The Fifth Affiliated Hospital of Xinjiang Medical University, 830011, China.
Biomed Res Int. 2022 Apr 26;2022:1232495. doi: 10.1155/2022/1232495. eCollection 2022.
To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP).
A total of 312 patients who underwent hysteroscopic polypectomy of EP in our hospital from June 2017 to November 2020 were enrolled retrospectively. Among them, 42 patients did not take any treatment after the operation (control group), 156 patients were treated with levonorgestrel intrauterine birth control system (Mirena group), and 114 patients were treated with oral spironolone ethinylestradiol tablets (oral group). The clinical data of 312 patients were recorded and followed up regularly. All patients were followed up through an outpatient clinic or telephone to 12 months after the operation. The patients' age, disease course, number of pregnancies, clinical manifestations, endometrial thickness before the operation, duration of operation, amount of bleeding during the operation, and number and size of polyps were analyzed. The recurrence and postoperative side effects of EP in the three groups were followed up within 12 months after the operation.
There was no significant difference in endometrial thickness among the three groups before treatment ( > 0.05). After 3 months, 6 months, and 12 months of treatment, the endometrial thickness of the three groups decreased, while the decrease in the Mirena group and the oral group was better compared to the control ( < 0.05). The decrease in the Mirena group was better than that in the oral group ( < 0.05). There was no significant difference in hemoglobin levels among the three groups before treatment ( > 0.05). After 3, 6, and 12 months of treatment, the hemoglobin levels of the three groups increased to varying degrees, while the levels of the Mirena group and oral group were better compared to the control ( < 0.05). Three months after the operation, the improvement of clinical symptoms was similar in the three groups, and there was no significant difference among the three groups ( > 0.05). At 6 and 12 months after the operation, the improvement of clinical symptoms in the oral group and Mirena group was better compared to the control group ( < 0.05), but there was no significant difference between the oral group and Mirena group ( > 0.05). After the operation, some patients had complications such as lower abdominal pain, breast distension pain, irregular vaginal bleeding, and abnormal liver function. There was no significant difference in the number of complications among the three groups ( > 0.05). During the follow-up to 12 months after the operation, the recurrence rate in the oral group and Mirena group was lower compared to the control ( < 0.05), and the recurrence rate in the Mirena group was lower than that in the oral group ( < 0.05).
Placing Mirena immediately after hysteroscopic polypectomy of EP can reduce the recurrence rate of endometrial polyps, increase the level of hemoglobin, and reduce the thickness of the endometrium, which can be employed and popularized according to the condition of patients in clinical work.
探讨宫腔镜手术联合曼月乐对子宫内膜息肉（EP）术后不良反应及复发率的影响。
回顾性分析 2017 年 6 月至 2020 年 11 月我院行宫腔镜息肉切除术的 312 例 EP 患者的临床资料，其中术后未行任何治疗 42 例（对照组），给予左炔诺孕酮宫内节育系统（曼月乐组）治疗 156 例，给予口服屈螺酮炔雌醇片（口服组）治疗 114 例。记录 312 例患者的临床资料，定期随访。所有患者均通过门诊或电话随访至术后 12 个月，分析患者年龄、病程、妊娠次数、临床表现、术前子宫内膜厚度、手术时间、术中出血量及息肉数目和大小。比较三组患者术后 12 个月内 EP 的复发及术后不良反应。
三组患者治疗前子宫内膜厚度比较，差异无统计学意义（>0.05）。治疗后 3 个月、6 个月、12 个月时，三组患者子宫内膜厚度均降低，且曼月乐组和口服组降低幅度优于对照组（<0.05），曼月乐组优于口服组（<0.05）。三组患者治疗前血红蛋白水平比较，差异无统计学意义（>0.05）。治疗后 3、6、12 个月时，三组患者血红蛋白水平均不同程度升高，且曼月乐组和口服组升高幅度优于对照组（<0.05），曼月乐组优于口服组（<0.05）。三组患者术后 3 个月时临床症状改善情况比较，差异无统计学意义（>0.05）；术后 6、12 个月时，口服组和曼月乐组临床症状改善情况优于对照组（<0.05），但口服组和曼月乐组比较，差异无统计学意义（>0.05）。术后部分患者出现下腹疼痛、乳房胀痛、不规则阴道出血、肝功能异常等并发症，三组患者并发症发生率比较，差异无统计学意义（>0.05）。术后随访 12 个月时，口服组和曼月乐组复发率低于对照组（<0.05），曼月乐组复发率低于口服组（<0.05）。
宫腔镜息肉切除术后即刻放置曼月乐能降低子宫内膜息肉的复发率，提高血红蛋白水平，降低子宫内膜厚度，可根据患者病情在临床工作中应用及推广。
