子宫内膜息肉患者宫腔镜术后应用左炔诺孕酮宫内节育系统或炔雌醇环丙孕酮的临床效果及对病情复发的影响

目的探讨子宫内膜息肉患者宫腔镜术后应用左炔诺孕酮宫内节育系统或炔雌醇环丙孕酮的临床效果及对病情复发的影响。方法选取2017年1月—2018年1月收治的择期行宫腔镜手术治疗的子宫内膜息肉80例,按照术后治疗方式的不同,分为观察组与对照组,每组各40例。观察组术后宫底部放置左炔诺孕酮宫内节育系统,对照组术后口服炔雌醇环丙3个疗程。比较术前及术后3、6、12个月的子宫内膜厚度,观察术前、术后12个月的雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)表达情况,采用月经失血图(pictorial blood loss assessment chart,PBAC)评分评定术前及术后3、6、12个月的月经恢复情况,记录术后6、12个月病情复发情况,观察不良反应发生情况。结果与对照组比较,观察组术后3、6、12个月子宫内膜厚度降低,术后3个月PBAC评分升高,差异有统计学意义(P<0.01)。与对照组比较,观察组术后12个月ER阳性率降低,差异有统计学意义(P<0.05);与本组术前比较,两组术后12个月ER阳性率显著降低,差异有统计学意义(P<0.01)。观察组术后12个月的病情复发率及病情总复发率均低于对照组,比较差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P=0.556)。结论子宫内膜息肉患者术后应用左炔诺孕酮宫内节育系统的临床疗效及预防病情复发的效果均优于炔雌醇环丙孕酮,同时可降低子宫内膜厚度,促进月经恢复。

Clinical Effects of Levonorgestrel Intrauterine System or Ethinylestradiol and Cyproterone Acetate in Patients with Endometrial Polyps after Hysteroscopic Surgery and Its Effects on Disease Recurrence

Objective To explore the clinical effects of levonorgestrel intrauterine system or ethinylestradiol and cyproterone acetate on patients with endometrial polyps(EP)after hysteroscopic surgery and its effects on disease recurrence.Methods A total of 80 patients with EP who underwent selective hysteroscopic surgery from January 2017 to January 2018 were selected and divided into observation group(n=40)and control group(n=40)according to the different postoperative treatment methods.After surgery,the observation group was placed with levonorgestrel intrauterine system at fundus while the control group was given ethinylestradiol and cyproterone acetate orally for three courses.The endometrial thickness was compared before surgery and at 3,6 and 12 months after surgery,and the expressions of estrogen receptor(ER)and progesterone receptor(PR)were observed before surgery and at 12 months after surgery.The menstrual recovery before surgery and at 3,6 and 12 months after surgery was evaluated by pictorial blood loss assessment chart(PBAC)score.The recurrence of the disease was recorded at 6 and 12 months after surgery,and the occurrence of adverse reactions was observed.Results Compared with control group,the endometrial thickness in observation group was decreased at 3,6 and 12 months after surgery,while the PBAC score was increased at 3 months after surgery(P<0.01).Compared with control group,the ER positive rate in observation group at 12 months after surgery was significantly decreased(P<0.05).Compared with the same group before surgery,the ER positive rate in the two groups was significantly reduced at 12 months after surgery(P<0.01).The recurrence rate at 12 months after surgery and total recurrence rate in observation group were lower than those in control group(P<0.05).There was no significant difference in the incidence rate of adverse reactions between the two groups(P=0.556).Conclusion The clinical efficacy and preventive effects of levonorgestrel intrauterine system in patients with EP are better than ethinylestradiol and cyproterone acetate,and the former one can reduce endometrial thickness and promote menstrual recovery.