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。

Clinical study of hysteroscopic surgery for endometrial polyps

OBJECTIVE: To investigate the methods of different types of hysteroscopic surgery for endometrial polyps. METHODS: A total of 109 cases by different ways by hysteroscopic surgery for endometrial polyp from October 2000 to May 2002 were followed up. The mean age was 45 +/- 9 (26 - 73) years. The mean follow-up was 12 +/- 5 (3 - 22) months. The patients of menstrual disorder were asked for filling in pictorial blood loss assessment chart (PBAC) before and after the surgery. RESULTS: By the PBAC there was significant difference between before and after the surgery (P = 0.001). After the surgery, among 84 polyps with menstrual disorder, 14 cases (16.7%) were amenorrhea, 26 cases (31.0%) spotting, other 24 cases reducing the amount. Thirty-four cases that had had anemia recovered in one month after the surgery. In 16 cases dysmenorrhea, 7 cases were recovered, 7 got better, and the other 2 got worse. Of 5 cases of infertility (3 were primary and 2 were secondary), 4 cases got pregnancy after the surgery. CONCLUSIONS: The polyp patient who had menstrual disorder without desire of fertility should undergo polypectomy with endometrial resection in order to avoid recurrence. The patient who has desire of fertility should undergo polypectomy merely. If she had polyp with polypoid hyperplasia she should undergo polypectomy with endometrial resection of superficial layer. The postmenopausal patient should perform polypectomy merely or polypectomy with endometrial ablation.