邵卫+刘晓+石晓+牛兆园

【摘要】目的：探讨宫腔镜下刮匙刮除术和电切除术对子宫内膜息肉的疗效。方法：将2010年8月至2013年8月医院收治的120例子宫内膜息肉不孕患者按照随机数字表法分为刮匙组60例和电切组60例，刮匙组在宫腔镜下行刮匙刮除术，电切组在宫腔镜下行电切除术。记录两组患者手术一般情况；术后随访1年，记录两组患者术后月经量、排卵期子宫内膜厚度及卵泡呈典型“三线征”比例，并记录两组患者术后1年内复发率和妊娠率。结果：两组患者手术时间、术中出血量、住院时间比较差异无统计学意义，两组患者术后并发症发生率比较差异亦无统计学意义（P>0.05）。两组患者术后月经量均显著高于手术前（P<0.05），术后各时段刮匙组月经量亦显著高于电切组（P<0.05），术后各时段刮匙组排卵期子宫内膜厚度均显著低于电切组（P<0.05）；术后3个月刮匙组子宫内膜“三线征”比例显著高于电切组，术后6、12个月电切组子宫内膜“三线征”比例显著高于刮匙组，各组间比较差异具有统计学意义（P<0.05）。随访1年内，两组患者半年复发率比较差异无统计学意义（P>0.05），刮匙组1年复发率显著高于电切组（P<0.05）；刮匙组半年妊娠率显著高于电切组（P<0.05），两组患者1年妊娠率比较差异无统计学意义（P>0.05）。结论：宫腔镜下刮匙刮除术和电切除术对子宫内膜息肉均可以取得满意效果；对于有生育要求的患者，可以优先考虑刮匙刮除术；对于无生育要求的患者，可以优先考虑电切除术。

【关键词】宫腔镜；刮匙刮除术；电切除术；子宫内膜息肉；子宫内膜厚度

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

【中图分类号】R711.74【文献标志码】A

子宫内膜息肉是常见的妇科疾病，也是导致女性不孕症的主要原因之一[1，2]。既往多采用息肉切除钳或刮匙治疗子宫内膜息肉，然而手术疗效不甚如人意。近年来随着宫腔镜技术的快速发展，在宫腔镜下操作对患者创伤小、术后恢复快、复发率低，已经成为子宫内膜息肉诊疗的首选方法。本研究对医院收治的子宫内膜息肉患者分别宫腔镜下刮匙刮除术和宫腔镜下电切除术治疗，探讨不同生育要求、不同年龄段的子宫内膜息肉患者最佳宫腔镜下术式，旨在为患者手术治疗提供参考，现将研究成果总结如下。