LiNA OperaScope^(TM) for microwave endometrial ablation for endometrial polyps with heavy menstrual bleeding: A case report

BACKGROUND The procedure for microwave endometrial ablation(MEA)follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after MEA.When a luminal uterine lesion is recognized,its removal requires preoperative dilation of the cervix because the outer diameter of a conventional rigid hysteroscope is 8.7 mm.Recently,a fully disposable rigid hysteroscope(LiNA OperaScope^(TM))with a narrow diameter(4.4 mm)and forceps capable of extracting endometrial lesions has become available.CASE SUMMARY Here,we report a case of heavy menstrual bleeding(HMB)complicated by endometrial polyps where MEA was performed after removing endometrial polyps using the LiNA OperaScope^(TM) device.A 48-year-old woman with three prior pregnancies and three deliveries was referred to our hospital for further examination and treatment after being diagnosed with HMB 2 years earlier.The patient underwent MEA following endometrial polypectomy using LiNA OperaScope^(TM).After MEA,endometrial cauterization was again examined using the LiNA OperaScope^(TM),and the procedure was completed.No preoperative cervical dilation was performed.The patient’s clinical course was favorable,and she was discharged 3 h after surgery.One month after surgery,menstruation resumed,and both HMB and dysmenorrhea improved markedly from 10 preoperatively to 1 postoperatively,as assessed subjectively using the visual analog scale.The patient’s postoperative course was uneventful with no complic-ations.CONCLUSION LiNA OperaScope^(TM) can be a minimally invasive treatment for MEA of HMB with uterine lumen lesions.

Application of Whole-Process Management in Day Surgery for Endometrial Polyp

Objective:To explore the effect of whole-process management model in nursing management of endometrial polyp day surgery.Methods:266 patients that underwent endometrial polyp day surgery from January to December 2022 were selected for this study,and they were separated into an observation group(131 patients)and a control group(135 patients);the clinical data of the two groups were compared.Results:After intervention,the scores of Hamilton Anxiety Scale(HAM-A)of the patients in the observation group were lower than those in the control group(P<0.05).The rate of postoperative complications in the observation group was lower than that in the control group(P<0.05),and the satisfaction degree of the patients in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the whole-course management model in endometrial polyp day surgery can alleviate patients’anxiety,ensure the quality and safety of day surgery nursing,and improve patients’satisfaction.

Multicentric Study on Endometrial Polyps and Endometriosis: Are They True or False Friends?

Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyps and endometriosis, is quite high among general population. The presence of endometrial polyps and endometriosis could affect infertile women. We performed a retrospective multicentric study, based on data collected from three Hospitals (S. Antonio Abate, Trapani, Civico-Ascoli, Palermo, and Cannizzaro, Catania). We analyzed 285 women undergoing diagnostic/office hysteroscopy. Clinical history demographic and hysteroscopic data were collected in the same sheet, containing within informed consent. On the base of our results no relationship exists between endometrial polyps and endometriosis nor cervical polyps. It’s the first time that none correlation is proved for the coexistence of endometrial polyps and endometriosis. Further research is needed.

Vascular markers CD31,CD34,actin,VEGFB,and VEGFR2,are prognostic markers for malignant development in benign endometrial polyps

Intention of the study: The prevalence of endometrial polyps has been demonstrated in between 10% and 35% of all women, but knowledge regarding malignant potential within polyps is limited. Even though premalignant and malignant changes have been reported in up to 24% of all cases, no objective tissue markers have ever been developed for routine diagnostics to select high risk cases. As vascular changes and activation of endometrial angiogenesis has been demonstrated in former studies, our main objective was to evaluate different members of the angiogenic pathway as potential risk factors for cancer development. Patients and methods: Formalin-fixed, paraffin-embedded tissue from 15 women with benign endometrial polyps, and 16 women diagnosed with endometrial cancer were included. Immunohistochemical investigation with antibodies against VEGF, VEGF-B, VEGFR2, VEGFR3, CD31, CD34, actin, and factorVIII was performed, followed by evaluation of staining intensity of microvessels, evaluation of H-score in glands (cell membrane, cytoplasm) and stroma, and measurement of micro vessel density. Results: Expression of CD31 in microvessels was significantly stronger in cancers compared to endometrial polyps (P = 0.006 for arterioles, P = 0.038, for venyles, and P = 0.002 for capillaries, respectively), whereas, a reverse change was shown for CD34. Expression of actin in capillary walls was also significantly increased in cancers compared to polyps (P = 0.002). No significant difference was found for staining intensity in microvessels (arterioles, venyles or capillaries) in endometrial benign polyps compared with endometrial cancers for VEGF, VEGFB, VEGFR2, VEGFR3, or Factor VIII. Also no difference in H-score values between benign polyps and endometrial cancers could be detected in glandular epithelium, in epithelial cell membrane or in stroma for VEGFR3, CD31 or Factor VIII. Conclusions: The present study strongly indicates that activation of angiogenesis differs in benign endometrial polyps and endometrial cancers. Thus, immunohistochemical expression of specific angiogenic markers may be of great importance as prognostic factors in the routine diagnostics of this lesion. The ratio between stromal expression of CD34 and actin might be of particular interest to select polyps with increased malignant potential.

