宫腔镜手术治疗子宫内膜息肉不孕患者的临床研究
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摘要
目的探讨宫腔镜外科手术治疗子宫内膜息肉(EP)不孕的最佳方式及临床疗效。方法收集147例子宫内膜息肉不孕患者为研究对象,根据手术方式不同分为宫腔镜直视下电切术组(93例)和宫腔镜直视下摘除组(54例),探讨两组患者手术情况及住院情况的差异性,并对两组患者的术后复发率、妊娠率及并发症例数进行统计学分析。结果两组患者治愈率100%,均无术后并发症。平均住院时间、住院费用两组比较差异无统计学意义(P>0.05)。而宫腔镜直视下电切除术组平均手术时间、术中出血量、术后12个月息肉复发率及术后12个月妊娠率均优于宫腔镜直视下摘除组(P<0.05)。结论宫腔镜下电切除术治疗子宫内膜息肉不孕患者具有明显优势,手术时间短、术中出血量少、术后复发率低,同时可提升妊娠率。可作为子宫内膜息肉首选的治疗方式。
Objective To explore the best surgical method and clinical effects of hysteroscopy in treating infertile patients with endometrial polyps(EP). Methods A total of 147 cases of infertile patients with EP were collected as study objects.According to the difference of surgical methods,the patients were divided into hysteroscopic electrotomy under direct vision group(electrotomy group,n=93)and hysteroscopic excision under direct vision group(excision group,n=54).The differences in operation situation and hospitalization situation between the two groups were compared,and the postoperative recurrence rate,pregnancy rate and complication cases of the patients in the two groups were statistically analyzed. Results The cure rates of both groups were 100%,and there were no postoperative complications in both groups.There was no statistically significant difference between the two groups in average hospitalization time and hospitalization expenses(P >0.05).The mean operative time,intraoperative blood loss,and the 12-month postoperative polyps recurrence rate and 12-month postoperative pregnancy rate of the electrotomy group were all better than those of the excision group(P <0.05). Conclusion Hysteroscopic electrotomy has the advantages of shorter average operation time,less intraoperative blood loss,lower postoperative recurrence rate and higher pregnancy rate,which can be the first choice for the treatment of infertile patients with endometrial polyps.
Objective To explore the best surgical method and clinical effects of hysteroscopy in treating infertile patients with endometrial polyps(EP). Methods A total of 147 cases of infertile patients with EP were collected as study objects.According to the difference of surgical methods,the patients were divided into hysteroscopic electrotomy under direct vision group(electrotomy group,n=93)and hysteroscopic excision under direct vision group(excision group,n=54).The differences in operation situation and hospitalization situation between the two groups were compared,and the postoperative recurrence rate,pregnancy rate and complication cases of the patients in the two groups were statistically analyzed. Results The cure rates of both groups were 100%,and there were no postoperative complications in both groups.There was no statistically significant difference between the two groups in average hospitalization time and hospitalization expenses(P >0.05).The mean operative time,intraoperative blood loss,and the 12-month postoperative polyps recurrence rate and 12-month postoperative pregnancy rate of the electrotomy group were all better than those of the excision group(P <0.05). Conclusion Hysteroscopic electrotomy has the advantages of shorter average operation time,less intraoperative blood loss,lower postoperative recurrence rate and higher pregnancy rate,which can be the first choice for the treatment of infertile patients with endometrial polyps.
引文
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[3]American Association of Gynecologic Laparoscopists.AAGL Practice report:practice guidelines for the diagnosis and management of endometrial polyps[J].J Minim Invasive Gynecol,2012,19(1):3-10.
[4]Ben-Nagi J,Miell J,Yazbek J,et al.The effect of hysteroscopic polypectomy on the concentrations of endometrial implantation factors in uterine flushings[J].Reproductive Biomedicine Online,2009,19(5):737-744.
[5]任红娟.子宫内膜息肉对不孕患者妊娠状况的影响[J].中国妇幼保健,2016,31(6):1233-1236.
[6]Karayalcin R,Ozcan S,Moraloglu O,et al.Results of2500office-based diagnostic hysteroscopies before IVF[J].Reprod Biomed Online,2010,20(5):689-693.
