宫腔镜手术联合孕激素对多发性子宫内膜息肉术后复发的影响

目的探讨宫腔镜下多发性子宫内膜息肉切除术后应用孕激素预防息肉复发的临床疗效。方法将2012年1月至2013年7月在内蒙古医科大学附属医院行宫腔镜诊治的94例多发性子宫内膜息肉患者分为观察组和对照组各47例,观察组术后予以安宫黄体酮周期性治疗3个月,对照组术后予以随访观察。比较两组患者术后6、12、24个月息肉复发、血红蛋白水平、子宫内膜厚度以及妊娠情况。结果观察组术后子宫内膜息肉的复发率为4.3%,明显低于对照组的17.4%,差异有统计学意义(P0.05);观察组患者术后6、12、24个月的血红蛋白水平均明显高于对照组,而术后6、12、24个月的子宫内膜厚度均低于对照组,差异均有统计学意义(P0.05),两组之间的妊娠率的差异无统计学意义(P0.05)。结论宫腔镜联合孕激素治疗多发性子宫内膜息肉能有效的防止息肉的复发,同时亦能改善其术后血红蛋白水平,降低子宫内膜厚度,改善患者生活质量。     

子宫内膜息肉伴胰岛素抵抗患者应用二甲双胍治疗后的疗效分析

目的分析子宫内膜息肉伴胰岛素抵抗患者的临床及内分泌代谢特征,探讨二甲双胍对于治疗子宫内膜息肉伴胰岛素抵抗患者的临床疗效。方法选取伴胰岛素抵抗并经宫腔镜检查病理证实为子宫内膜息肉患者112例,患者知情同意并选择术后处理方式,56例于术后给予二甲双胍片(二甲双胍组)6个月,其中单发性息肉40例,多发性息肉16例;56例不给予任何处理(对照组),其中单发性息肉42例,多发性息肉14例,观察两组患者随访2年后胰岛素抵抗改善状况及子宫内膜息肉复发。结果 112例患者手术均顺利实施,二甲双胍组体质指数(BMI)、腰围/臀围比(WHR)、空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)与对照组比较均降低(P0.05);二甲双胍组子宫内膜厚度[(8.37±1.41)mm]与对照组[(11.45±0.61)mm]比较,差异有统计学意义(P0.05)。二甲双胍组术后随访(1.44±0.47)年,对照组术后随访(1.49±0.46)年,差异无统计学意义(P0.05)。二甲双胍组术后2年多发性子宫内膜息肉复发2例,复发率3.57%,对照组术后复发20例,复发率35.71%,其中单发息肉7例,多发息肉13例,两者比较,差异有统计学意义(P0.05)。结论子宫内膜息肉伴胰岛素抵抗患者宫腔镜术后服用二甲双胍可能有助于改善其胰岛素抵抗现象,并有助于预防子宫内膜息肉的复发。     

左炔诺孕酮宫内缓释系统预防子宫内膜息肉复发的疗效分析

目的探讨宫腔镜下子宫内膜息肉电切术后应用左炔诺孕酮宫内缓释系统(LNG-IUS)预防子宫内膜息肉复发的疗效。方法将2009年8月-2011年8月郑州大学第一附属医院因子宫内膜息肉行宫腔镜下子宫内膜息肉电切术的60例患者,采用完全随机化分组法分为研究组(30例,术后放置LNG-IUS)和对照组(30例,术后未行特殊处理)。随访比较两组患者术后6、12、24个月子宫内膜息肉复发、血红蛋白水平和子宫内膜厚度。结果研究组患者治疗后24个月血红蛋白水平[(120.15±9.51)]g/L显著增加(P0.05);术后6、12、24个月子宫内膜厚度[(0.57±0.14)mm、(0.79±0.21)mm、(0.93±0.22)mm]均低于治疗前[(1.46±0.56)mm](P0.05);术后24个月子宫内膜息肉的复发率(6.90%,2/29)与对照组(39.29%,11/28)比较,差异有统计学意义(P0.05)。所有患者术后均无严重并发症发生,术后24个月随访,研究组2例(6.90%,2/29)患者有阴道淋漓出血。结论左炔诺孕酮宫内缓释系统能有效预防子宫内膜息肉复发,值得在临床推广。     

