宫腔镜下冷刀切除术治疗子宫内膜息肉的临床分析

Clinical Analysis of Cold Knife Resection Under Hysteroscope in the Treatment of Endometrial Polyps

目的:分析子宫内膜息肉(EP)患者行宫腔镜下冷刀切除术的临床效果。方法:回顾性分析55例EP患者临床资料,依据实施手术方案的不同分为对照组(行宫腔镜下电切术,27例)与观察组(行宫腔镜下冷刀切除术,28例)。比较2组手术相关指标(手术时间、手术总出血量、住院时间)及术前、术后3个月月经量及排卵期子宫内膜厚度、子宫内膜血流参数[血流阻力指数(RI)及搏动指数(PI)],统计2组术后1年复发率及妊娠率。结果:观察组手术时间短于对照组[(23.92±2.47)vs(27.28±2.36)min],手术总出血量低于对照组[(20.63±1.82)vs(23.18±2.07)mL],差异均有统计学意义(P<0.05);2组住院时间比较差异无统计学意义(P>0.05);术后3个月,2组月经失血图(PBAC)评分、排卵期子宫内膜厚度均较术前下降,且观察组PBAC评分、排卵期子宫内膜厚度高于对照组,差异有统计学意义(P<0.05);术后3个月,2组RI、PI值均降低,且观察组RI、PI值低于对照组,差异有统计学意义(P<0.05);随访1年,观察组术后复发率(7.14%)与对照组(11.11%)比较,差异无统计学意义(P>0.05);随访1年,观察组妊娠率46.43%高于对照组14.81%,差异有统计学意义(P<0.05)。结论:与宫腔镜下电切术比较,宫腔镜下冷刀切除术治疗EP可缩短手术时间,降低手术总出血量,促进患者月经量恢复正常,且对子宫内膜损伤较小,可改善子宫内膜血流参数及提高妊娠率。

Objective:To analyze the clinical effect of cold knife resection under hysteroscope in the treatment of patients with endometrial polyps(EP).Methods:The clinical data of 55 patients with EP treated in the Department of Obstetrics and Gynecology was retrospectively analyzed,according to the different surgical plans,the patients were divided into a control group(electrocision under hysteroscope,27 cases)and an observation group(cold knife resection under hysteroscope,28 cases).The operation-related indicators(operation time,total volume of surgical bleeding and hospitalization time),menstrual volume and endometrial thickness during ovulation before and 3 months after operation and endometrial blood flow parameters[blood flow resistance index(RI)and pulsatility index(PI)]of both groups were compared,the recurrence rate and pregnancy rate 1 year after operation of the two groups were compared.Results:The operation time of the observation group was shorter than that of the control group,the total volume of surgical bleeding was lower than that of the control group,with statistical significant differences(P<0.05);compared the hospitalization time in both groups,there was no statistical significant difference(P>0.05);3 months after operation,the PBAC score and endometrial thickness during ovulation in both groups were decreased than those before operation,and the PBAC score and endometrial thickness during ovulation in the observation group were higher than those in the control group,with statistical significant differences(P<0.05);3 months after operation,the values of RI and PI in both groups decreased,and the values of RI and PI in the observation group were lower than those in the control group,with a statistical significant difference(P<0.05);after 1 year of follow-up,compared the postoperative recurrence rate between the observation group(7.14%)and the control group(11.11%),there was no statistical significant difference(P>0.05);after 1 year of follow-up,the pregnancy rate in the observation group was 46.43%,higher than 14.81%in the control group,with a statistical significant difference(P<0.05).Conclusion:Compared with electrocision under hysteroscopy,cold knife resection under hysteroscope in the treatment of EP can shorten the operation time,reduce the total volume of surgical blood loss,promote the menstrual volume of patients to return to normal,and cause less damage to the endometrium,can improve endometrial blood flow parameters and increase pregnancy rate.