Clinical Study on Transcervical Resection of Polyp Combined with Levonorgestrel-Releasing Intrauterine System in the Treatment of Endometrial Polyps

doi:10.3877/cma.j.issn.1673-5250.2014.04.022

Objective

To explore the clinical value of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial polyps (EP) after transcervical resection of polyp (TCRP).

Methods

From July 2010 to July 2011, a total of 92 EP patients after TCRP surgery in Baoji Central Hospital were included. In accordance with the order of admission, they were randomly divided into research group(n = 46, TCRP + LNG-IUS) and control group(n = 46, TCRP). The menstrual blood volume [pictorial blood loss assessment chart (PBAC) score], endometrial thickness, hemoglobin level and EP recurrence rate were compared between two groups, and the adverse reactions of research group were observed at the same time. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Baoji Central Hospital. Informed consent was obtained from each patient. There were no significant difference in age, clinical symptoms and other general conditions between two groups (P>0.05).

Results

The results were:①The menstrual blood volume (PBAC score) of research group decreased significantly compared with that of control group in 3,9,12,18,24 months follow-up(t = 3.12,4.12,4.14,4.67,4.76; P<0.01); ②The endometrial thickness of research group were significantly thinner than that of control group in 9,12, 18,24 months follow-up(t=2.55,2.68,2.89,3.12; P<0.05);③Hemoglobin levels of research group were significantly higher than that of control group in 3,9,12,18,24 months follow-up(t= 1.02,2.10,2.41, 2.56,2.76; P< 0.05);④The EP recurrence rate of research group was significantly lower than that of control group (0 vs. 23.9%) in 2-year follow up(χ² =12.32,P=0.004).

Conclusions

In the treatment of EP, TCPR combined with LNG-IUS can effectively alleviate menorrhagia, reduce endometrial thickness, recover hemoglobin level and reduce EP recurrence rate.

Key words: Endometrium, Polyps, Hysteroscopes, Levonorgestrel

表1 两组月经量PBAC评分随访结果比较(分，±s)

Table 1 Comparison of the menstrual blood volume PBAC score between two groups (score, ±s)

组别	n	第3个月	第9个月	第12个月	第18个月	第24个月
研究组	46	39.20±11.90	15.46±12.40	12.40±10.90	11.20±9.60	10.60±8.60
对照组	46	74.20±14.90	69.46±12.40	70.40±10.90	79.20±9.60	82.60±9.70
t		3.12	4.12	4.14	4.67	4.76
P		0.009	0.008	0.008	0.006	0.004

表1 两组月经量PBAC评分随访结果比较(分，±s)

Table 1 Comparison of the menstrual blood volume PBAC score between two groups (score, ±s)

组别	n	第3个月	第9个月	第12个月	第18个月	第24个月
研究组	46	39.20±11.90	15.46±12.40	12.40±10.90	11.20±9.60	10.60±8.60
对照组	46	74.20±14.90	69.46±12.40	70.40±10.90	79.20±9.60	82.60±9.70
t		3.12	4.12	4.14	4.67	4.76
P		0.009	0.008	0.008	0.006	0.004

表2 两组子宫内膜厚度随访结果比较(cm，±s)

Table 2 Comparison of endometrial thickness between two groups (cm, ±s)

组别	n	第3个月	第9个月	第12个月	第18个月	第24个月
研究组	46	0.39±0.65	0.22±0.51	0.26±0.41	0.21±0.32	0.22±0.24
对照组	46	0.40±0.35	0.38±0.33	0.41±0.26	0.37±0.22	0.42±0.44
t		1.82	2.55	2.68	2.89	3.12
P		0.058	0.047	0.042	0.032	0.016

表2 两组子宫内膜厚度随访结果比较(cm，±s)

Table 2 Comparison of endometrial thickness between two groups (cm, ±s)

组别	n	第3个月	第9个月	第12个月	第18个月	第24个月
研究组	46	0.39±0.65	0.22±0.51	0.26±0.41	0.21±0.32	0.22±0.24
对照组	46	0.40±0.35	0.38±0.33	0.41±0.26	0.37±0.22	0.42±0.44
t		1.82	2.55	2.68	2.89	3.12
P		0.058	0.047	0.042	0.032	0.016

表3 两组贫血患者血红蛋白水平随访结果比较(g/L，±s)

Table 3 Comparison of hemoglobin levels between two groups (g/L, ±s)

组别	n	第3个月	第9个月	第12个月	第18个月	第24个月
研究组	33	96.40±10.20	116.30±11.40	124.60±8.20	131.10±10.60	134.20±9.80
对照组	33	97.40±13.20	101.30±14.40	112.60±16.20	104.10±15.60	100.20±16.80
t		1.02	2.10	2.41	2.56	2.76
P		0.020	0.015	0.012	0.008	0.007

表3 两组贫血患者血红蛋白水平随访结果比较(g/L，±s)

Table 3 Comparison of hemoglobin levels between two groups (g/L, ±s)

组别	n	第3个月	第9个月	第12个月	第18个月	第24个月
研究组	33	96.40±10.20	116.30±11.40	124.60±8.20	131.10±10.60	134.20±9.80
对照组	33	97.40±13.20	101.30±14.40	112.60±16.20	104.10±15.60	100.20±16.80
t		1.02	2.10	2.41	2.56	2.76
P		0.020	0.015	0.012	0.008	0.007

1	夏恩兰，主编．宫腔镜学及图谱．2版[M]．河南：河南科学技术出版社，2009：225-230.
2	冯利民，夏恩兰，从捷，等．应用月经失血图评估月经量[J]．中华妇产科杂志，2011，46(6)：128-130.
3	肖苑玲，何援利．曼月乐预防子宫内膜息肉复发的疗效评价[J]．现代妇产科学进展，2011，20(3)：241.
4	Garuti G, Gellani F, Colonnelli M, et al. Outpatient hysteroscopic polypectomy in 237 patiens: feasibility of a onestop "see-and-treat" procedure[J]. J Am Assoc Gynecol Laparose, 2004, 11(4):500.
5	曹泽毅，主编．中华妇产科学(临床版)[M]．北京：人民卫生出版社，2010：385-386.
6	Ponikau IU, Sherris DA, Kephart GM, et al. Feature of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the hospitathology similar to asthma [J]. J Allergy Clin Immunol, 2003, 112(5):877-882.
7	Gardner FJ, Konje JC, Abrams KR, et al. Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: a randomized controlled trial [J]. Lancet, 2000, 356(9243):1711-1717.
8	陈灿明．左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床效果研究[J]．实用妇产科杂志，2012，28(6)：479-481.
9	胡美英．曼月乐治疗子宫腺肌病70例疗效观察[J]．现代妇产科学进展，2012，12(21)：997.
10	张彦春．左炔诺孕酮宫内缓释系统治疗子宫腺肌病75例疗效观察[J]．中国实用妇科与产科杂志，2011，27(11)：851-853.
11	Robinson R, China S, Bunkheila A, et al. Mirena intrauterine system in the treatment of menstrual disorders: a survey of UK patients experience, acceptability and satisfaction [J]. J Obstet Gynaecol, 2008, 28(7):728-731.
12	牟红欣．左炔诺孕酮宫内缓释系统治疗子宫腺肌病的疗效观察[J]．中国计划生育学杂志，2011，19(8)：482-484.
13	吴丹梅．左炔诺孕酮宫内缓释系统治疗子宫腺肌病的疗效[J]．中国妇产科临床杂志，2011，11(12)：437-439.

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