177例不孕症患者宫腔镜下子宫内膜息肉摘除术的临床疗效分析

目的:探讨宫腔镜下子宫内膜息肉摘除术对不孕患者生育功能的改善和治疗效果。方法:对177例子宫内膜息肉(endometrial polyp,EP)的不孕患者(研究组)行宫腔镜下内膜息肉摘除结合刮宫术,术后追踪观察EP复发情况,并与374例同期行宫腔镜检查提示宫腔正常的不孕患者(对照组)进行术后妊娠情况的比较。结果:术后妊娠率研究组(25.99%,46/177)与对照组(29.14%,109/374)无差异,术后平均获得妊娠时间研究组为4.8±3.8个月,对照组为5.0±3.9个月,组间也无统计学差别(P>0.05)。研究组中131例EP患者未妊娠,另76例于术后1￣36个月进行了第二次宫腔镜检查:结果宫腔正常53例,EP复发23例。结论:子宫内膜息肉是引起不孕症的主要宫腔病因之一,宫腔镜下子宫内膜息肉摘除术可去除病因,使患者获得妊娠。     

黄体酮胶囊联合宫腔镜冷刀切除术治疗子宫内膜息肉的临床疗效

目的 探讨黄体酮胶囊联合宫腔镜冷刀切除术治疗子宫内膜息肉的临床疗效。方法 选取150例子宫内膜息肉患者为研究对象,随机分为对照组（72例）、试验组（78例）。对照组采用宫腔镜冷刀切除术治疗,试验组采用黄体酮胶囊联合宫腔镜冷刀切除术治疗,比较两组的月经情况、经前子宫内膜厚度、妊娠情况及复发情况。结果 术后3个月,试验组月经失血图评分低于对照组,经前子宫内膜厚度小于对照组,差异有统计学意义（P<0.05）;试验组妊娠率高于对照组,复发率低于对照组,差异有统计学意义（P<0.05）。结论 黄体酮胶囊联合宫腔镜冷刀切除术治疗子宫内膜息肉效果显著,可有效降低月经量评分及子宫内膜厚度,提高妊娠率,减少术后复发率。     

宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效观察

目的探讨宫腔镜下不同手术方式治疗子宫内膜息肉的疗效。方法对不同年龄和不同生育要求的子宫内膜息肉患者327例,分别行子宫内膜息肉切除+子宫内膜汽化电切术(A组,53例);子宫内膜息肉切除+子宫内膜电切术(B组,175例);子宫内膜息肉切除+息肉旁浅层内膜切除术(C组,54例,要求保留生育功能者);子宫内膜息肉切除+子宫内膜电凝术(D组,45例,绝经后患者)。结果手术时间:A组(15·1±0·8)s,B组(19·7±0·7)s,C组(20·9±0·7)s,D组(22·1±0·8)s,A组平均手术时间与其他3组比较,差异有统计学意义(P<0·01);术后子宫内膜息肉复发率:A、D组为0,B组为1·7%(3/175),C组为7·4%(4/54),C组术后复发率与其他3组分别比较,差异均有统计学意义(P<0·05);C组术后无闭经者,但术后息肉复发率高于其他3组,C组中有14例术后5~23个月妊娠。结论宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效无明显差异,但子宫内膜息肉切除+息肉旁浅层内膜切除术后复发率高;应根据患者年龄、生育要求等选择适宜的宫腔镜下手术方式。     

子宫内膜息肉治疗后预防复发策略

宫腔镜手术是子宫内膜息肉治疗的最佳手术方案,反对单纯诊刮这类盲操作。宫腔镜手术术中同时行息肉切除与子宫内膜去除术能降低其复发率,并能预防接受他莫昔芬治疗的乳腺癌患者子宫内膜息肉复发。     