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[8]Radwan P,Radwan M,Kozarzewski M,et al.Evaluation of sonohysterography in detecting endometrial polyps–241cases followed with office hysteroscopies combined with histopathological examination[J].Wideochir Inne Tech Maloinwazyjne,2014,9(3):344-350.
[9]李春梅,吴良芝,李玉萍,等.阴道超声与宫腔镜检查对子宫内膜息肉的诊断价值分析[J].中国妇幼保健,2011,26(17):2688-2690.
[10]李宇彬,欧建平,麦庆云,等.不孕症患者临床情况与子宫内膜息肉的关系研究[J].实用妇产科杂志,2011,27(11):852-855.
[11]Yang J H,Yang P K,Chen M J,et al.Management of endometrial polyps incidentally diagnosed during IVF:a case-control study[J].Reproductive Biomedicine Online,2017,34(3):285-290.
[12]吴佩蔚.子宫内膜息肉不孕患者宫腔镜下不同手术方式比较[J].中国妇幼保健,2015,30(6):905-907.
[13]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.
[14]张云燕.宫腔镜手术在妇科疾病中的临床应用进展[J].右江民族医学院学报,2004,26(2):286-288.
[15]李秀然.子宫内膜息肉不孕患者宫腔镜下不同治疗方式的疗效观察[J].中国妇幼保健,2012,27(17):2688-2690.
[16]栾雪峰,陈大立,侯文杰.子宫内膜息肉合并不孕症患者术后自然妊娠率及其影响因素分析[J].国际生殖健康/计划生育杂志,2017,36(4):287-290.
[2]Salim S,Won H,Nesbitt-Hawes E,et al.Diagnosis and management of endometrial polyps:a critical revew of the literature[J].Journal of Minimally Invasive Gynecology,2011,18(5):569-581.
[3]American Association of Gynecologic Laparoscopists.AAGL Practice report:practice guidelines for the diagnosis and management of endometrial polyps[J].J Minim Invasive Gynecol,2012,19(1):3-10.
[4]Ben-Nagi J,Miell J,Yazbek J,et al.The effect of hysteroscopic polypectomy on the concentrations of endometrial implantation factors in uterine flushings[J].Reproductive Biomedicine Online,2009,19(5):737-744.
[5]任红娟.子宫内膜息肉对不孕患者妊娠状况的影响[J].中国妇幼保健,2016,31(6):1233-1236.
[6]Karayalcin R,Ozcan S,Moraloglu O,et al.Results of2500office-based diagnostic hysteroscopies before IVF[J].Reprod Biomed Online,2010,20(5):689-693.
[7]夏恩兰.妇科内镜学[M].北京:人民卫生出版社,2001:558.
[8]Radwan P,Radwan M,Kozarzewski M,et al.Evaluation of sonohysterography in detecting endometrial polyps–241cases followed with office hysteroscopies combined with histopathological examination[J].Wideochir Inne Tech Maloinwazyjne,2014,9(3):344-350.
[9]李春梅,吴良芝,李玉萍,等.阴道超声与宫腔镜检查对子宫内膜息肉的诊断价值分析[J].中国妇幼保健,2011,26(17):2688-2690.
[10]李宇彬,欧建平,麦庆云,等.不孕症患者临床情况与子宫内膜息肉的关系研究[J].实用妇产科杂志,2011,27(11):852-855.
[11]Yang J H,Yang P K,Chen M J,et al.Management of endometrial polyps incidentally diagnosed during IVF:a case-control study[J].Reproductive Biomedicine Online,2017,34(3):285-290.
[12]吴佩蔚.子宫内膜息肉不孕患者宫腔镜下不同手术方式比较[J].中国妇幼保健,2015,30(6):905-907.
[13]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.
[14]张云燕.宫腔镜手术在妇科疾病中的临床应用进展[J].右江民族医学院学报,2004,26(2):286-288.
[15]李秀然.子宫内膜息肉不孕患者宫腔镜下不同治疗方式的疗效观察[J].中国妇幼保健,2012,27(17):2688-2690.
[16]栾雪峰,陈大立,侯文杰.子宫内膜息肉合并不孕症患者术后自然妊娠率及其影响因素分析[J].国际生殖健康/计划生育杂志,2017,36(4):287-290.