宫腔镜下息肉电切术对子宫内膜息肉合并不孕症患者的临床疗效、复发及术后妊娠结局的影响
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摘要
目的观察宫腔镜下子宫内膜息肉电切术(TCRP)治疗子宫内膜息肉(EP)伴不孕症的临床疗效,对复发和妊娠结局的影响。方法选取我院在2015年1月—2016年11月收治的EP伴不孕82例,按手术方法分为观察组和对照组,每组41例。观察组给予TCRP,对照组给予宫腔镜下刮宫术;观察2组围手术期指标、术后月经量,术后1年复发及妊娠情况。结果 2组手术时间、术中出血量、住院时间和围手术期并发症比较差异无统计学意义(P>0. 05)。2组术后月经量较术前减少,且术后3个观察组月经量少于对照组(P <0. 05)。观察组术后6个月复发率低于对照组,术后6～12个月内妊娠成功率高于对照组(P <0. 05)。结论宫腔镜子宫内膜息肉电切术治疗EP合并不孕症疗效显著,可改善患者月经情况,降低复发率,促进再孕。
Objective To observe clinical efficacy of hysteroscopes-guide transcervical resection of polyps( TCRP) in treatment of patients with endometrial polyps( EP) associated by infertility and to evaluate effects of recurrence and pregnancy outcome. Methods A total of 82 EP patients with infertility admitted during January 2015 and November 2016 were divided into observation group and control group( n = 41 for each group) according to operative methods. Observation group was given TCRP surgery,while control group was treated with hysteroscopes-guide uterine curetlage. In two groups,perioperative indexes,postoperative menstrual blood volume,conditions of recurrence and pregnancy in 1 year after surgery were observed. Results There were no significant differences in operative time,intraoperative blood loss,hospital stay and incidence rate of peroperative complications between two groups( P > 0. 05). Menstruation volumes after surgery were significantly less than those before surgery in two groups,and the volumes in 3rdmonth after surgery in observation group was significantly less than that that in control group( P < 0. 05). In observation group recurrence rate in 6thafter surgery was significantly lower. while pregnancy success rate from 6thmonth to 12 thmonth after surgery was significantly higher than those in control group( P < 0. 05). While the positive rates of VEGF and TGF-β after treatment were significantly lower than those in control group( P < 0. 05). Conclusion Hysteroscopes-guide TCRP in treatment of patients with EP associated by infertility may improve menstruation condition,reduce recurrence rate and promote re-pregnancy.
Objective To observe clinical efficacy of hysteroscopes-guide transcervical resection of polyps( TCRP) in treatment of patients with endometrial polyps( EP) associated by infertility and to evaluate effects of recurrence and pregnancy outcome. Methods A total of 82 EP patients with infertility admitted during January 2015 and November 2016 were divided into observation group and control group( n = 41 for each group) according to operative methods. Observation group was given TCRP surgery,while control group was treated with hysteroscopes-guide uterine curetlage. In two groups,perioperative indexes,postoperative menstrual blood volume,conditions of recurrence and pregnancy in 1 year after surgery were observed. Results There were no significant differences in operative time,intraoperative blood loss,hospital stay and incidence rate of peroperative complications between two groups( P > 0. 05). Menstruation volumes after surgery were significantly less than those before surgery in two groups,and the volumes in 3rdmonth after surgery in observation group was significantly less than that that in control group( P < 0. 05). In observation group recurrence rate in 6thafter surgery was significantly lower. while pregnancy success rate from 6thmonth to 12 thmonth after surgery was significantly higher than those in control group( P < 0. 05). While the positive rates of VEGF and TGF-β after treatment were significantly lower than those in control group( P < 0. 05). Conclusion Hysteroscopes-guide TCRP in treatment of patients with EP associated by infertility may improve menstruation condition,reduce recurrence rate and promote re-pregnancy.
引文
[1]吴阳春,段丽平.三种不同术式治疗子宫息肉疗效对比研究[J].中国性科学,2016,25(6):35-37.
[2]于筱卿.宫腔镜下子宫内膜电切治疗多发性子宫内膜息肉的效果观察[J].中国妇幼健康研究,2016,27(11):1387-1389.
[3] Yang J H,Chen C D,Chen S U,et al. Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy[J]. PLo S One,2015,10(12):e0144857.
[4]王娟,李燕,马俊旗.宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉的效果及安全性分析[J].中国妇幼保健,2017,32(9):2035-2037.
[5]夏恩兰.妇科内镜学[M].北京:人民卫生出版社,2001:71-72.
[6] Wortman M."See-and-Treat"Hysteroscopy in the Management of Endometrial Polyps[J]. Surg Technol Int,2016,28:177-184.
[7] Seto MT,Ip P P,Ngu S F,et al. Positive predictive value of endometrial polyps in Pipelle aspiration sampling:a histopathological study of 195 cases[J]. Eur J Obstet Gynecol Reprod Biol,2016,203:12-15.
[8]任美杰,杨敬春,杜岚,吴静.静脉声学造影与经阴道彩色多普勒超声诊断子宫内膜息肉价值的比较[J].首都医科大学学报,2017,38(4):620-625.
[9]张虹,杨悦,董文辉,等.子宫内膜息肉173例临床特征分析[J].中国综合临床,2015,31(11):1044-1046.
[10] Spadoto-Dias D,Bueloni-Dias F N,Elias L V,et al.The value of hysteroscopic biopsy in the diagnosis of endometrial polyps[J]. Womens Health(Lond),2016,12(4):412-419.
[11]侯晓凤,汪紫燕,陈薇.宫腔镜下电切术治疗子宫内膜息肉的临床效果观察[J].当代医学,2018,24(6):111-113.