宫腔镜手术联合孕激素治疗子宫内膜息肉的效果观察

目的 分析宫腔镜手术联合孕激素治疗子宫内膜息肉的效果。方法 选取80例子宫内膜息肉患者,根据随机数字表法将其分成两组,各40例。两组均采取宫腔镜手术,研究组术后服用地屈孕酮。比较两组临床效果。结果 研究组的宫颈粘连发生率5.00%、复发率2.50%均分别低于对照组的20.00%、15.00%(P<0.05)。术后,两组的月经周期、月经失血图评分、血红蛋白水平和子宫内膜厚度均明显改善,且研究组的月经周期短于对照组,月经失血图评分低于对照组,血红蛋白水平高于对照组,子宫内膜厚度明显薄于对照组（P<0.05）。术后,两组的血清白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)及C-反应蛋白（CRP）水平均明显降低,且研究组明显低于对照组（P<0.05）。结论 宫腔镜手术联合孕激素治疗子宫内膜息肉的效果确切,值得临床推广。     

宫腔镜下子宫内膜息肉切除术后两种不同方法预防息肉复发的效果比较

目的对比左炔诺孕酮宫内缓释系统曼月乐与地屈孕酮预防宫腔镜下子宫内膜息肉切除术(transcervical resection of polyp, TCRP)术后复发的效果。方法从我院2017年1月至2018年7月间收治的子宫内膜息肉患者中随机选取150例,随机分为对照组(TCRP)、地屈孕酮组(TCRP+地屈孕酮)和曼月乐组(TCRP+曼月乐)各50例。观察月经量、月经出血模式恢复情况、子宫内膜厚度的变化、复发情况及不良反应情况。结果研究组治疗后各时间点的月经量均明显低于对照组,曼月乐组更为显著(P 0.05);研究组患者治疗后12、18个月的子宫内膜厚度明显低于对照组;术后随访18个月,研究组正常月经出血模式恢复率好于对照组,曼月乐组更为显著(P 0.05);研究组子宫内膜息肉复发率明显低于对照组,且曼月乐组复发率更低(P0.05);两组不良反应相比无统计学差异(P0.05)。结论 TCRP术后联合使用曼月乐或地屈孕酮均可降低子宫内膜厚度,减少月经出血量,有助于异常月经出血模式恢复正常,有效减少术后息肉复发情况。曼月乐较地屈孕酮组表现出明显优势。     

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临床疗效分析

目的:探讨宫腔镜子宫内膜息肉电切术(TCRP)联合左炔诺孕酮宫内缓释系统(曼月乐宫内节育器)治疗子宫内膜息肉(EMP)的临床效果。方法:选择2013年1月~12月在我院行TCRP且合并中度贫血的EMP患者120例,由患者知情并选择术后处理方式,60例于术后1周宫腔内放置曼月乐(曼月乐组),其中单发性息肉42例,多发性息肉18例;60例不进行任何处理(对照组),其中单发性息肉45例,多发性息肉15例。术后6、12、24个月随访。比较两组的血红蛋白、子宫内膜厚度、子宫内膜息肉复发以及不良反应情况。结果:120例患者手术均顺利完成。曼月乐组术后6、12、24个月血红蛋白水平均高于对照组,差异有统计学意义(P0.001)。曼月乐组术后6、12、24个月的子宫内膜厚度[(0.58±0.16)mm、(0.88±0.14)mm、(1.19±0.26)mm]均低于对照组[(0.60±0.18)mm、(0.96±0.11)mm、(1.21±0.28)mm],差异均有统计学意义(P0.05)。曼月乐组术后2年4例多发性息肉复发,累计复发率为6.67%;对照组复发15例,复发率为25%,单发性息肉5例,多发性息肉10例。两组的复发率比较,差异有统计学意义(P0.05)。所有患者术后均无严重并发症发生,曼月乐组有15例患者有不规则阴道出血,未经任何治疗,6个月后自然恢复。结论:TCRP辅以左炔诺孕酮宫内缓释系统可提高血红蛋白水平,减少内膜厚度,降低内膜息肉复发率。     