Endometrial Polyps:Which Patients Should Be Selected for Hysteroscopic Surgery?--A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery

Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were <52 years old (p < 0.001). Among those women with dysplasia, 12/41 (29%) were p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The <52-year-old cancer patient had treatment-resistant bleeding. Increasing weight was a risk factor associated with tissue alterations in endometrial polyps (p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.

Effects of Huayu Xiaozheng Therapy on Recurrence of Multiple Endometrial Polyps After Electrotomy

Objective:To investigate the preventive effect of Huayu Xiaozheng therapy method of traditional Chinese medicine on the recurrence of multiple endometrial polyps after hysteroscopic electro resection.Methods:A total of 120 patients with blood stasis diagnosed with multiple endometrial polyps after hysteroscopic electroresection were divided into Traditional Chinese medicine group(38 people),Manyuele group(27 people),contraceptive pill group(34 people)and control group(21 people),and the endometrial thickness,polyp recurrence cases and TCM syndrome points were observed in 4 groups after treatment in 3 months,6 months and 12 months..Results:The endometrial thickness was statistically significant(P<0.05)before and after treatment in the Chinese medicine group,the Manyuele group and the contraceptive group,and the endometrial thickness was statistically significant(P<0.05)in the 1 year after treatment,and the endometrial thickness of the Chinese medicine group was compared with the contraceptive group and the Manyuele group in the 1 year after treatment,and the difference was not statistically significant.The differences in TCM symptoms in the Chinese medicine treatment group were statistically significant compared with those in the contraceptive group and the Manyuele group(P<0.05).The recurrence rate of polyps in the 1 year after treatment was statistically significant compared with the control group(P<0.05),and the difference between the three groups was not statistically significant(P>0.05).Conclusion:The traditional Chinese medicine stasis elimination method has a preventive effect on the recurrence of endometrial polyps,and its preventive effect is no different from that of Western medicine,and can significantly improve clinical symptoms.

Impact of gonadotropin-releasing hormone agonist and hormone replacement therapy on pregnancy outcomes in single euploid frozen-thawed embryo transfer for patients with endometrial polyps

Objective:Although consensus on the optimal endometrial preparation protocol for frozen-thawed embryo transfer(FET)is lacking,this is particularly true for patients with infertility and a history of endometrial polyps(EPs).In this study,we aimed to investigate whether a gonadotropin-releasing hormone agonist combined with hormone replacement therapy(GnRHa-HRT)could improve pregnancy outcomes in single euploid FET for patients with a history of EPs.Methods:In this retrospective cohort study,395 women who underwent their first single euploid FET cycle were divided into groups according to endometrial preparation protocols as follows:natural cycle(NC)(n=220),hormone replacement therapy(HRT)(n=122),and GnRHa-HRT groups(n=53).Subsequently,the FET cycles in the three groups were subdivided according to maternal age.All patients underwent hysteroscopic polypectomy before FET,and their EPs were confirmed by pathology.Results:No statistically significant differences were observed in live birth rates among the three groups(58.64%vs.58.20%vs.56.60%,P=0.964).Furthermore,the rates of miscarriage,ectopic pregnancy,premature live birth,and pregnancy complications were comparable among the three groups(P>0.05).After adjusting for potential confounding factors,no significant differences in pregnancy outcomes were reported between the groups(adjusted odds ratios[OR]and 95%credible intervals[CI]for live birth rate,HRTvs.NC:1.119,0.660–1.896,P=0.677;GnRHa-HRTvs.NC:1.165,0.610–2.226,P=0.643).Additionally,the pregnancy outcomes of the FET cycle were not influenced by the endometrial preparation protocols in the subgroups when stratified by maternal age(P>0.05).Conclusion:GnRHa-HRT did not improve the pregnancy outcomes of the single euploid FET in patients with a history of EPs.

