宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉疗效观察

Hysteroscopic electrotomy combined with levonorgestrel sustained-release intrauterine system in the treatment of endometrial polyps

目的探讨宫腔镜电切术联合左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫内膜息肉(EP)的疗效。方法选择2016年1月至2017年12月期间吴川市妇幼保健计划生育服务中心收治的90例EP患者作为研究对象,根据随机数表法将患者分为观察组和对照组,每组45例。对照组接受宫腔镜电切术治疗,观察组则于术后联合左炔诺孕酮宫内缓释系统治疗,随访24个月,分别在术前及术后6个月、12个月、24个月测定血红蛋白,采用月经失血图(PBAC)评分法评估月经失血量;超声测定子宫内膜厚度,记录复发及不良反应情况。结果观察组与对照组患者PBAC评分在术后6个月、12个月、24个月时分别为(45.20±10.73)分和(90.20±4.02)分、(37.46±9.61)分和(60.24±12.59)分、(30.45±13.60)分和(51.23±17.34)分,均明显低于术前的(179.52±40.21)分和(182.30±35.68)分,且观察组均明显低于对照组,差异均有统计学意义(P<0.05);上述时间点观察组与对照组血红蛋白水平分别为(93.19±3.69) g/L和(90.20±4.02) g/L、(102.37±4.31) g/L和(97.47±4.18) g/L、(117.05±5.61) g/L和(112.47±4.97) g/L,均明显高于术前的(86.56±3.36) g/L和(85.22±4.14) g/L,子宫内膜厚度分别为(0.58±0.15) cm和(0.69±0.17) cm、(0.82±0.20) cm和(0.98±0.18) cm、(1.12±0.27) cm和(1.24±0.11) cm,均明显低于术前的(1.51±0.21) cm和(1.59±0.39) cm,且观察组均明显优于对照组,差异均有统计学意义(P<0.05);观察组患者的复发率为6.67%,明显低于对照组的15.56%,差异有统计学意义(P<0.05);两组患者治疗期间均无严重不良反应发生,观察组患者有4例出现闭经。结论宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉可有效减少患者的月经量,提高血红蛋白水平,并且使患者的子宫内膜变薄,预防术后复发,临床治疗效果确切。

Objective To investigate the effect of hysteroscopic electrotomy combined with levonorgestrel sustained-release intrauterine system in the treatment of endometrial polyps. Methods A total of 90 patients with endometrial polyps, who admitted to Wuchuan Maternal and Child Health and Family Planning Service Center from January 2016 to December 2017, were selected as the study objects. According to random number table method, the patients were divided into the observation group(n=45) and the control group(n=45). The control group was treated by hysteroscopic electrotomy, and the observation group was treated with levonorgestrel sustained-release intrauterine system after operation, followed up for 24 months. Hemoglobin was measured before operation and 6 months, 12 months and 24 months after operation, and menstrual blood loss was assessed by pictorial blood loss assessment chart(PBAC) scoring method;endometrial thickness was measured by ultrasound, recurrence and adverse reactions were recorded. Results At 6, 12 and24 months after operation, PBAC score of the observation group and the control group were(45.20±10.73) points and(90.20±4.02) points,(37.46±9.61) points and(60.24±12.59) points,(30.45±13.60) points and(51.23±17.34) points, respectively, which were all significantly lower than the preoperative scores of(179.52±40.21) points and(182.30±35.68) points,and the scores in the observation group were significantly lower than those in the control group(all P<0.05);the hemoglobin of the observation group and the control group were(93.19±3.69) g/L and(90.20±4.02) g/L,(102.37±4.31) g/L and(97.47±4.18) g/L,(117.05±5.61) g/L and(112.47±4.97) g/L, respectively, which were significantly higher than the preoperative(86.56±3.36) g/L and(85.22±4.14) g/L;the thickness of endometrium was(0.58±0.15) cm and(0.69±0.17) cm,(0.82±0.20) cm and(0.98±0.18) cm,(1.12±0.27) cm and(1.24±0.11) cm, respectively, all of them were significantly lower than the preoperative(1.51±0.21) cm and(1.59±0.39) cm, and the indexes in the observation group was better than the control group, the differences were of statistically significant(all P<0.05);the recurrence rate in the observation group(6.67%)was significantly lower than that in the control group(15.56%), P<0.05. There were no serious adverse reactions in the two groups during the treatment, and there were 4 cases of amenorrhea in the observation group. Conclusion Hysteroscopic electrotomy combined with levonorgestrel sustained-release intrauterine system has a definite clinical effect in the treatment of endometrial polyps, which can effectively reduce the amount of menstruation, improve the level of hemoglobin,thin the endometrium and prevent recurrence, and the clinical treatment effect is accurate.