宫腔镜息肉切除术联合不同术后治疗方案治疗子宫内膜息肉疗效观察

Effect of hysteroscopic polypectomy combined with different postoperative treatment on endometrial polyps

目的探讨宫腔镜息肉切除术联合左炔诺孕酮宫内节育系统、炔雌醇环丙孕酮片治疗子宫内膜息肉(EMP)的临床效果。方法选择2017年1月至2018年6月中国人民解放军东部战区总医院收治的180例EMP患者为研究对象,根据治疗方案将患者分为A组、B组和C组,每60例。A组患者给予宫腔镜息肉切除术,术后不予任何处理;B组患者给予宫腔镜息肉切除术联合左炔诺孕酮宫内节育系统治疗;C组患者给予宫腔镜息肉切除术联合左炔诺孕酮宫内节育系统、炔雌醇环丙孕酮片治疗。分别于术前及术后3、6、12个月进行阴道超声检查,检测子宫内膜厚度,采用月经失血图评估月经量;分别于术前及术后6、12个月检测患者血红蛋白水平;统计患者术后6、12个月EMP复发情况及阴道点滴出血情况。结果3组患者术前子宫内膜厚度比较差异无统计学意义(P>0.05),3组患者术后3、6、12个月子宫内膜厚度小于术前(P<0.05)。A组患者术后6、12个月子宫内膜厚度小于术后3个月(P<0.05),A组患者术后12个月与术后6个月子宫内膜厚度比较差异无统计学意义(P>0.05)。B组和C组术后6、12个月子宫内膜厚度小于术后3个月,术后12个月子宫内膜厚度小于术后6个月(P<0.05)。3组患者术后3个月子宫内膜厚度比较差异无统计学意义(P>0.05);术后6、12个月,B组和C组患者子宫内膜厚度小于A组(P<0.05);术后6个月,B组与C组患者子宫内膜厚度比较差异无统计学意义(P>0.05);术后12个月,C组患者子宫内膜厚度小于B组(P<0.05)。3组患者术前血红蛋白水平比较差异无统计学意义(P>0.05);3组患者术后6、12个月血红蛋白水平高于术前,术后12个月血红蛋白水平高于术后6个月(P<0.05);术后6、12个月,B组、C组患者血红蛋白水平高于A组,C组患者血红蛋白水平高于B组(P<0.05)。3组患者术前月经量比较差异无统计学意义(P>0.05),3组患者术后3、6、12个月月经量少于术前(P<0.05);A组患者术后3、6、12个月月经量比较差异无统计学意义(P>0.05);B组和C组患者术后6个月月经量少于术后3个月,术后12个月月经量少于术后6个月(P<0.05);术后3、6个月,B组和C组患者月经量少于A组,C组患者月经量少于B组(P<0.05);术后12个月,B组和C组患者月经量少于A组(P<0.05),但B组与C组患者月经量比较差异无统计学意义(P>0.05)。术后6、12个月,B组和C组患者阴道点滴出血率、EMP复发率显著低于A组(P<0.05),B组与C组患者EMP复发率比较差异无统计学意义(P>0.05);术后6个月,C组患者阴道点滴出血率低于B组(P<0.05);术后12个月,B组与C组患者阴道点滴出血率比较差异无统计学意义(P>0.05)。结论EMP患者行宫腔镜息肉切除术后予以宫腔内放置左炔诺孕酮宫内节育系统可以显著提升治疗效果,不仅可使子宫内膜明显变薄、经量明显减少,还可降低EMP复发率等的发生率;在此基础上联合口服炔雌醇环丙孕酮片则可以进一步提升疗效,降低术后早期阴道点滴出血的发生。

Objective To investigate the clinical effect of hysteroscopic polypectomy combined with levonorgestrel intrauterine system and ethinylestradiol and cyproterone acetate tablets in the treatment of endometrial polyps(EMP).Methods A total of 180 patients with EMP admitted to the General Hospital of the Eastern Theater of the Chinese People′s Liberation Army from January 2017 to June 2018 were selected as the research subjects.All the patients were divided into group A,group B and group C according to the treatment plan,with 60 patients in each group.The patients in group A were treated with hysteroscopic polypectomy without any postoperative treatment,the patients in group B were treated with hysteroscopic polypectomy combined with levonorgestrel intrauterine system,and the patients in group C were treated with hysteroscopic polypectomy combined with levonorgestrel intrauterine system and ethinylestradiol and cyproterone acetate tablets.Before and 3,6,12 months after operation,transvaginal ultrasound was performed to detect the thickness of endometrium,and the menstrual blood volume was assessed by pictorial blood loss assessment chart.The hemoglobin level was detected before and 6 and 12 months after operation.The recurrence of EMP and vaginal spotting were recorded at 6 and 12 months after operation.Results There was no significant difference in the endometrial thickness among the three groups before operation(P>0.05).The endometrial thickness at 3,6 and 12 months after operation was less than that before operation in the three groups(P<0.05).In group A,the endometrial thickness at 6 and 12 months after operation was less than that at 3 months after operation(P<0.05),but there was no significant difference in endometrial thickness between 12 months and 6 months after operation(P>0.05).In group B and group C,the endometrial thickness at 6 and 12 months after operation was less than that at 3 months after operation,and the endometrial thickness at 12 months after operation was less than that at 6 months after operation(P<0.05).There was no significant difference in endometrial thickness among the three groups at 3 months after operation(P>0.05).The endometrial thickness in group B and group C was less than that in group A at 6 and 12 months after operation(P<0.05).There was no significant difference in endometrial thickness between group B and group C at 6 months after operation(P>0.05).The endometrial thickness in group C was less than that in group B at 12 months after operation(P<0.05).There was no significant difference in hemoglobin level among the three groups before operation(P>0.05).The hemoglobin level at 6 and 12 months after operation was higher than that before operation in the three groups,and the hemoglobin level at 12 months after operation was higher than that at 6 months after operation(P<0.05).At 6 and 12 months after operation,the hemoglobin level in group B and C was higher than that in group A,and it in group C was higher than that in group B(P<0.05).There was no significant difference in menstrual blood volume among the three groups before operation(P>0.05).The menstrual blood volume at 3,6 and 12 months after operation was less than that before operation in the three groups(P<0.05).There was no significant difference in menstrual blood volume at 3,6 and 12 months after operation in group A(P>0.05).In group B and C,the menstrual blood volume at 6 months after operation was less than that at 3 months after operation,and the menstrual blood volume at 12 months after operation was less than that at 6 months after operation(P<0.05).At 3 and 6 months after operation,the menstrual blood volume in group B and C was less than that in group A,and it in group C was less than that in group B(P<0.05).At 12 months after operation,the menstrual blood volume in group B and C was less than that in group A(P<0.05),but there was no significant difference in menstrual blood volume between group B and group C(P>0.05).At 6 and 12 months after operation,the rates of vaginal spotting and EMP recurrence in group B and C were significantly lower than that in group A(P<0.05),but there was no significant difference in the rates of vaginal spotting and EMP recurrence between group B and group C(P>0.05).The rate of vaginal spotting in group C was lower than that in group B at 6 months after operation(P<0.05).There was no significant difference in the rate of vaginal spotting between group B and group C at 12 months after operation(P>0.05).Conclusion Levonorgestrel intrauterine system can significantly improve the treatment effect of EMP patients after hysteroscopic polypectomy,it not only can significantly reduce the endometrium thinner and menstrual blood volume,but also can decrease the recurrence rate of EMP.On this basis,ethinylestradiol and cyproterone acetate tablet can further improve the efficacy and reduce the early rate of postoperative vaginal spotting.