The Intrauterine Bigatti Shaver for Endometrial Lesions: Our Experience and Modifications

Background: Removal of endometrial polyps and submucosal fibroids by blind avulsion or excision with resectoscope is associated with risks such as fluid imbalance and uterine perforation. This review describes our centre’s experience with the intrauterine Bigatti shaver (IBS), a new method for resecting these lesions. Methods: All procedures performed between August 2015 and June 2016 were included. Patient demographics and operation details (set-up time, resection time, operative findings and complications) were collected at time of surgery using a standardised form. Results: 21 cases were performed between August 2015 and June 2016 by two senior gynaecologists. The majority (18, 86%) were performed for polyps associated with menstrual abnormalities or subfertility. Mean operating time was 9.6 minutes (range 3 - 25), median fluid input 1450 mls (range 700 - 3000) and median fluid deficit 100 mls (range 50 - 300). There were no cases of infection, perforation or fluid overload. The IBS blade was bent after resection of an anterior wall polyp in an anteverted uterus. A 3 mm grade 1 submucosal fibroid could not be resected as it was too hard in consistency. Conclusions: The constant clear visualisation provided by the continuous flow of fluid enabled fast and complete resection of sizeable polyps with minimal fluid deficit. No serious complications occurred despite this being the initial series performed by both surgeons. Bending of the blade may be avoided by rotating the camera such that the operating channel is situated just next to the lesion. A drainage sock was fashioned out of ribbon gauze and attached to the end of the suction tubing for collection of small polyp fragments. The IBS is a valuable addition to current methods for resection of endometrial polyps. Further study is required to determine its utility for submucosal fibroids, particularly those with a hard consistency.

Endometrial Scratch-Suction and Implantation Failure

Objective: The aim of this trial was to determine whether endometrial scratch-suction caused by insertion tube of (IUCD) with suction improved the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome by removing small polyps and any hazardous materials. Design: Observational prospective cohort experimental study. Setting: Zagazig University Hospital, Obstetrics and Gynecology department. From period between September 2011 till September 2012. Population: 30 patients with previous failed IVF despite transfer of goodquality embryos were allocated to endometrial scratch-suction in the same the cycle of embryo transfer. Methods: From day 5 to day 7 of same ICSI cycle, the patients in study underwent endometrial scratch-suction technique. After preparation of insertion tube of (IUCD) and infant feeding tube 8 F, moving the insertion tube of IUCD from below upwards with scratching anterior uterine wall, then posterior, then left lateral uterine wall, then right lateral uterine wall, then fundus, all these steps are associated with suction by attaching proximal end of infant feeding tube 8 F to suction apparatus. Main Outcome Measures: Implantation and clinical pregnancy rates. Results: The implantation occurred in 24/30 (80%). The clinical pregnancy occurred in 20/30 patients (66.66%). 12/30 patients (40%) during scratch-suction technique had small fleshy masses obstructing suction tube which were small endometrial polyps. Conclusions: Endometrial scratch-suction improves clinical pregnancy and implantation rates in the same IVF-ET cycle in patients with previous unsuccessful IVF cycles.

经阴道二维超声对子宫内膜息肉及子宫内膜息肉病变诊断的应用价值

目的探讨经阴道二维超声对子宫内膜息肉及子宫内膜息肉病变诊断的应用价值。方法选取2019年1月至2022年1月在本院就诊的患者46例,据病理检查结果将其分为息肉组和病变组。记录两组患者临床资料、BMI、超声指标(子宫内膜厚度、病灶最大直径、病灶回声不均匀、血流丰富),并以病理检查为金标准,分析经阴道二维超声诊断价值。结果依据病理检查检查显示,息肉组30例,病变组16例。两组患者年龄、产次0次占比比较差异无统计学意义(P>0.05),两组患者BMI≥24kg/m^(2)、绝经后出血比较差异具有统计学意义(P<0.05);病变组子宫内膜厚度、病灶最大直径、病灶回声不均匀占比、血流丰富占比均显著高于息肉组,差异均具有统计学意义(P<0.05);以病理结果作为金标准,灵敏度为67.50%(27/40),特异度为16.67%(1/6),阳性预测值为84.38%(27/32),阴性预测值为7.14%(1/14),符合率为60.87%(28/46)。结论经阴道二维超声可作为辅助手段用于子宫内膜息肉及其病变的早期诊断和鉴别诊断。