[12] Martinez M R,Marazuela M A,Vallejo M R,et al. Metastasis of lobular breast cancer to endometrial polyps with and without the presence of vaginal bleeding[J]. Int J Gynaecol Obstet,2016,134(1):101-102.
[13] Troncon J K,Zani A C,Candido-Dos-Reis F J,et al.Endometrial Polyps-When Should Hysteroscopic Resection Be Performed?[J]. Rev Bras Ginecol Obstet,2016,38(7):315-316.
[14] Radowicka M,Legutowska E,Gajewska M,et al. Histopathological evaluation of intrauterine polyps and scrapings of the uterine cavity in women with endometrial polyp described in ultrasound[J]. Neuro Endocrinol Lett,2016,37(7):518-522.
[15] Bittencourt CA,Dos SSR,Bernardo W M,et al. Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding:systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol,2017,50(1):32-39.
[16] Clark T J,Stevenson H. Endometrial Polyps and Abnormal Uterine Bleeding(AUB-P):What is the relationship,how are they diagnosed and how are they treated?[J]. Best Pract Res Clin Obstet Gynaecol,2017,40:89-104.
[17]郭华峰,郭宝芝,方明珠.宫腔镜检查及手术治疗不孕症的临床意义[J].中国妇幼保健,2016,31(6):1238-1240.
[18]尹聪,白文佩,顾蓓,等.宫腔镜直视冷刀切除绝经后子宫内膜息肉的评价[J].中国妇幼健康研究,2018,(1):107-109.
[19]张艳青.宫腔镜子宫内膜息肉切除后EP合并不孕患者的妊娠结局及影响因素分析[J].中国妇产科临床杂志,2017,18(1):69-70.
[20]牛婧雅,顾倪浩,袁瑞.关于子宫内膜息肉和内膜息肉切除术对不孕症患者妊娠率影响的系统评价[J].重庆医科大学学报,2016,41(3):286-291.
[2]于筱卿.宫腔镜下子宫内膜电切治疗多发性子宫内膜息肉的效果观察[J].中国妇幼健康研究,2016,27(11):1387-1389.
[3] Yang J H,Chen C D,Chen S U,et al. Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy[J]. PLo S One,2015,10(12):e0144857.
[4]王娟,李燕,马俊旗.宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉的效果及安全性分析[J].中国妇幼保健,2017,32(9):2035-2037.
[5]夏恩兰.妇科内镜学[M].北京:人民卫生出版社,2001:71-72.
[6] Wortman M."See-and-Treat"Hysteroscopy in the Management of Endometrial Polyps[J]. Surg Technol Int,2016,28:177-184.
[7] Seto MT,Ip P P,Ngu S F,et al. Positive predictive value of endometrial polyps in Pipelle aspiration sampling:a histopathological study of 195 cases[J]. Eur J Obstet Gynecol Reprod Biol,2016,203:12-15.
[8]任美杰,杨敬春,杜岚,吴静.静脉声学造影与经阴道彩色多普勒超声诊断子宫内膜息肉价值的比较[J].首都医科大学学报,2017,38(4):620-625.
[9]张虹,杨悦,董文辉,等.子宫内膜息肉173例临床特征分析[J].中国综合临床,2015,31(11):1044-1046.
[10] Spadoto-Dias D,Bueloni-Dias F N,Elias L V,et al.The value of hysteroscopic biopsy in the diagnosis of endometrial polyps[J]. Womens Health(Lond),2016,12(4):412-419.
[11]侯晓凤,汪紫燕,陈薇.宫腔镜下电切术治疗子宫内膜息肉的临床效果观察[J].当代医学,2018,24(6):111-113.
[12] Martinez M R,Marazuela M A,Vallejo M R,et al. Metastasis of lobular breast cancer to endometrial polyps with and without the presence of vaginal bleeding[J]. Int J Gynaecol Obstet,2016,134(1):101-102.
[13] Troncon J K,Zani A C,Candido-Dos-Reis F J,et al.Endometrial Polyps-When Should Hysteroscopic Resection Be Performed?[J]. Rev Bras Ginecol Obstet,2016,38(7):315-316.
[14] Radowicka M,Legutowska E,Gajewska M,et al. Histopathological evaluation of intrauterine polyps and scrapings of the uterine cavity in women with endometrial polyp described in ultrasound[J]. Neuro Endocrinol Lett,2016,37(7):518-522.
[15] Bittencourt CA,Dos SSR,Bernardo W M,et al. Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding:systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol,2017,50(1):32-39.
[16] Clark T J,Stevenson H. Endometrial Polyps and Abnormal Uterine Bleeding(AUB-P):What is the relationship,how are they diagnosed and how are they treated?[J]. Best Pract Res Clin Obstet Gynaecol,2017,40:89-104.
[17]郭华峰,郭宝芝,方明珠.宫腔镜检查及手术治疗不孕症的临床意义[J].中国妇幼保健,2016,31(6):1238-1240.
[18]尹聪,白文佩,顾蓓,等.宫腔镜直视冷刀切除绝经后子宫内膜息肉的评价[J].中国妇幼健康研究,2018,(1):107-109.
[19]张艳青.宫腔镜子宫内膜息肉切除后EP合并不孕患者的妊娠结局及影响因素分析[J].中国妇产科临床杂志,2017,18(1):69-70.
[20]牛婧雅,顾倪浩,袁瑞.关于子宫内膜息肉和内膜息肉切除术对不孕症患者妊娠率影响的系统评价[J].重庆医科大学学报,2016,41(3):286-291.