Impact of levonorgestrel-releasing intrauterine system placement following hysteroscopic transcervical resection of endometrial polyps on therapeutic effect and recurrence rate of polyps

doi:10.3877/cma.j.issn.1673-5250.2025.03.009

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Key words: Polyps, Endometrium, Hysteroscopes, Endometrial ablation techniques, Levonorgestrel intrauterine sustained-release system, Therapeutic uses, Recurrence, Female

表1 2组EP患者一般临床资料比较

组别	例数	年龄(岁，±s)	EP病程(年，±s)	EP数量[例数(%)]		合并慢性盆腔炎[例数(%)]	合并子宫肌瘤[例数(%)]
组别	例数	年龄(岁，±s)	EP病程(年，±s)	单发	多发	合并慢性盆腔炎[例数(%)]	合并子宫肌瘤[例数(%)]
观察组	45	40.3±6.5	2.7±1.5	34(75.6)	11(24.4)	10(22.2)	7(15.6)
对照组	44	39.8±6.2	2.5±1.3	32(72.7)	12(27.3)	12(27.3)	6(13.6)
统计量		t＝0.37	t＝0.67	χ²＝0.09		χ²＝0.31	χ²＝0.07
P值		0.711	0.504	0.761		0.581	0.798

表1 2组EP患者一般临床资料比较

组别	例数	年龄(岁，±s)	EP病程(年，±s)	EP数量[例数(%)]		合并慢性盆腔炎[例数(%)]	合并子宫肌瘤[例数(%)]
组别	例数	年龄(岁，±s)	EP病程(年，±s)	单发	多发	合并慢性盆腔炎[例数(%)]	合并子宫肌瘤[例数(%)]
观察组	45	40.3±6.5	2.7±1.5	34(75.6)	11(24.4)	10(22.2)	7(15.6)
对照组	44	39.8±6.2	2.5±1.3	32(72.7)	12(27.3)	12(27.3)	6(13.6)
统计量		t＝0.37	t＝0.67	χ²＝0.09		χ²＝0.31	χ²＝0.07
P值		0.711	0.504	0.761		0.581	0.798

表2 2组EP患者治疗效果及复发率比较[例数(%)]

组别	例数	显效	有效	无效	总有效率	宫腔镜TCRP术后12个月内复发率
观察组	45	31(68.9)	13(28.9)	1(2.2)	44(97.8)	2(4.4)
对照组	44	23(52.3)	14(31.8)	7(15.9)	37(84.1)	8(18.2)
χ²值		2.57	0.09	5.09	5.09	4.21
P值		0.108	0.763	0.024	0.024	0.040

表2 2组EP患者治疗效果及复发率比较[例数(%)]

组别	例数	显效	有效	无效	总有效率	宫腔镜TCRP术后12个月内复发率
观察组	45	31(68.9)	13(28.9)	1(2.2)	44(97.8)	2(4.4)
对照组	44	23(52.3)	14(31.8)	7(15.9)	37(84.1)	8(18.2)
χ²值		2.57	0.09	5.09	5.09	4.21
P值		0.108	0.763	0.024	0.024	0.040

表3 2组EP患者宫腔镜TCRP 4个不同时间点子宫内膜厚度及PBAC评分比较(

±s)

组别	例数	子宫内膜厚度(mm)				PBAC评分(分)
组别	例数	术前	术后3个月	术后6个月	术后12个月	术前	术后3个月	术后6个月	术后12个月
观察组	45	12.9±3.6	5.2±1.4	5.3±0.8	5.5±0.3	114.0±18.4	82.2±10.4	53.8±8.0	35.5±7.7
对照组	44	12.9±3.3	6.4±1.8	7.9±1.4	10.2±1.0	114.0±18.3	93.3±11.8	79.3±14.4	51.2±10.4
t值^a		<0.01	30.52	10.79	30.17	<0.01	4.71	10.36	8.12
P值^a		>0.999	0.001	<0.001	<0.001	>0.999	<0.001	<0.001	<0.001

表3 2组EP患者宫腔镜TCRP 4个不同时间点子宫内膜厚度及PBAC评分比较(

±s)

组别	例数	子宫内膜厚度(mm)				PBAC评分(分)
组别	例数	术前	术后3个月	术后6个月	术后12个月	术前	术后3个月	术后6个月	术后12个月
观察组	45	12.9±3.6	5.2±1.4	5.3±0.8	5.5±0.3	114.0±18.4	82.2±10.4	53.8±8.0	35.5±7.7
对照组	44	12.9±3.3	6.4±1.8	7.9±1.4	10.2±1.0	114.0±18.3	93.3±11.8	79.3±14.4	51.2±10.4
t值^a		<0.01	30.52	10.79	30.17	<0.01	4.71	10.36	8.12
P值^a		>0.999	0.001	<0.001	<0.001	>0.999	<0.001	<0.001	<0.001

表4 进一步分别对表3中2组EP患者宫腔镜TCRP 4个不同时间点2个指标的时间因素单独效应分析(组内总体及两两比较)结果

4个时间点2个指标的总体及两两比较	观察组		对照组
4个时间点2个指标的总体及两两比较	子宫内膜厚度	PBAC评分	子宫内膜厚度	PBAC评分
总体比较(F值/P值)	164.81/<0.001	371.57/<0.001	82.83/<0.001	154.80/<0.001
两两比较(t值/P值)
术前vs术后3个月	19.21/<0.001	17.31/<0.001	19.30/<0.001	11.57/<0.001
术前vs术后6个月	16.70/<0.001	30.34/<0.001	13.79/<0.001	19.83/<0.001
术前vs术后12个月	14.56/<0.001	39.13/<0.001	7.07/<0.001	34.02/<0.001
术后3个月vs术后6个月	0.72/0.477	28.89/<0.001	8.72/<0.001	10.15/<0.001
术后3个月vs术后12个月	1.68/0.099	47.41/<0.001	20.80/<0.001	36.83/<0.001
术后6个月vs术后12个月	2.22/0.031	23.23/<0.001	17.09/<0.001	20.33/<0.001

