宫腔镜电切术联合左炔诺孕酮宫内节育系统治疗子宫内膜息肉的临床研究

Clinical study of hysteroscopic resection combined with levonorgestrel intrauterine birth control system in the treatment of endometrial polyps

目的探讨宫腔镜电切术(TCRP)联合左炔诺孕酮宫内节育系统(LNG-IUS)治疗子宫内膜息肉(EP)患者的临床效果。方法选取60例EP患者,按照随机数字表法分为对照组与研究组,每组30例。对照组行TCRP治疗,研究组在TCRP后放置LNG-IUS治疗。对比两组手术前后子宫内膜厚度、月经失血评分、血红蛋白水平、雌、孕激素受体表达水平、术后并发症发生情况及复发率。结果与手术前比较,手术后3~12个月两组患者子宫内膜厚度、月经失血图(PBAC)评分均呈逐渐下降趋势,血红蛋白水平均呈逐渐升高趋势,且研究组各时间点均显著优于对照组,差异有统计学意义(P<0.05)。手术后12个月研究组患者腺上皮与间质雌激素受体、孕激素受体均较术前显著降低,且研究组与对照组相比显著下降,差异有统计学意义(P<0.05)。研究组患者并发症发生率13.33%、复发率6.67%均显著低于对照组的40.00%.26.67%,差异有统计学意义(P<0.05)。结论TCRP联合LNG4US治疗EP,可有效减少患者月经量,促使子宫内膜变薄,提高血红蛋白水平,调节雌、孕激素受体的表达,抑制子宫内膜增生,降低并发症发生率及复发率,值得临床推广与应用。

Objective To investigate the clinical effect of hysteroscopic resection(TCRP)combined with levonorgestrel intrauterine birth control system(LNG-IUS)in the treatment of patients with endometrial polyps(EP).Methods 60 EP patients were selected and divided into control group and study group according to the random number table method,30 cases in each group.The control group was treated with TCRP,and the study group was treated with LNG-IUS after TCRP.The endometrial thickness,menstrual blood loss score,hemoglobin level,estrogen and progesterone receptor expression levels,postoperative complications and recurrence rate were compared between the two groups before and after operation.Results Compared with before operation,endometrial thickness and menstrual blood loss map(PBAC)score of patients in the two groups gradually decreased and hemoglobin level gradually increased from 3 to 12 months after operation,and the study group was significantly better than the control group at each time point,and the diiferences were statistically significant(P<0.05).At 12 months after operation,estrogen receptor and progesterone receptor in glandular epithelium and interstitial of the study group were significantly decreased compared with those before operation,and the difference was statistically significant(P<0.05).The complication rate of the study group(13.33%)and the recurrence rate(6.67%)were significantly lower than those of the control group(40.00%and 26.67%),and the differences were statistically significant(P<0.05).Conclusion TCRP combined with LNG-IUS in the treatment of EP can effectively reduce menstrual volume,promote endometrial thinning,increase hemoglobin level,regulate the expression of estrogen and progesterone receptors,inhibit endometrial hyperplasia,and reduce the incidence of complications and recurrence rate,which is worthy of clinical promotion and application.