠率为53.85%;另外两组患者无妊娠。结论宫腔镜电切术可有效改善EMP患者的临床症状,复发率低,应根据患者病情和治疗要求,选择个体化电切术方案。

Objective To investigate the clinical effect and recurrence rate of hysteroscopic electrocision in the treatment of endometrial polyps （EMP）. Methods Data of 143 patients with EMP treated by hysteroscopic surgery in Guang＇ an People＇ s Hospital were retrospectively analyzed. According to the ages and fertility requirements, all patients were divided into three groups： 63 patients with transcervical resection of endometrial polyps （TCRP）, 49 patients with TCRP ＋ partial transcervical resection of endometrium （TCRE）, and 31 patients with TCRP ＋ roller - boll endometrial ablation（REA）. By followed up for 1 ~ 12 months, the menstrual conditions, recurrence and gestation of patients were observed. Results The mean operation time of patients in the TCRP group was shorter, and also with less blood loss in the surgery than the other two groups （ P 〈 0. 05 ）. All surgeries of patients were successfully completed without any surgical complications. After surgery, there were 2 cases in the TCRP group with postoperative mild dizziness;respectively 1 case with transient fever in TCRP ＋ partial TCRE group and TCRP ＋ REA group. Besides, the menstrual conditions of 99 patients with paramenia were improved. As a result of re - examination, the improvement rate of EMP patients with the clinical symptoms was relatively better. And after followed up for 1 - 12 months, there were 3 recurrences in the TCRP group and 1 recurrence in the TCRP ＋ partial TCRE group. There were 13 patients with infertility in the TCRP group before treatment, of whom there were 7 cases（53.85 % ） with intrauterine pregnancy within 1 year. There were no pregnancy in the other two groups. Conclusion The application of hysteroscopic electrocision in the treatment of endometrial polyps could effectively improve the clinical symptoms mad decrease recurrence. According to the treatment requirements of various patients, the individual hysteroscopic electrocision plan should be selected, which would be recommended for the clinical used as an effective choice.