不同方法预防子宫内膜息肉切除术后复发的临床观察  

Clinical observation of different methods for preventing recurrence after endometrial polypectomy

作　　者：葛芬芬[1] 铁炜炜[1] 

机构地区：[1]宁波市医疗中心李惠利医院妇科,315040

出　　处：《中国计划生育学杂志》2014年第10期675-677,681,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨口服短效避孕药和宫腔内放置左炔诺孕酮宫内缓释系统(LNG-IUS)对预防子宫内膜息肉(EP)切除术后复发的临床疗效。方法:随访观察宫腔镜下EP切除术后(对照组,40例)及术后放置LNG-IUS(LNG-IUS组,42例),或口服炔雌醇环丙孕酮(避孕药组,44例)患者息肉复发等情况。结果:术后18个月随访,复发率LNG-IUS组为0(0/42),避孕药组为2.3%(1/44),对照组为17.5%(7/40),LNG-IUS组与避孕药组复发率无统计学差异(χ2=0.97,P>0.05),但均明显低于对照组(χ2=8.04,P<0.05;χ2=5.64,P<0.05);子宫内膜LNG-IUS组最薄,与避孕药组及对照组比较差异均有统计学意义(q=8.83,P<0.05;q=16.39,P<0.05)。LNG-IUS组与避孕药组的月经改善率无统计学差异(χ2=0.42,P>0.05),但均高于对照组(χ2=7.28,P<0.05;χ2=4.63,P<0.05);避孕药组有6例(86.4%)未坚持服药,LNG-IUS组无因症取出病例,两组依从性有统计学差异(χ2=6.16,P<0.05)。结论:宫腔镜术后服用短效口服避孕药或宫腔放置LNG-IUS均可预防术后EP复发且疗效相当,放置LNG-IUS对子宫内膜有更强的抑制作用,患者依从性好。Objective： To compare clinical effects of oral contraceptive or levonorgestrel-releasing intrauterine system （LNG-IUS） on preventing recurrence of endometrial polyps （EP） after hysteroscopic polypectomy. Methods： A retrospective study was performed. Patients who underwent hysteroscopic polypectomy were divided into three groups： control group （n= 40）, oral contraceptive group （n= 44） and LNG-IUS group （n= 42）. The recurrence rate of EP was evaluated. Results： Eighteen months after the operation, significantly higher recurrence rate was found in the control group （17.5% , 7/40） than those of oral contraceptive group （2.3%, 1/44） and LNG-IUS group （0, 0/42, P all〈0. 05）. But there was no significant difference between oral contraceptive group and LNG-IUS group （X2 = 0.97, P 〉0. 05）. The thickness of endometrium in LNG-IUS group was significantly decreased compared with that of oral contraceptive group （q= 8.83, P%0.05） and the control group（q= 16.39, P 〈0.05）. The abnormal menstruation in the LNG-IUS group （X2 =7.28, P 〈0.05） and oral contraceptive group （X2 =4.63, P 〈0.05） were significantly improved compared with that of the control group. But no significant difference could be found between oral contraceptive group and LNG-IUS group （X2 =0.42, P ~0.05）. No adherence to medication was found in 6 （86.4%） women. No women experienced removal of LNG-IUS. LNG-IUS group had better compliance than oral contraceptive group with statistical significance （X2 =6.1, P〈0.05）. Conclusion= Oral contraceptive use or LNG-IUS insertion after hysteroscopic polypectomy is effective to prevent the recurrence of EP. LNG-IUS insertion could inhibit endometrial hyperplasia better than oral contraceptive, and owns better compliance.

关 键 词：宫腔镜 子宫内膜息肉 短效口服避孕药 左炔诺孕酮宫内缓释系统 复发 

分 类 号：R713.4[医药卫生—妇产科学]