子宫内膜息肉行不同手术治疗的临床比较

Clinical comparison of different surgical treatments of endometrial polyps

目的:探究与分析子宫内膜息肉(EP)行不同手术治疗后对生育功能及复发的影响。方法:回顾性分析仙桃市第三人民医院自2018年4月至2020年12月收治的子宫内膜息肉患者97例的临床资料,按照不同的手术方案分为电切组(n=52)及钳夹组(n=45),电切组给予宫腔镜子宫内膜息肉切除术治疗,钳夹组给予宫腔镜下息肉钳夹机械清除术治疗,对比两组临床疗效、手术治疗前后子宫内膜厚度、月经失血图(PBAC)评分、宫腔液细胞因子水平,治疗期间不良反应,随访1年复发率及妊娠结局。结果:电切组与钳夹组相比临床总有效率较高,差异有统计学意义(P<0.05)。电切组手术后与钳夹组手术后相比子宫内膜厚度及PBAC评分较低、宫腔液细胞因子中的IL-1β、IFN-γ及IGF-1水平均较低,差异有统计学意义(P<0.05)。两组治疗期间不良反应发生率相比差异无统计学意义(P>0.05)。电切组与钳夹组相比随访1年复发率较低、宫内妊娠率较高,差异有统计学意义(P<0.05)。结论:宫腔镜子宫内膜息肉切除术与宫腔镜下息肉钳夹机械清除术治疗相比,能够明显地改善子宫内膜厚度,减少月经出血量,同时还可调节宫腔液细胞因子,在随访期间复发率较低,宫内妊娠率较高,且治疗期间无明显不良反应,安全性有保障。

Objective:To explore and analyze the effect of different surgical treatments on fertility and recur-rence of endometrial polyps(EP).Methods:The clinical data of 97 patients with EP,who were in-cluded in this study from April 2018 to December 2020 in the Third People's Hospital of Xiantao,were retrospectively analyzed.The patients were divided into an electrotomy group(n=52)and a clamp group(n=45),according to the different operation methods,and the hysteroscopic polyps were removed by electrotomy or by mechanical clamp removal procedures.The clinical efficacy,endome-trial thickness before and after the operation,pictorial blood loss assessment chart(PBAC)score,cy-tokines levels in uterine,adverse reactions during treatment,recurrence rate,and pregnancy outcome were compared between the two groups.Results:The total effective rate of the electrotomy group was higher than that of the clamp group with significant difference(P<0.05).Compared with the clamp group,the endometrial thickness and PBAC scores were significantly lower,and the levels of IL-1β,IFN-γ,and IGF-1 in the uterine were also lower in the electrotomy group after surgery(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The recurrence rate was lower and the intrauterine pregnancy rate was higher in the electrotomy group than in the clamp group at 1-year follow-up,and the differences were statistical-ly significant(P<0.05).Conclusion:Compared with the mechanical clamp removal procedures,elec-trotomy of endometrial polyps under hysteroscopy can improve the endometrial thickness,reduce men-strual blood loss and decrease the uterine levels of cytokines,the recurrence rate is lower and the intra-uterine pregnancy rate is higher,and the procedures are safe with fewer adverse reactions during treat-ment.