门诊局麻下宫腔镜冷刀治疗子宫内膜息肉的临床应用效果

Clinical Effect of Hysteroscopy Cold Knife Under Local Anesthesia in Outpatient Department in the Treatment of Endometrial Polyps

目的:探讨门诊局麻下宫腔镜冷刀治疗子宫内膜息肉(EP)的临床应用效果。方法:选择2020年9月-2021年11月于江西省妇幼保健院就治的120例EP患者,按照随机数字表法将其随机分为两组,各60例。对照组采用宫腔镜下电切术,观察组采用门诊局麻下宫腔镜冷刀治疗,均随访6个月。比较两组围手术期指标、术后疼痛、月经情况、子宫内膜厚度、子宫动脉血流参数、并发症发生情况及妊娠率。结果:与对照组相比,观察组手术操作时间、术后阴道出血时间均较短,术中出血量较少,差异均有统计学意义(P<0.05)。观察组术后12 h视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05)。观察组术后3个月的月经失血图(PBAC)评分、排卵期子宫内膜厚度均高于对照组,血流阻力指数(RI)及搏动指数(PI)均低于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为3.33%(3/60),低于对照组的13.33%(8/60),差异有统计学意义(P<0.05)。术后随访6个月,观察组妊娠率为55.00%(33/60),高于对照组的18.33%(11/60),差异有统计学意义(P<0.05)。结论:门诊局麻下宫腔镜冷刀治疗EP效果较好,具有手术操作时间较短、术中出血量较低、术后恢复快、疼痛程度轻等优势,有利于月经尽早恢复正常,提高妊娠率,且并发症发生率较低。

Objective:To investigate the clinical application effect of hysteroscopy cold knife under local anesthesia in Outpatient Department in the treatment of endometrial polyps(EP).Method:A total of 120 EP patients in Maternity and Child Health Hospital of Jiangxi Province from September 2020 to November 2021 were selected,they were randomly divided into two groups according to random number table method,60 cases in each group.The control group was treated with hysteroscopic electrotomy,and observation group received hysteroscopy cold knife under local anesthesia in Outpatient Department,followed up for 6 months.The perioperative period indicators,postoperative pain,menstruation,endometrial thickness,uterine artery blood flow parameters,complications and pregnancy rate were compared between the two groups.Result:Compared with the control group,the operation time and postoperative vaginal bleeding time in the observation group were shorter,and the amount of intraoperative bleeding was less,the differences were statistically significant(P<0.05).Visual analog scale(VAS)scores at 12 h after operation in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).The pictorial blood loss assessment(PBAC)scores and endometrial thickness during ovulation at 3 months after operation in the observation group were higher than those in the control group,and the blood flow resistance index(RI)and pulsatile index(PI)in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The complications incidence in the observation group was 3.33%(3/60),which was lower than 13.33%(8/60)in the control group,the difference was statistically significant(P<0.05).The pregnancy rate in the observation group was 55.00%(33/60),which was higher than 18.33%(11/60)in the control group,the difference was statistically significant(P<0.05).Conclusion:Hysteroscopy cold knife under local anesthesia in Outpatient Department in the treatment of EP is effective,it has the advantages of shorter operation time,lower intraoperative blood loss,faster postoperative recovery,and less pain,which is conducive to the early return to normal menstruation,improve the pregnancy rate,and lower complication rate.