| 董国霞,周燕飞,段柏情,曾铭强,李利平.宫腔镜下电切术与刮宫术治疗子宫内膜息肉合并不孕症的疗效比较及术后妊娠的影响因素分析[J].,2022,(16):3137-3142 |
| 宫腔镜下电切术与刮宫术治疗子宫内膜息肉合并不孕症的疗效比较及术后妊娠的影响因素分析 |
| Comparison of the Efficacy of Hysteroscopic Electrosurgery and Curettage in the Treatment of Endometrial Polyps Combined with Infertility and Analysis of Influencing Factors of Postoperative Pregnancy |
| 投稿时间：2022-02-05 修订日期：2022-02-27 |
| DOI：10.13241/j.cnki.pmb.2022.16.028 |
| 中文关键词: 子宫内膜息肉 不孕症 宫腔镜下电切术 宫腔镜下刮宫术 妊娠 |
| 英文关键词: Endometrial polyps Infertility Hysteroscopic electrosurgery Hysteroscopic curettage Pregnancy |
| 基金项目:湖南省卫生计生委科研计划项目(B201601330) |
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| 中文摘要: |
| 摘要 目的：比较宫腔镜下电切术与宫腔镜下刮宫术治疗子宫内膜息肉合并不孕症的疗效，并分析术后妊娠的影响因素。方法：选取2018年10月～2020年9月我院收治的318例子宫内膜息肉合并不孕症患者，其中接受宫腔镜下电切术治疗的159例归为电切术组，接受宫腔镜下刮宫术治疗的159例归为刮宫术组，术后均随访12个月，比较两组手术相关指标、子宫内膜厚度、月经量和围术期并发症、息肉复发率、临床妊娠率，多因素Logistic回归分析术后妊娠的影响因素。结果：电切术组术中出血量低于刮宫术组（P＜0.05），两组患者手术时间、住院时间比较无差异（P＞0.05）。两组患者术后12个月子宫内膜厚度较术前降低，且电切术组术后子宫内膜厚度低于刮宫术组（P＜0.05）。两组患者术后1个月、术后3个月月经量较术前逐渐减少，且电切术组较刮宫术组变化更明显（P＜0.05）。电切术组息肉复发率低于刮宫术组，而临床妊娠率高于刮宫术组（P＜0.05），两组患者围术期并发症总发生率比较差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，年龄≥35岁、多发息肉、息肉直径≥1 cm、宫角息肉、术后子宫内膜厚度≥13 mm、术后息肉复发是影响子宫内膜息肉合并不孕症患者术后妊娠的危险因素（P＜0.05）。结论：宫腔镜下电切术治疗子宫内膜息肉合并不孕症患者疗效较宫腔镜下刮宫术更为显著，其术后妊娠率受年龄、息肉类型、息肉直径、息肉部位、术后子宫内膜厚度、术后息肉复发等因素影响。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the efficacy of hysteroscopic electrosurgery and hysteroscopic curettage in the treatment of endometrial polyps combined with infertility, and to analyze the influencing factors of postoperative pregnancy. Methods: 318 patients with endometrial polyps combined with infertility who were treated in our hospital from October 2018 to September 2020 were selected, of which 159 patients treated with hysteroscopic electrosurgery were classified as electrosurgical resection group and 159 patients treated with hysteroscopic curettage were classified as curettage group. The patients were postoperative followed up for 12 months. The surgical indexes, endometrial thickness, menstrual volume, perioperative complications, polyp recurrence rate and clinical pregnancy rate were compared between the two groups. The influencing factors of postoperative pregnancy were analyzed by multivariate Logistic regression. Results: The intraoperative blood loss in the electrosurgery group was lower than that in the curettage group (P<0.05), and there were no significant differences in operation time and hospitalization time between the two groups (P>0.05). The endometrial thickness of patients in the two groups at 12 months after operation was lower than that before operation, and the endometrial thickness in the electrosurgery group was lower than that in the curettage group(P<0.05). The menstrual volume of patients in the two groups at 1 month and 3 months after operation gradually decreased compared with that before operation, and the change in the electrosurgery group was more obvious than that in the curettage group(P<0.05). The polyp recurrence rate in the electrosurgery group was lower than that in the curettage group, while the clinical pregnancy rate was higher than that in the curettage group(P<0.05). There was no significant difference in the total incidence of perioperative complications between the two groups(P>0.05). The results of multivariate Logistic regression analysis showed that age ≥ 35 years, multiple polyps, polyp diameter ≥ 1 cm, uterine horn polyps, postoperative endometrial thickness ≥ 13 mm and postoperative polyp recurrence were the risk factors of postoperative pregnancy in patients with endometrial polyps combined with infertility(P<0.05). Conclusion: The curative effect of hysteroscopic electrosurgery in the treatment of endometrial polyps combined with infertility is more significant than hysteroscopic curettage. The postoperative pregnancy rate is affected by age, polyp type, polyp diameter, polyp location, postoperative endometrial thickness, postoperative polyp recurrence and other factors. |
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