宮腔鏡下刮匙刮除術對子宮內膜息肉不孕患者療效及子宮內膜厚度的影響

邵衛+劉曉+石曉+牛兆園

【摘要】目的：探討宮腔鏡下刮匙刮除術和電切除術對子宮內膜息肉的療效。方法：將2010年8月至2013年8月醫院收治的120例子宮內膜息肉不孕患者按照隨機數字表法分為刮匙組60例和電切組60例，刮匙組在宮腔鏡下行刮匙刮除術，電切組在宮腔鏡下行電切除術。記錄兩組患者手術一般情況；術后隨訪1年，記錄兩組患者術后月經量、排卵期子宮內膜厚度及卵泡呈典型“三線征”比例，并記錄兩組患者術后1年內復發率和妊娠率。結果：兩組患者手術時間、術中出血量、住院時間比較差異無統計學意義，兩組患者術后并發癥發生率比較差異亦無統計學意義（P>0.05）。兩組患者術后月經量均顯著高于手術前（P<0.05），術后各時段刮匙組月經量亦顯著高于電切組（P<0.05），術后各時段刮匙組排卵期子宮內膜厚度均顯著低于電切組（P<0.05）；術后3個月刮匙組子宮內膜“三線征”比例顯著高于電切組，術后6、12個月電切組子宮內膜“三線征”比例顯著高于刮匙組，各組間比較差異具有統計學意義（P<0.05）。隨訪1年內，兩組患者半年復發率比較差異無統計學意義（P>0.05），刮匙組1年復發率顯著高于電切組（P<0.05）；刮匙組半年妊娠率顯著高于電切組（P<0.05），兩組患者1年妊娠率比較差異無統計學意義（P>0.05）。結論：宮腔鏡下刮匙刮除術和電切除術對子宮內膜息肉均可以取得滿意效果；對于有生育要求的患者，可以優先考慮刮匙刮除術；對于無生育要求的患者，可以優先考慮電切除術。

【關鍵詞】宮腔鏡；刮匙刮除術；電切除術；子宮內膜息肉；子宮內膜厚度

Clinical effect of hysteroscopic curettage on infertile patients with endometrial polyps and its impact on endometrial thicknessSHAO Wei1， LIU Xiao1， SHI Xiao1， Niu Zhaoyuan2△. 1. Department of Obstetrics， Jiaozhou Central Hospital， Qingdao 266300， Shandong， China； 2. Department of Gynecology， The Hospital Affiliated to Qingdao University， Qingdao 266300， Shandong， China

【Abstract】Objectives： To explore the clinical effect of hysteroscopic curettage on infertile patients with endometrial polyps and its impact on endometrial thickness. Methods： 120 infertile patients with endometrial polyps treated in hospital from August 2013 to August 2010， according to random digit table method， were divided into curette group （n=60） and transurethral resection group （n=60）. The curette group underwent hysteroscopic curettage while transurethral resection group underwent hysteroscopic electroresection. General operation information of the two groups was recorded； in the 1-year follow-up， the menstrual blood volume， endometrial thickness during ovulation period and the proportion of follicles with typical "three lines" was recorded， as well as the postoperative recurrence rate and pregnancy rate. Results： Difference in operative time， blood loss， hospitalization time between the two groups was not significant （P>0.05）， so as the incidence of postoperative complications （P>0.05）. The postoperative menstrual blood volume was significantly higher than those before operation in both groups （P<0.05）； the postoperative menstrual blood volume of curette group was also significantly higher than that of transurethral resection group （P<0.05）， and the postoperative endometrial thickness during ovulation period in curette group was also significantly thinner than that of transurethral resection group （P<0.05）. The proportion of follicles with typical "three lines" in curette group was significantly higher than that of transurethral resection group 3 months after operation， while it was significantly lower than that of the transurethral resection group 6 and 12 months after operation （all P<0.05）. In the 1-year follow-up， difference in recurrence rate within half a year was not statistically significant （P>0.05）， while the 1-year recurrence rate of curette group was significantly higher than that of transurethral resection group （P<0.05）. The half year pregnancy rate of curette group was significantly higher than that of transurethral resection group （P<0.05）， while no significant difference was found in the 1-year pregnancy rate （P>0.05）. Conclusion： Hysteroscopic curettage and transurethral resection both have satisfactory results for infertile patients with endometrial polyps. For those with fertility requirements， hysteroscopic curettage is preferred.endprint

【Key words】Hysteroscopy； Curettage； Transurethral resection； Endometrial polyps； Endometrial thickness

【中圖分類號】R711.74【文獻標志碼】A

子宮內膜息肉是常見的婦科疾病，也是導致女性不孕癥的主要原因之一[1，2]。既往多采用息肉切除鉗或刮匙治療子宮內膜息肉，然而手術療效不甚如人意。近年來隨著宮腔鏡技術的快速發展，在宮腔鏡下操作對患者創傷小、術后恢復快、復發率低，已經成為子宮內膜息肉診療的首選方法。本研究對醫院收治的子宮內膜息肉患者分別宮腔鏡下刮匙刮除術和宮腔鏡下電切除術治療，探討不同生育要求、不同年齡段的子宮內膜息肉患者最佳宮腔鏡下術式，旨在為患者手術治療提供參考，現將研究成果總結如下。