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目的:探讨宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫内膜息肉的疗效及安全性。方法:总结、分析129例围绝经期患者经宫腔镜下切除及术后放置曼月乐治疗子宫内膜息肉的临床及随访资料。结果:全部患者宫腔镜手术均顺利完成,无手术并发症发生,术后病理结果为子宫内膜息肉,诊断性刮宫、子宫内膜病理结果排除子宫内膜恶性病变,于术后7～10日放置曼月乐。所有患者随访满2年,患者月经模式改变,月经过多者月经量明显减少,血红蛋白值明显升高,术前血红蛋白水平为(96.23±10.22)g/L,术后6、12、24个月血红蛋白值分别为(115.46±7.38)g/L、(120.16±8.23)g/L和(126.56±9.79)g/L,手术前与手术后各组血红蛋白值比较差异均有统计学意义(P<0.05);术前及术后6、12、24个月子宫内膜厚度分别为(1.48±0.36)cm、(0.78±0.22)cm、(0.69±0.16)cm和(0.58±0.13)cm,手术前与手术后子宫内膜厚度各组间比较差异均有统计学意义(P<0.001);无病例复发;术后患者血清雌、孕激素水平均无明显变化,无明显不良反应发生。结论:宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统治疗子宫内膜息肉临床效果肯定,可抑制子宫内膜增长,随访无复发病例,安全、有效,值得临床推广。
Objective: To investigate the efficacy and safety of hysteroscopic resection and postnatal levonorgestrel-releasing intrauterine system (Mirena) in the treatment of endometrial polyps. Methods: To summarize and analyze the clinical and follow-up data of 129 cases of perimenopausal women who underwent hysteroscopic resection and postoperative Mirena treatment of endometrial polyps. Results: Hysteroscopic surgery was successfully performed in all patients, no complications occurred. The postoperative pathological findings were endometrial polyps, diagnostic curettage, endometrial pathology results exclude endometrial malignant lesions, after 7 to 10 Day placed Mirena. All patients were followed up for 2 years. The patient’s menstruation pattern changed. The menorrhagia was significantly reduced, hemoglobin value was significantly increased, the preoperative hemoglobin level was (96.23 ± 10.22) g / L, 6,12,24 months The hemoglobin values were (115.46 ± 7.38) g / L, (120.16 ± 8.23) g / L and (126.56 ± 9.79) g / L, respectively. There were significant differences in hemoglobin values between preoperative and postoperative groups (P < 0.05). The thickness of endometrium at preoperative, postoperative 6, 12 and 24 months were (1.48 ± 0.36) cm, (0.78 ± 0.22) cm, (0.69 ± 0.16) cm and (0.58 ± 0.13) cm, respectively There were significant differences in the thickness of the endometrium between before and after operation (P <0.001). No recurrence was found. There was no significant change in serum estradiol and progesterone levels after operation, and no significant adverse reactions occurred. Conclusion: Hysteroscopic resection and postoperative levonorgestrel intrauterine system for the treatment of endometrial polyps affirmed the clinical effect, can inhibit the growth of the endometrium, no recurrence of cases, safe and effective, worthy of clinical promotion.