Treatment of endometrial polyps

OBJECTIVE: To determine the effectiveness of different treatments for abnormal uterine bleeding in women with known endometrial polyps. METHODS: We retrospectively assessed the effectiveness of polypectomy and other treatments of women with abnormal uterine bleeding who had benign polyps detected by sonohysterography. Women with endometrial polyps diagnosed by sonohysterography between January 1997 and July 1998 were sent questionnaires on pretreatment and posttreatment uterine bleeding and satisfaction with their treatments. Charts were reviewed to validate questionnaire responses and determine treatments administered. RESULTS: Seventy-eight women had endometrial polyps by sonohysterography, and 60 of them (77%) responded to the questionnaire. Two with endometrial adenocarcinoma were excluded. The average age of the remaining 58 was 49 years; 37 (64%) were premenopausal and 21 (36%) postmenopausal. The average time from treatment to follow-up was 13 months (range 5-24 months). Participants were grouped according to the following treatments: polypectomy, polypectomy plus endometrial ablation, polypectomy plus hysteroscopic myomectomy, hysterectomy, D&C, and nonsurgical treatment. The most frequent treatment was polypectomy (n = 26). Polypectomy, polypectomy plus endometrial ablation, polypectomy plus myomectomy, and hysterectomy each resulted in at least a twofold decrease in the number of bleeding days per month and led to high satisfaction rates. CONCLUSION: Our results showed that simple polypectomy and more invasive surgical procedures led to subjective improvement in symptoms of menorrhagia and metrorrhagia and a high satisfaction rate in women with endometrial polyps.     

Pregnancy rates after hysteroscopic polypectomy depending on the size or number of the polyps

Objective To assess the reproductive benefits of hysteroscopic polypectomy in previous infertile women depending on the size or number of the polyps. Design and methods In this retrospective study, from February 2000 to September 2005, totally 83 selected women were included with: a) diagnoses of primary or secondary infertility, endometrial polyp/polyps and abnormal uterine bleeding. Endometrial polyps were diagnosed by transvaginal ultrasound followed by diagnostic hysteroscopy, to confirm diagnosis, and hysteroscopic polypectomy. All 83 subjects who consisted the study group, met inclusion criteria: age under 35 years, at least 12 months of infertility, from 3 to 8 months menstrual disorders (intermenstrual bleeding or spotting, menometrorrhagia or menorrhagia) and from 3 to 18 months of follow-up with attempts to conceive after hysteroscopic polypectomy. The endometrial polyp/polyps appeared to be the only reason to explain their infertility after infertility workup of the couples. There was a comparison of fertility rates after hysteroscopic polypectomy between patients having endometrial polyp ≤ 1 cm and patients with bigger or multiple polyps. Results Of the 83 subjects, all were found to have endometrial polyps in diagnostic hysteroscopy, confirmed at histologic examination after hysteroscopic polypectomy. Among patients of the study group, there were no significant differences in age, type or length of infertility, or follow-up period after the procedure. The mean size of the endometrial polyps was 1.9 ± 1.4.cm. Thirty-one patients had endometrial polyp ≤ 1 cm and 52 patients had bigger or multiple endometrial polyps. Following polypectomy, menstrual pattern was normalized in 91.6% of patients. Spontaneous pregnancy and delivery at term rates, in the total population of the study, increased after the procedure and were 61.4% and 54.2% respectively. There was no statistical difference in fertility rates between patients having polyps ≤ 1 cm and patients having >1 cm polyps or multiple polyps. Spontaneous abortion rate in the first trimester of pregnancy was 6% of the total number of patients and there was no statistical difference between patients with small or bigger/multiple polyps. Type of infertility did not affect fertility rates after hysteroscopic polypectomy. Complication rate after hysteroscopic polypectomy was as low as 2.4%, while recurrence rate of the procedure reached 4.9% of patients. Conclusion Hysteroscopic polypectomy of endometrial polyps appeared to improve fertility and increase pregnancy rates in previous infertile women with no other reason to explain their infertility, irrespective of the size or number of the polyps. Type of infertility of patients seems not to affect fertility rates after hysteroscopic polypectomy. Menstrual pattern was normalized in the majority of patients after hysteroscopic polypectomy. In addition, hysteroscopic polypectomy is a safe procedure with low complication rate.     

Three-year follow-up results of polypectomy with endometrial ablation in the management of endometrial polyps associated with tamoxifen in Chinese women

Objective

The aim of this study was to investigate the role of hysteroscopic polypectomy with endometrial ablation in the management of tamoxifen-associated endometrial polyps in postmenopausal women with a more than 3-year follow-up period.

