子宫内膜息肉术后口服避孕药与放置左炔诺孕酮宫内缓释系统疗效比较

CLINICAL EFFECT OF ORAL CONTRACEPTIVE VERSUS PLACEMENT OF LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM AFTER SURGERY FOR ENDOMETRIAL POLYPS

目的比较宫腔镜下子宫内膜息肉切除术(TCRP)后放置左炔诺孕酮宫内缓释系统(曼月乐)与口服避孕药的临床效果。方法选择因为子宫内膜息肉行TCRP且术后病理证实为子宫内膜息肉病人229例,其中月经来潮第3~5天放置曼月乐的74例病人为曼月乐组,术后第2天开始服用口服避孕药的77例病人为避孕药组,术后未行特殊处理的78例病人为对照组。比较3组病人术前与术后3、6、12个月月经量、血红蛋白水平及复发、不良反应等情况。结果曼月乐组与避孕药组病人术后复发率均明显低于对照组(χ~2=8.13、15.64,P<0.05)。曼月乐组、避孕药组病人术后3、6、12个月月经量减少的构成比与对照组比较差异有显著性(χ~2=36.45~89.51,P<0.05)。术后12个月3组病人血红蛋白水平比较差异有显著性(F=6.62,P<0.05),且曼月乐组、避孕药组血红蛋白水平明显高于对照组(q=2.64、3.46,P<0.05)。曼月乐组不良反应少于避孕药组(χ~2=5.24,P<0.05)。结论TCRP后放置曼月乐与口服避孕药均可减少息肉复发,但放置曼月乐病人不良反应少,更具临床应用价值。

Objective To investigate the clinical effect of oral contraceptive versus placement of levonorgestrel-releasing intrauterine system（Mirena）after transcervical resection of polyp（TCRP）. Methods A total of 229 patients with endometrial polyps who underwent TCRP and had pathologically confirmed endometrial polyps were enrolled,and among these patients,74 underwent the placement of Mirena during 3-5 days of menstruation and were enrolled as Mirena group,77 started to take oral contraceptive since the second day after surgery and were enrolled as contraceptive group,and 78 were not given any special treatment after surgery and were enrolled as control group.The three groups were compared in terms of menstrual blood volume,hemoglobin level,recurrence,and adverse reactions before surgery and at 3,6,and 12 months after surgery. Results The Mirena group and the contraceptive group had a significantly lower postoperative recurrence rate than the control group（χ~2=8.13,15.64;P0.05）.At 3,6,and 12 months after surgery,there was a significant difference in the constituent ratio of the reduction in menstrual blood volume between the Mirena group/the contraceptive group and the control group（χ~2=36.45-89.51,P 0.05）.At 12 months after surgery,there was a significant difference in hemoglobin level between the three groups（F=6.62,P0.05）,and the Mirena group and the contraceptive group had a significantly higher hemoglobin level than the control group（q=2.644,3.46;P0.05）.The Mirena group had significantly fewer adverse reactions than the contraceptive group（χ~2=5.24,P0.05）. Conclusion Both the placement of Mirena and oral contraceptive can reduce the recurrence of polyps after TCRP,and the placement of Mirena has fewer adverse effects and a higher clinical value than oral contraceptive.