子宫内膜息肉宫腔镜电切术后不同干预措施对预后的影响

Effects of different strategy on the prognosis of endometrial polyps after hysteroscopic resection

目的分析子宫内膜息肉并发异常子宫出血的患者行宫腔镜电切术后四种不同干预措施对预后影响,探讨子宫内膜息肉手术后长期管理的有效方法。方法采用前瞻性研究方法将2015年6月~2018年6月因异常子宫出血经宫腔镜下行子宫内膜息肉电切术的311例病例按照患者知情选择分为A、B、C、D四组。A组99例患者手术后周期性口服地屈孕酮6个月;B组48例患者手术后放置左炔诺孕酮宫内释放系统(LNG-IUS);C组71例患者手术后周期性口服屈螺酮炔雌醇6个月;D组93例手术后不用孕激素治疗。随访四组手术后3个月、6个月和12个月月经情况和子宫内膜息肉复发情况。结果259例患者完成随访,A、B、C、D四组术后3个月、术后6个月和12个月发生异常子宫出血有差异,但组间比较差异无统计学意义(P>0.05);术后3个月和6个月子宫内膜息肉复发率组间比较差异无统计学意义(P>0.05);术后12月子宫内膜息肉复发率比较,B组与D组比较差异有统计学意义(P<0.05)。结论精准的宫腔镜手术对减少子宫内膜息肉术后复发和异常子宫出血的发生有重要意义,术后采取长期有效的管理措施是必要的,LNG-IUS是目前推荐的主要方法;短期口服孕激素或避孕药的方法对预防子宫内膜息肉术后复发和异常子宫出血的发生无明显优势,长期用药的获益需进一步研究。

Objective To analyze the effect of four different strategies on the prognosis of patients with endometrial polyps complicated with abnormal uterine bleeding after hysteroscopic resection,and to explore the effective methods of long-term management of endometrial polyps.Methods 311 cases of endometrial polyps caused by abnormal uterine bleeding and underwent hysteroscopic resection in our hospital from June 2015 to June 2018 were selected to conduct a prospective study.They were divided into four groups according to their choices.99 patients in group A received oral dydrogesterone for 6 months periodically;48 patients in group B received levenorgestrel intrauterine system(LNG-IUS);71 patients in group C received oral drospirenone and ethinylestradiol for 6 months;93 patients in group D did not receive progesterone.The menstruation and recurrence of endometrial polyps were followed up at 3,6 and 12 months after treatment.Results 259 patients were followed up.There was no significant difference in abnormal uterine bleeding 3 months,6 months and 12 months after treatment in group A,B,C and D(P>0.05);there was no significant difference in recurrence rate of endometrial polyps at 3 months and 6 months after treatment between groups(P>0.05);there was significant difference in recurrence rate of endometrial polyps at 12 months after treatment between group B and Group D,and the difference was statistically significant(P<0.05).Conclusion Precise hysteroscopic operation is of great significance to reduce the recurrence and abnormal uterine bleeding of endometrial polyps.It is necessary to take long-term and effective management measures after operation.LNG-IUS is the main recommended method at present.Short-term oral progesterone or contraceptive technique has no obvious advantage in preventing recurrence and abnormal uterine bleeding of endometrial polyps.The benefits of long-term medication need further study.