地屈孕酮辅助宫腔镜下子宫内膜息肉切除术治疗子宫内膜息肉的效果

目的观察地屈孕酮辅助宫腔镜下子宫内膜息肉切除术(TCRP)治疗子宫内膜息肉(EP)的效果。方法回顾性选取福鼎市医院2019年1月—2021年6月收治的EP患者120例,根据治疗方式分为TCRP组(n=60)和联合治疗组(n=60)。TCRP组患者接受宫腔镜下TCRP治疗,联合治疗组患者在TCRP组基础上加用地屈孕酮片治疗,药物治疗6个月经周期。2组患者均随访12个月。比较2组临床疗效,治疗前、治疗6个月后、治疗后12个月血红蛋白(Hb)、血清雌二醇(E2)、子宫内膜厚度、异常子宫出血发生率,随访12个月疾病复发率及不良反应。结果联合治疗组总有效率高于TCRP组(95.00%vs.83.33%,χ^(2)=4.227,P=0.040)。治疗6个月后及治疗后12个月,2组Hb水平高于治疗前,血清E2水平低于治疗前,且联合治疗组升高/降低幅度大于TCRP组(P<0.05或P<0.01);2组子宫内膜厚度、异常子宫出血发生率低于治疗前,且联合治疗组低于TCRP组(P<0.05或P<0.01)。2组随访12个月疾病复发率、不良反应总发生率比较,差异无统计学意义(P>0.05)。结论地屈孕酮辅助TCRP治疗EP的疗效确切,可有效降低异常子宫出血发生率,改善患者贫血症状,还可有效调节雌激素水平,进而抑制子宫内膜增生,且安全性较高。

温阳化浊方对不孕症合并子宫内膜息肉患者TCRP术后妊娠结局的影响

[目的]回顾性分析温阳化浊方对不孕症合并子宫内膜息肉患者行宫腔镜子宫内膜息肉电切除术(TCRP)后妊娠结局的影响。[方法]筛选不孕症合并子宫内膜息肉患者109例作为研究对象,按照患者术后是否服用温阳化浊方进行分组,试验组71例,对照组38例。分析两组患者TCRP术后1年内的妊娠结局、子宫内膜息肉是否复发以及月经改善情况。[结果]试验组活产率、持续妊娠率、子宫内膜息肉复发率及月经改善情况优于对照组(P<0.05)。[结论]温阳化浊方可显著改善不孕症合并子宫内膜息肉患者TCRP术后的妊娠成功率,降低不孕症患者的子宫内膜息肉复发率,改善不孕症患者的月经状况。

宫腔镜手术联合曼月乐环放置治疗子宫内膜息肉临床疗效

目的 探讨宫腔镜手术联合曼月乐环放置治疗子宫内膜息肉的临床疗效。方法 将180例子宫内膜息肉患者依据治疗方法分为对照组(90例,宫腔镜手术)、试验组(90例,宫腔镜手术+曼月乐环)。治疗后,对比分析两组患者病症改善情况、不良反应及临床疗效。结果 治疗前试验组患者黄体生成激素(LH)、促卵泡生成素(FSH)、雌二醇(E2)水平及子宫内膜厚度与对照组比较差异无统计学意义(P>0.05);治疗后试验组各项指标均优于对照组(P<0.05)。试验组不良反应发生率为5.55%,显著低于对照组的15.55%(P<0.05);试验组患者的临床治疗有效率为97.78%,明显高于对照组的88.89%(P<0.05)。结论 采用宫腔镜手术联合曼月乐环放置方案治疗子宫内膜息肉能够防范子宫内膜增生等不良反应发生,有效改善临床病症,利于患者预后,疗效确切。

