子宫内膜息肉切除术前预处理联合术后药物治疗的疗效及对预防复发的影响

Efficacy of pretreatment before endometrial polypectomy combined with postoperative drug therapy and its effect on prevention of recurrence

目的 探讨子宫内膜息肉切除术前预处理联合术后药物治疗及预防复发的研究。方法 选取2018年1月至2019年12月本院120例子宫内膜息肉患者作为研究对象,按照随机数字表法分为A组、B组、C组、D组,每组30例。A组仅给予宫腔镜下子宫内膜息肉切除术,B组术前给予地屈孕酮片、术后给予左炔诺孕酮宫内缓释系统,C组手术前后均给予地屈孕酮片,D组术前给予地屈孕酮片、术后给予屈螺酮炔雌醇片,比较术前与术后6、12个月的月经量、子宫内膜厚度变化及月经改善、息肉复发情况、临床疗效。结果 术前,B组、C组、D组子宫内膜厚度均于A组(P<0.05);术后6、12个月,B组、C组、D组月经量、子宫内膜厚度均低于A组(P<0.05),其中B组低于C组、D组(P<0.05),C组、D组组间比较差异无统计学意义;B组、C组、D组月经改善率均高于A组(P<0.05),且B组高于C组、D组(P<0.05),C组、D组组间比较差异无统计学意义;B组复发率显著低于A组、C组、D组(P<0.05);B组、C组、D组治疗总有效率均高于A组(P<0.05),但B组、C组、D组组间比较差异无统计学意义。结论 子宫内膜息肉切除术前预处理联合术后左炔诺孕酮宫内缓释系统的治疗效果更为显著,左炔诺孕酮宫内节育系统和屈螺酮炔雌醇片适用于无生育需求的患者,对于有生育需求的患者,适宜选用地屈孕酮片。

Objective To investigate the effect of preconditioning before endometrial polypectomy combined with postoperative drug therapy to prevent recurrence. Methods A total of 120 patients with endometrial polyps in our hospital from January 2018 to December 2019 were selected as the research subjects, and they were divided into group A, group B, group C and group D according to the random number table method, with 30 cases in each group. The group A was only given hysteroscopic endometrial polypectomy, the group B was given dydrogesterone tablets before the operation, and the levonorgestrel intrauterine sustained-release system after the operation, and the group C was given before and after the operation. All patients were given dydrogesterone tablets, while group D was given dydrogesterone tablets before operation and drospirenone and ethinylestradiol tablets after operation. The menstrual flow, endometrial thickness changes before and 6 and 12 months after surgery and menstrual improvement, polyp recurrence and clinical efficacy were compared. Results The endometrial thickness of group B, group C and group D before operation were lower than those of group A(P<0.05), in which group B was lower than that in groups C and group D(P<0.05), and there was no difference between group C and group D;the menstrual improvement rates in group B, group C, and group D were higher than those in group A(P<0.05), and group B was higher than group C and group D(P<0.05), and there was no difference between group C and group D;the recurrence rate of group B was significantly lower than that of group A, group C, and group D(P<0.05);The total effective rates of group B, group C, and group D were higher than those of group A(P<0.05), but there was no difference between group B, group C, and group D. Conclusion The therapeutic effect of pretreatment before endometrial polypectomy combined with postoperative levonorgestrel intrauterine sustained-release system is more significant. levonorgestrel intrauterine system and drospirenone ethinylestradiol tablets are suitable for patients without reproductive needs, for patients with reproductive needs,dydrogesterone tablets are suitable.