Study design

The medical records of 76 postmenopausal patients on tamoxifen who were performed hysteroscopic polypectomy with endometrial ablation were evaluated more than 3 years after the procedure with recurrence of polyps, recurrent abnormal uterine bleeding and surgical re-intervention.

Results

Average follow-up period was 74.91 ± 20.84 months. No patient underwent hysterectomy, 7 of 76 patients had a surgical re-intervention representing a total of 90.8% avoidance of additional surgery during the follow-up period, and 4 patients had a recurrent endometrial polyp representing the recurrence rate was 5.3%. 3 of 41 patients with postmenopausal bleeding had a recurrent abnormal uterine bleeding representing symptomatic relief rate is 92.7%. The treatment failed in 7 patients who requested surgical re-intervention: 4 patients requested a repeat polypectomy and ablation, 1 patient requested a repeat ablation and 2 patients requested a repeat hysteroscopy with uterine adhesion. No malignant endometrial pathological result was found.

Conclusions

For postmenopausal patients suffering from endometrial polyps associated with tamoxifen, hysteroscopic polypectomy with endometrial ablation continues to be proven as a safe and effective minimally invasive treatment method. The high rate of surgical re-intervention avoidance, great symptomatic relief and low recurrence rate are very encouraging for this technology.     

Evaluation of endometrial polyps

OBJECTIVE: Endometrial polyps are relatively common in all groups of women. More polyps are being diagnosed with the widespread use of transvaginal ultrasound scanning and sonohysterography. The reported incidence of malignancy is low. The potential benefit of a noninvasive technique to distinguish benign from malignant polyps is obvious. This study was undertaken to evaluate endometrial polyps by color flow Doppler ultrasound scanning and histopathologic examination. STUDY DESIGN: This was an observational study of patients with an endometrial polyp on sonohysterography who underwent interrogation of their polyp with color Doppler ultrasound scanning and subsequently polypectomy. Polyp volume, resistive index, pulsatility index, indication for scan (bleeding vs incidental), and patient age were correlated with histopathologic type of the polyp (nonfunctional, proliferative, secretory, hyperplastic, or malignant). RESULTS: Of 61 patients studied, 42 patients (68.9%) were scanned for abnormal bleeding, and 19 patients (31.1%) had their polyps discovered incidentally. There were no statistically significant differences between histologic categories and the resistive index, pulsatility index, or size of the polyp. The age of patients with nonfunctional polyps was significantly greater than any other group (P <.001). Ninety-four percent of the functional polyps were discovered because of abnormal bleeding; 38% of the nonfunctional polyps were discovered incidentally (P <.001). CONCLUSION: The data suggest that the objective assessment of blood flow impedance (resistive index, pulsatility index) in endometrial polyps and the size of these polyps cannot replace surgical removal and pathologic evaluation to predict histologic type. Patients with nonfunctional polyps were older and less likely to have vaginal bleeding.     

Management of endometrial polyps diagnosed before or during ICSI cycles

This retrospective study aimed to shed light on the management options of endometrial polyps diagnosed before or during intracytoplasmic sperm injection (ICSI) treatment. The study included all fresh ICSI cycles performed in the Anatolia IVF Center between July 2005 and January 2009. Group 1 consisted of 47 patients who were diagnosed with an endometrial polyp before their ICSI cycle. All patients diagnosed with an endometrial polyp by transvaginal ultrasonography before the ICSI cycle underwent hysteroscopic polyp resection. Group 1 was compared with 47 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 2). Group 3 included 128 patients diagnosed with an endometrial polyp during stimulation in their ICSI cycles. Group 3 was compared with 128 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 4). Patients diagnosed with an endometrial polyp before ICSI cycles were similar to their controls with regard to clinical pregnancy (29.8% versus 38.3%) and live-birth (25.5% versus 31.9%) rates per transfer, as were patients diagnosed with an endometrial polyp during ovarian stimulation (clinical pregnancy rates 45.3% versus 46.9%; live-birth rates 40.6% versus 39.8%). In conclusion, further studies are required to identify the most appropriate management of endometrial polyps.     

Risk factors associated with endometrial polyps in abnormal uterine bleeding.