胰岛素抵抗和糖酵解代谢与子宫内膜息肉发生的相关性研究

目的:探讨子宫内膜息肉(EP)的发生与子宫内膜局部胰岛素抵抗和糖酵解代谢的关系。方法:选择2023年6月至2024年2月中山大学孙逸仙纪念医院妇科诊断为EP并接受宫腔镜手术的患者230例和非EP患者220例为研究对象,行OGTT及胰岛素释放试验,比较两组糖代谢异常和胰岛素抵抗的差异。从EP患者中提取EP组织及周围正常子宫内膜组织,比较两者PI3K/Akt信号通路及Glut4蛋白的表达水平,糖酵解酶和中间产物表达水平的差异。结果:1.EP组FPG、OGTT 2h、FINS、1hINS、2hINS和HOMA-IR水平均明显高于非EP组(P均<0.05)。2.EP患者中,与正常子宫内膜相比,EP组织中胰岛素诱导的激酶p-AKT(Ser473)、p-PI3K(Tyr458)表达均明显上调,p-IRS1(Ser307)、葡萄糖转运体Glut4、糖酵解代谢调节蛋白己糖激酶I(Hexo Ⅰ)、己糖激酶Ⅱ(HexoⅡ)、丙酮酸激酶M亚型1/2(PKM1/2)和血小板磷酸果糖激酶(PFKP)的表达均明显降低,乳酸脱氢酶A(LDHA)表达明显增加(P均<0.05)。结论:EP患者存在外周血胰岛素抵抗。Glut4诱导子宫内膜的局部胰岛素抵抗和糖酵解代谢功能障碍,可能导致EP形成。

李光荣活血化瘀学术思想治疗子宫内膜息肉探析

子宫内膜息肉可引起异常子宫出血、不孕,有恶变风险,术后易复发,影响女性的身心健康,属中医学“癥瘕”“不孕”范畴。李光荣教授认为女性多虚、多郁、多瘀,临床予活血化瘀学术思想治疗子宫内膜息肉。采用分级分时分类为原则的活血化瘀法,祛瘀求本、瘀湿同治、固护阴血,效果满意。

宫腔镜手术联合炔诺酮片治疗子宫内膜息肉的临床疗效及对复发率的影响

目的探讨宫腔镜手术联合炔诺酮片治疗子宫内膜息肉的临床疗效及对复发率的影响。方法选取2020年1月至2021年12月肇庆市中心人民医院收治的144例子宫内膜息肉患者作为研究对象,采用随机数字表法分为研究组与对照组,每组72例。对照组给予宫腔镜手术治疗,研究组在对照组基础上联合炔诺酮片治疗。比较两组子宫内膜厚度、血红蛋白、月经情况(月经量、月经周期)、激素指标[促卵泡素(FSH)、促黄体生成素(LH)及雌二醇(E2)]、临床疗效及术后6、12个月复发率。结果术后6个月,研究组子宫内膜厚度薄于对照组,血红蛋白水平高于对照组,差异有统计学意义(P<0.05);术后6个月,研究组月经量少于对照组,月经周期短于对照组,差异有统计学意义(P<0.05);术后6个月,研究组FSH、LH及E2水平均低于对照组,差异有统计学意义(P<0.05);研究组治疗总有效率高于对照组(88.89%vs.63.89%),差异有统计学意义(P<0.05);研究组术后6、12个月复发率均低于对照组,差异有统计学意义(P<0.05)。结论宫腔镜手术联合炔诺酮片治疗子宫内膜息肉效果显著,能有效改善患者子宫内膜厚度、血红蛋白水平、月经情况及雌、孕激素动态平衡状态,降低复发率。

体重指数、腰臀比及胰岛素抵抗与绝经后子宫内膜息肉发病的相关性分析

目的探究体重指数(BMI)、腰臀比(WHR)及胰岛素抵抗(IR)与绝经后子宫内膜息肉(EP)发病的相关性。方法选取2021年10月至2023年1月资阳市人民医院收治的180例怀疑为绝经后EP患者作为研究对象。根据病理检查结果将其分为EP组(n=90)和非EP组(n=90)。比较两组的BMI、WHR、IR发生情况、性激素水平,分析BMI、WHR及IR与绝经后EP发病的关系。结果EP组的BMI、腰围、臀围、WHR均高于对照组(P<0.05);EP组空腹血糖(FBG)、空腹胰岛素(FIN)、稳态模型胰岛素抵抗指数(HOMA-IR)水平及IR发生率均高于非EP组(P<0.05);两组黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_(2))、孕酮(P)水平比较,差异无统计学意义(P>0.05);EP患者BMI、WHR与HOMA-IR均呈正相关(P<0.05);BMI、WHR、HOMA-IR是EP发生的独立危险因素。结论BMI、WHR、HOMA-IR与绝经后EP发生均具有相关性,临床需重视肥胖、胰岛素水平过高患者,定期进行妇科检查。

