宫腔镜切除术治疗子宫内膜息肉的效果及影响术后自然妊娠状态的因素分析

The Effect of Hysteroscopic Resection Endometrial Polyp and the Influence Factors of Natural Gestation after Surgery

目的:探讨宫腔镜切除子宫内膜息肉(endometrial polyp,EP)的疗效及影响术后自然妊娠状态的因素。方法:选取2013年2月—2014年11月在天津市咸水沽医院妇产科宫腔镜电切治疗的60例EP合并不孕患者为研究对象。术后3、6、18个月随访患者的阴道不规则出血、EP复发率、自然妊娠率,并分析影响患者术后自然妊娠的因素。结果:术后阴道不规则出血发生率为3.33%,EP复发率为1.67%。术后3个月累积自然妊娠率为28.33%,术后6个月累积自然妊娠率为50%,术后18个月累积自然妊娠率为65.00%。单因素分析结果显示,不同年龄EP患者宫腔镜术后自然妊娠率差异有统计学意义(P<0.01);不同不孕年限、不孕类型及息肉大小的EP患者宫腔镜术后自然妊娠率比较差异无统计学意义(P>0.05)。多因素分析显示,年龄>30岁是EP患者宫腔镜切除术后自然妊娠率的影响因素(OR=11.00,95%CI:4.108~29.454,P=0.000);原发性不孕、不孕年限>3年、息肉>1 cm或多发则不是EP患者术后自然妊娠率的影响因素(P>0.05)。结论:对于EP合并不孕的患者,宫腔镜治疗具有良好的治疗效果,且患者年龄越小术后自然妊娠的成功率越高。

Objective:To explore the effect of transcervical resection by hysteroscopy in the management of endometrial polyps and influencing factors in pregnancy.Methods:Sixty infertile patients due to endometrial polyps treated in our hospital from February2013to November2014were collected as research object.All patients were treated with hysteroscopic resection.3months,6months and18months of follow-up were made.The incidence rates of abnormal vaginal bleeding,recurrence rates,and spontaneous pregnancy rates were counted.Influence factors in spontaneous pregnancy rate of patients with endometrial polyps underwent transcervical resection were analyzed.Results:After surgery,the incidence rate of abnormal vaginal bleeding was3.33%.The recurrence rate was1.67%.Three months after surgery,the accumulated spontaneous pregnancy rate was28.33%.Six months after surgery,the accumulated spontaneous pregnancy rate was50.00%.Eighteen months after surgery,the accumulated spontaneous pregnancy rate was65.00%.Single factor analysis showed the difference of spontaneous pregnancy rate of patients underwent surgery between ages was statistically significant(P<0.01),the difference of spontaneous pregnancy rate of patients underwent surgery between duration of infertility,the kind of infertility,and polyp size were not statistically significant(P>0.05).Logistic regression analysis showed age>30was the influence factor in spontaneous pregnancy rate of patients with endometrial polyps underwent transcervical resection(OR=11.00,95%CI:4.108-29.454,P=0.000).However,primary infertility,duration of infertility>3years,polyp size>1cm or more polyps did not influence spontaneous pregnancy of patients underwent surgery(P>0.05).Conclusions:For infertile patients due to endometrial polyps,the hysteroscopic resection treatment had good therapeutic effect.The younger the age,the higher the spontaneous pregnancy rate after hysteroscopic surgery.