美奥舒宫腔镜组织切除系统与宫腔镜电切术治疗宫腔良性病变的临床疗效对比

Comparison of the Clinical Efficacy of Myosure Hysteroscopic Tissue Resection System and Hysteroscopic Electric Resection in the Treatment of Benign Uterine Lesions

目的比较宫腔镜组织切除系统(Myosure,美奥舒)与宫腔镜电切术治疗宫腔良性病变的效果。方法选择2016年2月至2019年3月在本院使用宫腔镜组织切除系统治疗的197例宫腔良性病变患者作为美奥舒组,选择同期我院行宫腔镜电切术治疗的215例宫腔良性病变患者作为电切组。采用客观评分量表评估其治疗效果。排除宫腔因素以外所致不孕不育的患者,评估两种治疗方式对患者的生殖预后情况。结果美奥舒组相较于电切组,在治疗0型、Ⅰ型黏膜下平滑肌瘤及子宫内膜息肉时可明显减少手术时间、膨宫液的用量以及反复插入宫腔次数;在治疗Ⅱ型黏膜下平滑肌瘤及子宫纵隔时,美奥舒组反复插入宫腔次数少于电切组,组间差异具有统计学意义(P<0.05),但两组膨宫液的用量及手术时间差异不大(P>0.05);在治疗宫腔粘连时,美奥舒组膨宫液的用量及反复插入宫腔次数少于电切组,组间差异具有统计学意义(P<0.05),但两组手术时间差异不大(P>0.05)。在治疗宫腔残留时,两组一般术中情况组间差异不具有统计学意义(P>0.05)。美奥舒组与电切组在治疗宫腔良性病变后,评估患者月经症状评分、肌瘤生活质量评分、肌瘤症状评分均有不同程度改善。电切组病理标本不满意度为5.52%,美奥舒组其病理标本不满意度为0,电切组术中与术后病灶体积差异具有统计学意义(P<0.05),美奥舒组术中与术后病灶体积差异无统计学意义(P>0.05)。美奥舒组手术并发症发生率为2.54%,低于电切组的8.84%,美奥舒组妊娠率为78.43%,高于电切组的53.33%,美奥舒胎盘异常率为5.00%,低于电切组37.50%,差异具有统计学意义(P<0.05)。结论宫腔镜组织切除系统治疗大部分宫腔良性病变具有手术时间、手术并发症少等优势,能够显著提高有妊娠需求患者的术后妊娠率,可减少妊娠期胎盘异常情况,从而改善患者的妊娠结局。

Objective To compare the effect of hysteroscopic tissue resection system(Myosure)and hysteroscopic electric resection in the treatment of benign lesions of uterine cavity.Methods The 197 patients with benign uterine cavity lesions treated with the hysteroscopic tissue resection system in our hospital from February 2016 to March 2019 were selected as the Myosure group,in the same period,215 patients with benign lesions of the uterine cavity who underwent hysteroscopic electric resection were selected as the electric resection group.The objective scoring scale was used to evaluate the treatment effect.Exclude patients with infertility caused by factors other than uterine cavity,and evaluate the reproductive prognosis of the two treatment methods.Results Compared with the electric resection group,the Myosure group can significantly reduce the operation time,the amount of dilatation fluid and the number of repeated insertions into the uterine cavity in the treatment of type 0,typeⅠsubmucosal leiomyomas and endometrial polyps.It is in the treatment of typeⅡthe number of repeated insertions into the uterine cavity in the submucosal leiomyoma and uterine mediastinum group was less than that in the electric resection group,and the difference between the groups was statistically significant(P<0.05).There was no significant difference in the amount of uterine dilatation fluid and the operation time between the two groups(P>0.05);in the treatment of intrauterine adhesions,the amount of uterine swelling fluid and the number of repeated insertions into the uterine cavity in the treatment of intrauterine adhesions were less than that of the electric resection group,the difference between the groups was statistically significant(P<0.05),and there was no significant difference in operation time between the two groups(P>0.05).In the treatment of residual uterine cavity,the difference between the two groups of general intraoperative conditions was no statistically significant(P>0.05).After the treatment of benign uterine cavity lesions in the Myosure group and the electric resection group,the menstrual symptoms scores,fibroids quality of life scores,and fibroids symptom scores were all improved to varying degrees.The dissatisfaction rate of pathological specimens in the electric resection group was 5.52%,and the dissatisfaction rate of pathological specimens in the electric resection group was 0,the difference between intraoperative and postoperative lesion volume in the electric resection group was statistically significant(P<0.05),and in the Myosure group there was no statistically significant difference in lesion volume between intraoperative and postoperative lesions(P>0.05).The surgical complication rate in the Myosure group was 2.54%,which was lower than 8.84%in the electric resection group;the pregnancy rate in the Myosure group was 78.43%,which was higher than 53.33%in the electric resection group,the placental abnormality rate of Myosure was 5.00%,which was lower than 37.50%in the electric resection group 37.50%,the difference was statistically significant(P<0.05).Conclusion The hysteroscopic tissue resection system has the advantages of operation time and fewer operative complications in the treatment of most benign lesions of the uterine cavity.It can significantly increase the postoperative pregnancy rate of patients with pregnancy needs,reduce the abnormalities of the placenta during pregnancy,and improve the patient's health.Outcome of pregnancy.