宫腔镜手术配合术后孕激素治疗子宫内膜息肉患者的效果及对月经状况和复发率的影响分析

目的分析对于用宫腔镜手术治疗的子宫内膜息肉患者,配合术后孕激素治疗的效果及对月经状况和复发率的影响。方法方便选择2022年1月—2023年1月兰州市妇幼保健院收治的96例子宫内膜息肉患者为研究对象,并按照治疗方法的不同分为两组,每组48例。两组均接受宫腔镜手术治疗,在此基础上,对照组采用醋酸甲羟孕酮分散片治疗,观察组采用地屈孕酮治疗。比较两组治疗前后的月经量、月经期、子宫内膜厚度及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)表达评分,复发率、并发症发生率、临床疗效。结果治疗后3个月和6个月,观察组月经量比对照组少,且月经期比对照组短,差异有统计学意义(P均<0.05)。治疗后3个月和6个月,观察组子宫内膜厚度比对照组小,差异有统计学意义(P均<0.05)。治疗后,观察组ER表达评分低于对照组,PR表达评分高于对照组,差异有统计学意义(P均<0.05)。观察组复发率为0,低于对照组的10.00%(4/40),差异有统计学意义(χ^(2)=4.824,P<0.05)。两组的并发症发生率比较,差异无统计学意义(P>0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。结论对于子宫内膜息肉患者,在开展宫腔镜手术治疗的基础上采用孕激素类药物(地屈孕酮)加强治疗,能够调节ER、PR水平,改善月经状况和子宫内膜厚度,降低复发风险,且安全性较高,增强临床治疗效果。

经阴道彩色多普勒超声在子宫内膜病变患者中的应用价值

目的分析经阴道彩色多普勒超声在子宫内膜病变患者中的应用价值。方法选取2021年2月至2022年4月南昌大学第四附属医院收治的88例子宫内膜病变患者作为研究对象,所有患者均接受经阴道彩色多普勒超声及病理学检查,按照病理学检查结果将患者分为息肉组与癌变组,每组44例。比较两组二维超声子宫内膜情况、病灶血流动力学情况、经阴道彩色多普勒超声血流相关参数;以病理学检查结果为金标准,分析经阴道彩色多普勒超声对子宫内膜癌变的诊断效能。结果癌变组子宫内膜厚度厚于息肉组,内膜-肌层分界清晰、病灶回声均匀占比均低于息肉组,差异有统计学意义(P<0.05);癌变组血流丰富占比高于息肉组,差异有统计学意义(P<0.05);癌变组血流阻力指数(RI)、搏动指数(PI)均低于息肉组,时间平均峰值流速(TAP)慢于息肉组,差异有统计学意义(P<0.05);经阴道彩色多普勒超声对子宫内膜癌变的诊断灵敏度为86.36%,特异度为84.09%,准确度为85.23%;诊断息肉的灵敏度为84.09%,特异度为86.36%,准确度为85.23%。结论经阴道彩色多普勒超声对子宫内膜病变的诊断准确率较高,能通过血流动力学、RI、PI、TAP及影像学表现鉴别息肉或癌变。

活血化瘀方预防宫腔镜术后子宫内膜息肉复发的系统评价

目的:系统评价活血化瘀方与西药对比在预防子宫内膜息肉宫腔镜术后复发方面的有效性和安全性。统计纳入文献中的中药使用频次,探讨常用药物,为中医治疗子宫内膜息肉提供用药思路。方法:检索从建库至2023年4月20日中国知网、维普、万方数据库、中国生物医学文献数据库、PubMed及Cochrane Library数据库中收录的有关活血化瘀方预防子宫内膜息肉宫腔镜术后复发的临床随机对照试验(Randomized Controlled Trial,RCT)。依照原本制定的纳入和剔除标准,确认符合要求的文献。由2人使用Cochrane协作网制定的“偏倚风险评估工具”对文献质量进行评估后绘制图表。最后提取所需数据,导入RevMan 5.4软件进行分析。主要结局指标为子宫内膜息肉复发率,次要结局指标为不良反应发生率。用Q检验和I2检验对提取的数据进行异质性分析。复发率、不良反应发生率均为二分类变量,进行统计分析时选用相对危险度(RR),取95%可信区间(CI)。采用Excel表统计入选文献中的中药使用频次。结果:依据检索策略,检索到492篇可能符合标准的文献,再根据纳入与剔除标准,最终纳入17篇文献。活血化瘀方降低复发率的效果优于西药(P<0.00001)。中药组的不良反应发生率低于西药对照组(P<0.0001)。前10味常用药物的排序为当归、赤芍、川芎、桃仁、茯苓、丹参、炙/生甘草、白术、益母草、牡丹皮。结论:与西药治疗相比,在降低子宫内膜息肉宫腔镜术后复发率方面,中药活血化瘀方具有明显优势,而且不良反应少,比较安全。