OBJECTIVES: To evaluate the significance of various risk factors associated with endometrial polyps in women with abnormal uterine bleeding. METHODS: A prospective cohort study of 248 consecutive patients evaluated for abnormal uterine bleeding in a Rapid Access Ambulatory Diagnostic (RAAD) clinic was carried out from 1996 to 1997. Endometrial polyps were diagnosed using outpatient hysteroscopy and their histological nature was confirmed in all patients by performing inpatient polypectomy. Multivariate logistic regression modeling was used to evaluate the effects of age, parity, menopausal status, hormone replacement therapy and tamoxifen treatment on the occurrence of polyps. RESULTS: In an analysis adjusted for the effects of age, parity and menopausal status, tamoxifen treatment was associated with endometrial polyps (adjusted odds ratio 11.21, 95% confidence interval 2.70-46.46, P=0.0009) but hormone replacement therapy was not (adjusted odds ratio 1.48, 95% confidence interval 0.68-3.20, P=0.32). CONCLUSION: Our study confirmed that tamoxifen is associated with endometrial polyps. However, it rejects the hypothesis that hormone replacement therapy is a risk factor for endometrial polyps.     

宫腔镜手术治疗子宫内膜息肉的临床分析

目的　探讨宫腔镜手术治疗子宫内膜息肉的临床效果。方法　因子宫内膜息肉行各类宫腔镜手术 10 9例 ,其中绝经后子宫内膜息肉 15例、生育期子宫内膜息肉 94例。 10 9例中合并月经紊乱 84例、贫血 34例、痛经 16例、原发不孕 3例、继发不孕 2例。患者年龄 2 6～ 73岁 ,平均 (45± 9)岁 ;随访时间 3～ 2 2个月 ,平均 (12± 5 )个月。月经紊乱者在术前和术后分别填写月经失血图以评估月经血量。结果　 10 9例中 ,单纯息肉切除 35例 ,息肉切除同时浅层内膜切除 9例 ,息肉切除同时内膜切除 6 3例 ,息肉切除同时内膜剥除 2例。 84例月经紊乱者术后闭经 14例、阴道点滴出血 2 6例 ,其余 4 4例月经血量均较术前减少。 34例术前贫血患者 ,术后 1个月血红蛋白即恢复正常。 16例痛经者术后 7例症状消失、7例缓解、2例加重。 5例不孕者术后 4例妊娠。 15例绝经后患者术后无异常出血。结论　有月经改变且无生育要求者 ,息肉切除同时应行子宫内膜电切术 ,可避免息肉复发 ;需保留生育功能的患者 ,可行单纯息肉切除 ,如合并内膜息肉样增生 ,应同时行浅层内膜切除 ;绝经后患者 ,可行单纯息肉切除 ,如合并内膜息肉样增生 ,应同时行子宫内膜剥除。     

宫腔镜和超声波对子宫内膜息肉诊断价值的比较

目的：探讨宫腔镜与超声波在诊断子宫内膜息肉上的价值，为子宫内膜息肉的诊断提供参考依据。方法：调查2004年12月至2010年12月在广州某医院进行妇科检查的患者1338例，患者均进行超声、宫腔镜及诊刮后送病理检查，以病理检查作为金标准，超声波和宫腔镜的诊断结果与之进行比较。结果：病理诊断子宫内膜息肉428例，超声诊断子宫内膜息肉的灵敏度、特异度、正确指数分别为61．21％、91．87％、0．53；宫腔镜诊断子宫内膜息肉的灵敏度、特异度、正确指数分别为95．33％、99．23％、0．95，两种检验方法比较差异有统计学意义（P〈0．01）。超声波与宫腔镜联合检查和超声检查诊断子宫内膜息肉的比较中，超声波的检出率为61．45％，超声波与宫腔镜联合检出率为99．30％，两种检验方法比较差异有统计学意义（P〈0．01）。结论：超声波是一种无创伤、操作简单的检查方法，可作为子宫内膜息肉的筛查手段，但漏诊率偏高。宫腔镜诊断的符合率高，准确且直观，但操作较繁杂。超声波与宫腔镜联合检查可弥补各自的缺陷，是诊断子宫内膜息肉的较好的方法。