宫腔镜手术联合孕激素诊治子宫内膜息肉的临床分析

目的:分析宫腔镜手术联合孕激素诊治子宫内膜息肉的临床效果。方法:回顾性分析167例子宫内膜息肉患者采用宫腔镜检查和手术完全一次性去除子宫内膜息肉,根据宫腔镜术后子宫内膜息肉病理类型不同,决定术后是否配合孕激素治疗。结果:167例患者中,术后病理诊断95例子宫内膜息肉,30例子宫内膜息肉合并内膜单纯型增生,42例子宫内膜息肉合并内膜复杂型增生。89例子宫内膜息肉和内膜息肉合并内膜单纯型增生患者,术后给予配合孕激素类药物周期性治疗3个月～6个月(安宫黄体酮片6mg1次/d口服),经随访观察(12例失访),84例无复发;有5例因未按正规方案口服孕激素治疗,术后6个月～14个月再次出现临床症状予宫腔镜复查,证实为子宫内膜息肉复发。42例子宫内膜息肉合并内膜复杂型增生患者,术后未给予任何药物治疗,36例随访观察(6例失访),无复发病例。因不孕症行宫腔镜检查的29例患者中,输卵管开口附近息肉者21例,术后成功妊娠23例。结论:宫腔镜检查对子宫内膜息肉的诊断和治疗有较高的临床价值;子宫内膜息肉患者术后盲目辅助孕激素类药物治疗没有必要;宫腔镜手术去除内膜息肉可以明显提高内膜息肉导致不孕的妊娠率。

Clinical Analysis of Hysteroscopic Surgery Combined Progestin for Endometrial Polyps

Objective To assess the clinical effectiveness of hysteroscopic surgery combined progestin to treat the endometrial polyps.Methods Retrospective analysis of 167 patients with endometrial polyps treated by hysteroscopic polypectomy,depending on the pathological results of the endometrial polypsto decide whether use progestogen or not after polypectomy.Results Among the 167 patients,95 patients were diagnosed of only endometrial polyps according topathology,30 patients were diagnosed of endometrial polyps accompany with simple hyperplasia,42 patients were diagnosed of endometrial polyps accompany with complex hyperplasia.89 patients with only endometrial polyps were treated by progestin for 3-5 months(progestin pill 8 mg daily) No recurrence in 84 patients by follow-up(5 patients were lost).6 patients have not followed our advice of treating with progestin routinely,and were recurrent of clinical symptoms in 6-14 months after surgery and were examined by hysteroscopy.42 patients accompanied by simple or complex endometrial hyperplasia haven’t been treated with any drugs after surgery,no recurrence in 36 patients among them by follow-up(6 patients were lost).In 29 infertility patients examined by hysteroscopy,23 patients were diagnosed of polyps near the outlet of fallopian tube and 26 patients were pregnant after surgery.Conclusion Hysteroscopic examining has high clinical significancy in diagnosis and treatment of endometrial polyps.Routinely treating with progestin after endometrial polypectomy isn’t necessary.Hysteroscopic endometrial polypectomy apparently raises the pregnancy rate due to infertility by endometrial polyps.