宫腔镜剪刀切除术治疗子宫内膜息肉不孕的临床效果

Clinical effect of hysteroscopic scissors resection in the treatment of endometrial polyp infertility

目的探讨宫腔镜剪刀切除术治疗子宫内膜息肉不孕的临床效果。方法选取2016年1月~2017年6月我院收治的120例子宫内膜息肉不孕患者作为研究对象,按照随机数字表法将其分为观察组与对照组,每组各60例。对照组患者给予宫腔镜下刮宫术治疗,观察组患者则给予宫腔镜剪刀切除术治疗。记录两组患者的围术期指标(术中出血量、手术时间、住院时间),分别于术前及术后1、6、12个月采用月经失血图计算方法评估两组患者的月经量情况,并采用酶联免疫吸附法测定两组患者的血清血管内皮生长因子(VEGF)水平变化情况;术后随访12个月,统计两组患者的息肉复发率以及自然妊娠成功率。结果两组均顺利完成手术,手术成功率高达100.00%。两组患者的术中出血量、手术时间以及住院时间比较,差异无统计学意义(P>0.05);观察组患者的术后复发率为5.00%,明显低于对照组的25.00%,自然妊娠成功率为95.00%,明显高于对照组的70.00%,差异有统计学意义(P<0.05)。两组患者术前的月经量比较,差异无统计学意义(P>0.05);对照组患者术后1、6个月的月经量均少于术前,差异有统计学意义(P<0.05);对照组患者术后12个月的月经量与术前比较,差异无统计学意义(P>0.05);观察组患者术后1、6、12个月的月经量均明显少于术前及对照组,差异有统计学意义(P<0.05)。两组患者术前、术后1个月的血清VEGF水平比较,差异无统计学意义(P>0.05);术后1、6、12个月,两组患者的血清VEGF水平均明显低于术前,差异有统计学意义(P<0.05);观察组患者术后6、12个月的血清VEGF水平均明显低于对照组,差异有统计学意义(P<0.05)。结论相较于宫腔镜刮宫术,宫腔镜剪刀切除术治疗子宫内膜息肉不孕的效果更理想,术后自然妊娠率更高、复发率更低,其机制可能与显著下调子宫内膜组织VEGF的表达有关。

Objective To investigate the clinical effect of hysteroscopic scissors resection in the treatment of endometrial polyp infertility.Methods A total of 120 cases of patients with endometrial polyp infertility who were treated in our hospital from January 2016 to June 2017 were selected as subjects.According to the random number table method,they were divided into observation group and control group,60 cases in each group.The control group was treated with hysteroscopic curettage and the observation group with hysteroscopic scissors resection.Perioperative indexes (the amount of intraoperative blood loss,operation time,hospital stay) were recorded in both groups.The menstrual blood loss map was used to evaluate the menstrual flow of the two groups before surgery and 1,6 and 12 months after surgery.The enzyme-linked immunosorbent assay was used to determine the levels of serum vascular endothelial growth factor (VEGF) in the two groups.After 12 months of follow-up,the polyp recurrence rate and the success rate of natural pregnancy were compared between the two groups.Results Both groups successfully completed the operation,and the success rate of the operation was as high as 100.00%.There were no significant differences in the amount of intraoperative blood loss,operation time and hospital stay between the two groups (P>0.05).The postoperative recurrence rate in the observation group was 5.00%,which was significantly lower than that in the control group (25.00%),and the success rate of natural pregnancy was 95.00%,which was significantly higher than that in the control group (70.00%),with statistically significant differences (P<0.05).There was no significant difference in the amount of menstrual flow between the two groups before surgery (P>0.05).The menstrual volume of the control group at 1 and 6 months after surgery was less than that before surgery,and the difference was statistically significant (P<0.05).There was no significant difference in the amount of menstrual flow in the control group between the 12 months after surgery and before surgery (P>0.05).The amount of menstrual flow in the observation group at 1,6,and 12 months after surgery was significantly less than that before surgery and in the control group,and the differences were statistically significant (P<0.05).There were no significant differences in serum VEGF levels between the two groups before surgery and 1 month after surgery (P>0.05).At 1,6,and 12 months after surgery,serum VEGF levels in the two groups were significantly lower than those before surgery,and the differences were statistically significant (P<0.05).The serum VEGF levels in the observation group at 6 and 12 months after surgery were significantly lower than those in the control group,and the differences were statistically significant (P<0.05).Conclusion Compared with hysteroscopic curettage,hysteroscopic scissors resection is more effective in the treatment of endometrial polyp infertility.The postoperative natural pregnancy rate is higher and the recurrence rate is lower.The mechanism may be related to a significant down-regulation of VEGF expression in endometrial tissues.