左炔诺孕酮宫内释放系统联合宫腔镜下冷刀切除术治疗子宫内膜息肉患者的效果

Effects of Levonorgestrel-releasing intrauterine systemcombined with hysteroscopic cold knife resection in treatment of patients with endometrial polyps

目的:观察左炔诺孕酮宫内释放系统联合宫腔镜下冷刀切术除治疗子宫内膜息肉(EP)患者的效果。方法:选取2020年10月至2022年2月该院收治的90例EP患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各45例。两组均接受宫腔镜下冷刀切除术治疗,术后,对照组给予地屈孕酮治疗,观察组给予左炔诺孕酮宫内释放系统治疗,比较两组围术期指标(术中出血量、住院时间、术后阴道出血时间)水平、治疗前后子宫动脉血流参数[搏动指数(PI)、阻力指数(RI)]水平、血清学指标[胰岛素样生长因子-1(IGF-1)、白细胞介素-1β(IL-1β)]水平、并发症发生率及术后6个月EP复发率。结果:两组术中出血量比较,差异无统计学意义(P>0.05);观察组住院时间、术后阴道出血时间均短于对照组,差异有统计学意义(P<0.05);治疗后,两组子宫动脉血流PI、RI均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组IGF-1、IL-1β水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05);术后6个月,观察组EP复发率为2.22%,低于对照组的17.77%,差异有统计学意义(P<0.05)。结论:左炔诺孕酮宫内释放系统联合宫腔镜下冷刀切除术治疗EP患者,可缩短住院时间和术后阴道出血时间,改善子宫动脉血流参数和血清学指标水平,降低EP复发率,效果优于地屈孕酮联合宫腔镜下冷刀切除术治疗。

Objective:To observe effects of Levonorgestrel-releasing intrauterine system combined with hysteroscopic cold knife resection in treatment of patients with endometrial polyps(EP).Methods:A prospective study was conducted on 90 EP patients admitted to this hospital from October 2020 to February 2022.They were divided into control group and observation group according to the random number table method,45 cases in each group.Both groups were treated with hysteroscopic cold knife resection.After the surgery,the control group was treated with Dydrogesterone,while the observation group was treated with Levonorgestrel-releasing intrauterine system.The levels of perioperative indicators(intraoperative blood loss,hospitalization time,postoperative vaginal bleeding time),the endometrial related parameter levels[pulsatility index(PI),resistance index(RI)]and the serological indicator levels[insulin-like growth factor-1(IGF-1),interleukin-1β(IL-1β)]before and after the treatment,the incidence of complications,and the recurrence rate of EP 6 months after the treatment were compared between the two groups.Results:There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The hospitalization time and the postoperative vaginal bleeding time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).After the treatment,the PI and RI of uterine artery blood flow in the two groups were lower than those before the treatment,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of IGF-1 and IL-1βin the two groups were lower than those before the treatment,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).6 months after the surgery,the recurrence rate of EP in the observation group was 2.22%,which was lower than 17.77%in the control group,and the difference was statistically significant(P<0.05).Conclusions:Levonorgestrel-releasing intrauterine system combined with hysteroscopic cold knife resection in the treatment of the EP patients can shorten the hospitalization time and the postoperative vaginal bleeding time,improve the uterine artery blood flow index and serological index levels,and reduce the recurrence rate of EP.Moreover,it is superior to Dydrogesterone combined with hysteroscopic cold knife resection treatment.