宫腔镜下冷刀切除术联合左炔诺孕酮宫内节育系统治疗子宫内膜息肉患者的效果

Effect of Hysteroscopic Cold Knife Resection Combined with Levonorgestrel Intrauterine Birth Control System in the Treatment of Patients with Endometrial Polyps

目的:探讨宫腔镜下冷刀切除术联合左炔诺孕酮宫内节育系统(曼月乐)治疗子宫内膜息肉患者的效果。方法:选取2021年9月—2023年6月瑞金市人民医院妇产科收治的102例子宫内膜息肉患者作为研究对象,按随机数字表法分为对照组(行宫腔镜下冷刀切除术)和研究组(行宫腔镜下冷刀切除术+曼月乐),各51例。统计两组术前、术后6个月的血红蛋白(Hb)、子宫内膜厚度、子宫内膜组织雌孕激素受体[雌激素受体(ER)、孕激素受体(PR)]、血清性激素指标[黄体生成素(LH)、卵泡生成激素(FSH)、雌二醇(E_(2))、孕酮(P)]、宫腔灌洗液炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、γ干扰素(IFN-γ)]及并发症发生率、复发情况。结果:术后6个月,研究组并发症发生率及复发率均低于对照组,差异均有统计学意义(P<0.05)。术后6个月,两组Hb、LH、FSH、P水平均高于术前,子宫内膜厚度、ER、PR、E_(2)及宫腔灌洗液炎症因子水平均低于术前,且研究组Hb、LH水平高于对照组,子宫内膜厚度、ER、PR、FSH、P、宫腔灌洗液炎症因子水平均低于对照组,差异均有统计学意义(P<0.05);而两组E_(2)水平比较,差异无统计学意义(P>0.05)。结论:宫腔镜下冷刀切除术联合曼月乐治疗子宫内膜息肉,可调节雌孕激素受体表达及性激素水平,减轻宫腔炎症反应,降低术后并发症发生率及复发率。

Objective:To investigate the effect of hysteroscopic cold knife resection combined with Levonorgestrel Intrauterine Birth Control System(Mirena)in the treatment of patients with endometrial polyps.Method:A total of 102 patients with endometrial polyps admitted to the Obstetrics and Gynecology Department of Ruijin People's Hospital from September 2021 to June 2023 were selected as the study objects,and they were divided into the control group(underwent hysteroscopic cold knife resection)and the study group(underwent hysteroscopic cold knife resection+Mirena)according to random number table method,with 51 cases in each group.Hemoglobin(Hb),endometrial thickness,estrogen receptors in endometrial tissue[estrogen receptor(ER),progesterone receptor(PR)],serum sex hormone indexes[luteinizing hormone(LH),follicle-forming hormone(FSH),estradiol(E_(2)),progesterone(P)]and inflammatory factors in uterine lavage fluid[reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interferon-γ(IFN-γ)]before and 6 months after operation,complication rate and recurrence of two groups were analyzed.Result:Six months after operation,the complication rate and recurrence rate of the study group were lower than those of the control group,the differences were statistically significant(P<0.05).Six months after surgery,the levels of Hb,LH,FSH and P in both groups were higher than those before surgery,and the levels of endometrial thickness,ER,PR,E_(2) and inflammatory factors in uterine lavage fluid were lower than those before surgery,and the levels of Hb and LH in the study group were higher than those in the control group,while the levels of endometrial thickness,ER,PR,FSH,P and inflammatory factors in uterine lavage fluid were lower than those in the control group,the differences were statistically significant(P<0.05),but there was no significant difference in E_(2) levels between two groups(P>0.05).Conclusion:Hysteroscopic cold knife resection combined with Mirena in the treatment of endometrial polyps can regulate the expression of estrogen and progesterone receptors and sex hormone levels,reduce uterine inflammation,and reduce the incidence of postoperative complications and recurrence.