探讨宫腔镜子宫内膜息肉切除术(TCRP)后放置左炔诺孕酮宫内节育系统(LNG-IUS)，对子宫内膜息肉(EP)患者的疗效及术后12个月内复发率的影响。

选择2020年12月至2022年12月于南通市第六人民医院接受治疗的89例EP患者为研究对象。采用前瞻性研究方法，按照随机数字表法将其分为观察组(n＝45，采取宫腔镜TCRP后放置LNG-IUS治疗)和对照组(n＝44，采取宫腔镜TCRP治疗，未放置LNG-IUS)。对2组EP患者一般临床资料，治疗效果及宫腔镜TCRP术后12个月内复发率，以及宫腔镜TCRP术前及术后12个月的临床症状评估指标、子宫血流动力学指标及炎症因子水平、血清性激素水平，采用独立样本t检验及χ²检验进行统计学分析；对2组患者宫腔镜TCRP的4个时间点(术前与术后3、6、12个月)子宫内膜厚度及月经失血量图表(PBAC)评分比较，采用重复测量资料方差分析。本研究经病例收集医院伦理委员会批准(审批文号：NTLyLy2020042)。所有受试者签署临床研究知情同意书。

①观察组EP患者治疗总有效率为97.8%，显著高于对照组为84.1%，宫腔镜TCRP术后12个月内复发率为4.4%，显著低于对照组的18.2%，并且差异均有统计学意义(χ²＝5.09、4.21，P＝0.024、0.040)。②对2组EP患者宫腔镜TCRP术前，以及术后3、6、12个月的子宫内膜厚度及PBAC评分进行重复测量资料方差分析结果显示，不同治疗措施与时间因素的交互效应，均有统计学意义(F_{治疗×时间}＝18.48、10.14，均为P_{治疗×时间}<0.001)。对2组EP患者不同治疗措施的单独效应分析结果显示，观察组EP患者宫腔镜TCRP术后3、6、12个月的子宫内膜厚度及PBAC评分，均薄于、低于对照组，并且差异均有统计学意义(P<0.05)。对观察组EP患者时间因素的单独效应分析结果显示，观察组EP患者宫腔镜TCRP术后3、6、12个月的子宫内膜厚度，均分别薄于术前，而术后12个月子宫内膜厚度，则厚于术后6个月，并且差异均有统计学意义(P<0.05)；观察组EP患者宫腔镜TCRP术后3、6、12个月的PBAC评分呈降低趋势，并且差异有统计学意义(P<0.05)。对对照组EP患者时间因素的单独效应分析结果显示，对照组EP患者宫腔镜TCRP术后3、6、12个月的子宫内膜厚度呈增厚趋势，PBAC评分呈下降趋势，并且差异有统计学意义(P<0.05)。③观察组EP患者宫腔镜TCRP术后12个月下腹部疼痛视觉模拟量表(VAS)评分、经期不规律计分、白带异常评分、子宫动脉阻力指数(RI)和搏动指数(PI)值、血清白细胞介素(IL)-1及IL-6水平，均显著低于对照组；而血清卵泡刺激素(FSH)、促黄体激素(LH)、雌二醇及抗缪勒管激素(AMH)水平，则均显著高于对照组，并且差异均有统计学意义(P<0.05)。

EP患者宫腔镜TCRP术后放置LNG-IUS，能有效降低EP复发率，改善患者临床症状，并且不增高不良反应发生率。

To investigate the efficacy of placing a levonorgestrel-releasing intrauterine system (LNG-IUS) after hysteroscopic transcervical resection of polyps (TCRP) and its impact on the recurrence rate of endometrial polyps (EP) within 12 months postoperatively.

A total of 89 EP patients treated in Nantong Sixth People′s Hospital from December 2020 to December 2022 were selected as the study subjects. Using a prospective study design, the patients were randomly divided into an observation group (n=45, treated with hysteroscopic TCRP followed by LNG-IUS placement) and a control group (n=44, treated with hysteroscopic TCRP without LNG-IUS placement) according to the random number table method. The general clinical data, treatment effects, recurrence rates within 12 months after hysteroscopic TCRP, as well as clinical symptom assessment indicators, uterine hemodynamic parameters, inflammatory cytokine levels, and serum sex hormone levels before hysteroscopic TCRP and 12 months after hysteroscopic TCRP were statistically compared between two groups of EP patients using independent-samples t test and chi-square test. Repeated measures analysis of variance (ANOVA) was used to compare the endometrial thickness and pictorial blood loss assessment chart (PBAC) scores at four time points (before hysteroscopic TCRP and 3, 6, and 12 months after hysteroscopic TCRP) in two groups. This study was approved by the case collection hospital′s Ethics Committee (Approval No. NTLyLy2020042). All subjects signed informed consent forms for the clinical study.

① The total treatment efficacy rate in observation group (97.8%) was higher than that in control group (84.1%), while the recurrence rate within 12 months after hysteroscopic TCRP in observation group (4.4%) was lower than that in control group (18.2%), and the differences were statistically significant (χ²=5.09, 4.21; P=0.024, 0.040). ② Repeated measures ANOVA of endometrial thickness and PBAC scores before hysteroscopic TCRP and at 3, 6, and 12 months after hysteroscopic TCRP in two groups showed interaction effects between different treatment measures and time factors were statistically significont (F_{treatment×time}=18.48, 10.14; both with P_{treatment×time}<0.001). Analysis of the individual effects of different treatment measures in two groups revealed that the endometrial thickness and PBAC scores at 3, 6, and 12 months after hysteroscopic TCRP in observation group were thinner and lower than those in control group, and the differences were statistically significant (P<0.05). Analysis of the individual effects of time factors in observation group showed that the endometrial thickness at 3, 6, and 12 months after hysteroscopic TCRP was thinner than that before hysteroscopic TCRP, respectively, and the endometrial thickness at 12 months after hysteroscopic TCRP was thicker than that at 6 months, and the differences were statistically significant (P<0.05). The PBAC scores in observation group showed a decreasing trend at 3, 6, and 12 months after hysteroscopic TCRP, and the differences were statistically significant (P<0.05). Analysis of the individual effects of time factors in control group showed that the endometrial thickness showed an increasing trend, while the PBAC scores showed a decreasing trend at 3, 6, and 12 months after hysteroscopic TCRP, and the differences were statistically significant (P<0.05). ③ The visual analog scale (VAS) score for lower abdominal pain, irregular menstruation score, abnormal vaginal discharge score, uterine artery resistance index (RI) and pulsatility index (PI) values, and serum interleukin (IL)-1 and IL-6 levels at 12 months after hysteroscopic TCRP in observation group were all lower than those in control group, while the serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) levels in observation group were all higher than those in control group, and the differences were statistically significant (P<0.05).

Placing an LNG-IUS after hysteroscopic TCRP in EP patients can effectively reduce the recurrence rate of EP, improve clinical symptoms, and does not increase the incidence of adverse reactions.