子宫内膜息肉大小、数目及位置对术后自然妊娠率的影响分析

Analysis of the influence of size,number and location of endometrial polyps on natural pregnancy rate after operation

目的评估在持续性子宫内膜息肉合并不孕患者中,息肉大小、数目及位置等因素对术后自然妊娠率的影响。方法采用回顾性研究,收集2016年3月至2018年3月于我院妇产生殖中心就诊的持续性子宫内膜息肉合并不孕患者166例为研究对象,所有患者行宫腔镜子宫内膜息肉切除术,术后随访6~12个月,记录患者术前基本情况及术后自然妊娠情况,并分析息肉单复发情况、单发息肉大小、息肉位置及不孕类型对术后妊娠的影响。结果(1)所纳入研究对象中,单发息肉者106例,多发息肉者60例;按不同息肉数目分组中,单发息肉组术后自然妊娠率(28.30%)略低于多发息肉组(40.00%),但差异尚无统计学意义(P>0.05)。(2)单发息肉患者中,息肉大小≤1 cm的41例,息肉大小1~2 cm的47例,息肉≥2 cm的18例;按照不同息肉大小分组中,与<2 cm组比较,≥2 cm组术后自然妊娠率显著升高(P<0.05)。(3)按照不同息肉位置的分组中,息肉在输卵管开口部者术后自然妊娠率高于其他部位,与子宫前壁组比较,差异有统计学意义(P<0.05);且单发息肉多位于子宫后壁。(4)166例患者中,原发不孕82例,继发不孕84例;按照不孕类型分组中,原发不孕组和继发不孕组术后自然妊娠率比较差异无统计学意义(P>0.05)。结论持续性子宫内膜息肉合并不孕患者术后自然妊娠率与息肉大小、位置有关,尤其是与输卵管开口部位的息肉关系密切;而与息肉数目、不孕类型的关系并不明显。

Objective:To explore the effects of the size,number and location of polyps on the postoperative spontaneous pregnancy rates in patients with persistent endometrial polyps and infertility.Methods:A retrospective study was conducted on 166 patients with persistent endometrial polyps and infertility in the Maternity and Reproduction Center of our hospital from March 2016 to March 2018.All patients underwent transcervical resection of polyp(TCRP)and were followed for 6 to 12 months.The preoperative basic information and status postoperative spontaneous pregnancy of the patients were recorded,and the effects of polyp number,size,location and infertility type on postoperative spontaneous pregnancy rate were analyzed.Results:Among the patients included,106 had single polyps and 60 multiple polyps.According to the different number of polyps,the natural pregnancy rate(28.30%)in the patients with single polyp group was slightly lower than that in the polyp group(40.00%),but the difference was not statistically significant(P>0.05).Among the patients with single polyps,41 patients had polyp size≤1 cm,47 patients had polyp size 1 to 2 cm,and 18 patients had polyps≥2 cm.According to the different polyp size,the natural pregnancy rate of polyps≥2 cm group was significantly higher than that of polyps<2 cm group(P<0.05).According to the different location of polyp,the natural pregnancy rate of polyps in the uterotubal junction was higher than other locations,the difference was significant when compared with the anterior wall of the uterus(P<0.05);and single polyp mostly located in the posterior wall of uterus.Among 166 patients,82 were primary infertility and 84 were secondary infertility.According to the type of infertility,there was no significant difference in the natural pregnancy rate between the primary infertility group and the secondary infertility group(P>0.05).Conclusions:The postoperative spontaneous pregnancy rate in patients with persistent endometrial polyps and infertility is closely related to the size and location of polyps,especially the polyps located at the uterotubal junction,but it was no significantly related with the polyp number and infertility type.