宫腔镜手术联合不同药物治疗老年子宫内膜息肉患者的临床研究

Clinical trial of hysteroscopic surgery combined with different drugs in the treatment of elderly patients with endometrial polyp

目的 观察宫腔镜手术联合不同药物治疗老年子宫内膜息肉(EP)的临床疗效和安全性。方法 将老年EPs患者按随机数表法分为对照组、试验A组、试验B组。对照组术后无药物治疗;试验A组术后给予孕三烯酮胶囊2.5 mg,术后第3天开始服用,每周2次,治疗3个月;试验B组术后给予去氧孕烯炔雌醇片,术后第1天开始服用,每日1片,服用21 d后停药7 d,治疗3个月。比较3组患者临床疗效、子宫内膜厚度、宫腔灌洗液炎症因子水平、雌孕激素受体、EPs复发情况,以及药物不良反应的发生情况。结果 试验A组、试验B组和对照组最终分别纳入35、35和32例。治疗后6个月,对照组、试验组A组和试验B组患者子宫内膜厚度分别为(0.87±0.13)、(0.51±0.10)和(0.60±0.12)cm,宫腔灌洗液白细胞介素-6(IL-6)表达水平分别为(181.85±28.41)、(142.06±23.04)和(154.69±26.72)ng·L^(-1),肿瘤坏死因子-α(TNF-α)水平分别为(38.76±4.67)、(27.52±4.24)和(25.47±5.81)ng·L^(-1);对照组的腺皮质雌激素受体(ER)、间质ER、腺皮质孕激素受体(PR)、间质PR水平分别为1.99±0.46、1.97±0.58、1.72±0.43、1.62±0.54;试验A组的腺皮质ER、间质ER、腺皮质PR、间质PR水平分别为1.69±0.42、1.68±0.44、0.89±0.28、1.06±0.34;试验B组的腺皮质ER、间质ER、腺皮质PR、间质PR水平分别为1.87±0.52、1.84±0.35、0.96±0.31、1.18±0.37,对照组上述指标与试验A组和B组比较,试验A组上述指标与试验B组比较,差异均有统计学意义(均P<0.05)。治疗后12个月,试验A组和对照组的EP复发率分别为2.86%和25.00%,差异有统计学意义(P<0.05)。试验A组和试验B组的总药物不良反应发生率分别为5.71%和9.09%,差异无统计学意义(P>0.05)。结论 宫腔镜手术后使用孕三烯酮比去氧孕烯炔雌醇治疗EPs的疗效更佳,可以有效预防复发,药物安全性良好。

Objective To observe the clinical effects and safety of hysteroscopic surgery combined with different drugs in the treatment of elderly patients with endometrial polyp(EP).Methods The elderly patients with EP were divided into control group,treatment A group,treatment B group according to random number table method.Control group had no drug treatment after operation;treatment A group was given pregnrienone capsule 2.5 mg after operation,twice a week from the 3rd day after operation,and treated for 3 months;treatment B group was given deoxypregnenestradiol tablets after operation,starting from the 1st day after operation,1 tablet a day,stopped for7 days after 21 days,and treated for 3 months.The clinical efficacy,endometrial thickness,levels of inflammatory factors in uterine lavage fluid,estrogen and progesterone receptors,EP recurrence,and the occurrence of adverse drug reactions were compared among the 3 groups.Results Treatment A group,treatment B group and control group included 35,35 and 32 cases,respectively.At 6 months after treatment,endometrial thickness in control group,treatment A group,treatment B group was(0.87±0.13),(0.51±0.10)and(0.60±0.12)cm,respectively;the expression levels of interleukin-6(IL-6)in uterine lavage fluid were(181.85±28.41),(142.06±23.04)and(154.69±26.72)ng·L^(-1),respectively;tumor necrosis factor-α(TNF-α)levels were(38.76±4.67),(27.52±4.24)and(25.47±5.81)ng·L^(-1),respectively;the levels of glandular corticoestrogen receptor(ER),interstitial ER,glandular progesterone receptor(PR)and interstitial PR in the control group were 1.99±0.46,1.97±0.58,1.72±0.43 and 1.62±0.54,respectively;the levels of ER,ER,PR and interstitial PR in treatment Agroup were 1.69±0.42,1.68±0.44,0.89±0.28 and 1.06±0.34,respectively;the levels of ER,interstitial ER,glandular cortex PR and interstitial PR in treatment B group were 1.87±0.52,1.84±0.35,0.96±0.31 and1.18±0.37,respectively.The above indexes in control group were compared with those in treatment A and B groups,and the above indexes in treatment A group were compared with those in treatment B group,and the differences were statistically significant(all P<0.05).At 12 months after treatment,the recurrence rate of EPs in treatment A group and control group was 2.86%and 25.00%,respectively,and the difference was statistically significant(P<0.05).The total incidence of adverse drug reactions in treatment A group and treatment B group was 5.71%and 9.09%,respectively,with no statistical significance(P>0.05).Conclusion Compared with using desogestrel/ethinyl estradiol after hysteroscopic surgery,using gestrinone after hysteroscopic surgery can achieve better therapeutic effect on EPs.The latter can effectively prevent recurrence,with good drug safety.