宫腔镜联合负压吸刮治疗子宫内膜息肉后妊娠分析

Pregnancy status after treatment of endometrial polyps with hysteroscopic negative pressure suction and curettage

目的分析经宫腔镜子宫内膜息肉电切术联合宫腔负压吸刮术治疗不孕症妇女子宫内膜息肉的有效性和安全性。方法回顾性分析空军军医大学唐都医院生殖医学中心病区2015年9至12月收治的拟行体外授精-胚胎移植(IVF-ET)助孕治疗,助孕前检查发现多发性子宫内膜息肉患者共计67例,根据手术方式不同分为A组和B组,A组患者31例,行单纯经宫腔镜子宫内膜息肉电切术。B组患者36例,行经宫腔镜子宫内膜息肉电切术联合宫腔负压吸刮术。比较两组患者年龄,息肉平均大小;比较两组患者手术效果及术后并发症;比较两组患者术后排卵期内膜厚度;比较两组患者术后妊娠情况。结果两组患者年龄及息肉平均直径经统计学比较无差异,具有可比性。经比较,术后首次月经来潮后复查A组正常宫腔比例为54.84%,明显低于B组88.89%,而术后息肉复发比例(12.90%vs 2.78%)、创面未修复比例(19.35%vs 2.78%)、宫腔粘连比例(9.68%vs5.56%)及子宫内膜炎发生比例(3.23%vs 0)A组均高于B组,以上差异均具有统计学意义(χ~2=10.85,P=0.03),术后排卵期两组子宫内膜厚度A组为0.99±0.15cm,B组为0.98±0.15cm,差异无统计学意义(t=-0.47,P=0.64)。两组患者均行IVF-ET助孕。A组与B组患者术后临床妊娠率(51.61%vs 69.44%)、未妊娠率(38.71%vs 22.22%),生化妊娠率(0vs 5.56%),流产率(6.45%vs 0)及异位妊娠率(3.23%vs 2.78%),以上数据经分析无统计学意义(χ~2=6.44,P=0.17)。结论经宫腔镜子宫内膜息肉电切术联合宫腔负压吸刮术手术治疗效果好,虽术后妊娠率与传统的经宫腔镜子宫内膜息肉电切术无差异,但此术式术后并发症发生率低,术后恢复快,明显缩短不孕症患者的预处理周期,可视为治疗不孕症妇女多发性子宫内膜息肉的理想方法。

Objective To analyze the effectiveness and safety of hysteroscopic electrotomy of endometrium polyps combined with intrauterine negative pressure suction and curettage for the treatment of infertility women with endometrial polyps.Methods Sixtyseven cases of multiple endometrial polyps found in prepregnancy examination in women preparing to receive in vitro fertilization and embryo transfer（IVF-ET）in reproductive medicine center of Tangdu Hospital of the Fourth Military Medical University from September to December in 2015 were retrospectively analyzed.They were divided into group A and B based on different operation modes.Thirty-one patients in group A and were treated with sole hysteroscopic electrotomy of endometrium polyps,while 36 patients in group B were treated with hysteroscopic electrotomy of endometrium polyps combined with intrauterine negative pressure suction and curettage.Age,average size of endometrial polyps,operation effect and postoperative complications,endometrial thickness in post-operational oviposit period and pregnancy results were compared between two groups.Results Differences in age and average size of endometrial polyps in two groups were not statistically significant and were comparable.Postoperative reexaminations after first menstrual cramps revealed that normal uterine ratio in group A was 54.84%,which was significantly less than that in group B（88.89%）.Compared with group B,group A had higher post-operation polyp recurrence ratio（12.90% vs 2.78%）,unrepaired area ratio（19.35% vs 2.78%）,intrauterine adhesion ratio（9.68% vs 5.56%）and endometritis ratio（3.23% vs 0）,which had statistically significant differences（χ~2=10.85,P=0.03）.Endometrial thickness in post-operational oviposit period was 0.99±0.15 cm in group A and 0.98±0.15 cm in group B,respectively,which were not statistically different（t=-0.47,P =0.64）.Patients in both groups were assisted with IVF-ET reproduction.Post-operational clinic pregnancy ratios in group A and group B（51.61% vs 69.44%）,non pregnancy ratio in group A and B（38.71% vs 22.22%）,biochemical pregnancy ratio in group A and B（0 vs 5.56%）,abortion ratio in group A and B（6.45% vs 0%）and ectopic pregnancy ratio in group A and B（3.23% vs 2.78%）were not statistically different（χ~2=6.44,P =0.17）.Conclusion Hysteroscopic electrotomy of endometrium polyps combined with intrauterine negative pressure suction and curettage is an effective method for treatment of endometrial polyps in infertility women.Although pregnancy ratio under this combined method is not different from that under traditional hysteroscopic electrotomy of endometrium polyps,post-operational complication ratio is lower and the recovering process is faster under combined method than under traditional method.This combined method can obviously reduce pretreatment cycle of infertility women and be seen as an ideal method for treating multiple endometrial polyps in infertility women.