宫腔镜电切术联合LNG-IUS治疗子宫内膜息肉效果及炎症因子变化

Efficacy and the changes of the inflammatory cytokines of hysteroscopic electrotomy combined with LNG-IUS for treating endometrial polyps

目的:探究宫腔镜电切术联合左炔孕酮宫内节育系统(LNG-IUS)治疗子宫内膜息肉的疗效。方法:选取2014年1月-2016年12月本院收治的子宫内膜息肉患者178例,随机数字表法分为观察组和对照组各89例。所有患者均实施宫腔镜电切术,术后对照组给予常规药物治疗及护理,观察组在对照组治疗基础上于术后第一次月经来潮时置入LNG-IUS。术后随访2年,比较治疗后血清炎症因子水平、子宫内膜厚度、月经量以及随访期间复发率和盆腔炎发生率。结果:术后3、6个月时观察组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和C-反应蛋白(CRP)水平均低于对照组,白细胞介素-4(IL-4)水平高于对照组(P均<0.05)。术后6、12个月时观察组子宫内膜厚度(7.9±1.2mm、5.6±0.9mm)和月经量(78.3±16.4ml、52.5±11.0ml)均低于对照组(P均<0.05)。随访期间,观察组内膜息肉复发率(5.6%)低于对照组(19.1%),盆腔炎发生率(3.4%)低于对照组(10.1%)(P均<0.05)。结论:宫腔镜电切术联用LNG-IUS可显著提高子宫内膜息肉治疗效果,降低复发率,其机制可能与抑制炎症反应有关。

Objective:To explore the efficacy of hysteroscopic electrotomy combined with levonorgestrel-releasing intrauterine system(LNG-IUS)for treating endometrial polyps.Methods:178 women with endometrial polyps were included and divided into observation group and control group(89 cases in each group)according to random number table method from January 2014 to December 2016,and all women had undergone hysteroscopic electrotomy.The women in the control group had received routine medication and nursing after operation,and the women in the observation group had received LNG-IUS inserted additionally when their first menstrual recovery after operation.After 2 years of followed up,the levels of serum inflammatory factors,endometrial thickness,menstrual volume,recurrence rate,and incidence of pelvic inflammation of women were compared between the two groups.Results:3 and 6 months after operation,the levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)levels of women in the observation group were significant lower than those of women in the control group,but the level of interleukin-4(IL-4)of women in the observation group was significant higher(all P<0.05).3 and 6 months after operation,the endometrial thickness of women in the observation group were 7.9±1.2mm and 5.6±0.9mm,and the menstrual volume of women in the observation group were 78.3±16.4ml and 52.5±11.0ml,which were all significant lower than those of women in the control group(all P<0.05).During followed up,the recurrence rate of endometrial polyp and the incidence of pelvic inflammatory disease of women in the observation group were 5.6%and 3.4%,which were significant lower than those(19.1%and 10.1%)of women in the control group(all P<0.05).Conclusion:Hysteroscopic electrotomy combined with LNG-IUS for treating women with endometrial polyps can significantly improve the curative effect and reduce the recurrence rate,which’s mechanism may be related to inhibit inflammatory reaction.