表4 进一步分别对表3中2组EP患者宫腔镜TCRP 4个不同时间点2个指标的时间因素单独效应分析(组内总体及两两比较)结果

4个时间点2个指标的总体及两两比较	观察组		对照组
4个时间点2个指标的总体及两两比较	子宫内膜厚度	PBAC评分	子宫内膜厚度	PBAC评分
总体比较(F值/P值)	164.81/<0.001	371.57/<0.001	82.83/<0.001	154.80/<0.001
两两比较(t值/P值)
术前vs术后3个月	19.21/<0.001	17.31/<0.001	19.30/<0.001	11.57/<0.001
术前vs术后6个月	16.70/<0.001	30.34/<0.001	13.79/<0.001	19.83/<0.001
术前vs术后12个月	14.56/<0.001	39.13/<0.001	7.07/<0.001	34.02/<0.001
术后3个月vs术后6个月	0.72/0.477	28.89/<0.001	8.72/<0.001	10.15/<0.001
术后3个月vs术后12个月	1.68/0.099	47.41/<0.001	20.80/<0.001	36.83/<0.001
术后6个月vs术后12个月	2.22/0.031	23.23/<0.001	17.09/<0.001	20.33/<0.001

表5 2组EP患者宫腔镜TCRP术前及术后12个月临床症状评估指标比较(分，

±s)

组别	例数	下腹疼痛VAS评分		经期不规律计分		白带异常评分
组别	例数	术前	术后12个月	术前	术后12个月	术前	术后12个月
观察组	45	6.4±1.2	1.3±0.8	5.3±1.3	2.2±1.0	4.1±1.4	0.55±0.17
对照组	44	6.1±1.7	3.2±0.5	5.3±1.3	3.5±0.5	4.3±1.4	1.25±0.91
t值		0.98	13.69	0.18	7.93	0.40	5.07
P值		0.330	<0.001	0.853	<0.001	0.690	<0.001

表5 2组EP患者宫腔镜TCRP术前及术后12个月临床症状评估指标比较(分，

±s)

组别	例数	下腹疼痛VAS评分		经期不规律计分		白带异常评分
组别	例数	术前	术后12个月	术前	术后12个月	术前	术后12个月
观察组	45	6.4±1.2	1.3±0.8	5.3±1.3	2.2±1.0	4.1±1.4	0.55±0.17
对照组	44	6.1±1.7	3.2±0.5	5.3±1.3	3.5±0.5	4.3±1.4	1.25±0.91
t值		0.98	13.69	0.18	7.93	0.40	5.07
P值		0.330	<0.001	0.853	<0.001	0.690	<0.001

表6 2组EP患者宫腔镜TCRP术前及术后12个月子宫血流动力学指标及炎症因子水平比较(

±s)

组别	例数	子宫动脉RI		子宫动脉PI		血清IL-1水平(pg/mL)		血清IL-6水平(ng/L)
组别	例数	术前	术后12个月	术前	术后12个月	术前	术后12个月	术前	术后12个月
观察组	45	0.94±0.08	0.52±0.05	1.31±0.14	0.82±0.13	51.9±6.1	28.5±3.6	23.0±4.3	14.0±2.3
对照组	44	0.92±0.09	0.73±0.07	1.27±0.12	0.97±0.11	52.0±6.0	34.2±4.4	23.0±4.3	15.3±2.5
t值		1.11	16.31	1.45	5.87	0.08	6.68	0.04	2.62
P值		0.270	<0.001	0.151	<0.001	0.937	<0.001	0.964	0.010

表6 2组EP患者宫腔镜TCRP术前及术后12个月子宫血流动力学指标及炎症因子水平比较(

±s)

组别	例数	子宫动脉RI		子宫动脉PI		血清IL-1水平(pg/mL)		血清IL-6水平(ng/L)
组别	例数	术前	术后12个月	术前	术后12个月	术前	术后12个月	术前	术后12个月
观察组	45	0.94±0.08	0.52±0.05	1.31±0.14	0.82±0.13	51.9±6.1	28.5±3.6	23.0±4.3	14.0±2.3
对照组	44	0.92±0.09	0.73±0.07	1.27±0.12	0.97±0.11	52.0±6.0	34.2±4.4	23.0±4.3	15.3±2.5
t值		1.11	16.31	1.45	5.87	0.08	6.68	0.04	2.62
P值		0.270	<0.001	0.151	<0.001	0.937	<0.001	0.964	0.010

表7 2组EP患者宫腔镜TCRP术前及术后12个月血清性激素水平比较(

±s)

组别	例数	FSH(U/L)		LH(U/L)		雌二醇(pmol/L)		AMH(ng/mL)
组别	例数	术前	术后12个月	术前	术后12个月	术前	术后12个月	术前	术后12个月
观察组	45	5.7±1.0	6.8±0.8	5.7±0.9	9.7±1.5	18.6±2.0	30.2±2.9	4.5±0.7	3.9±0.5
对照组	44	5.6±0.9	6.3±0.8	5.6±0.9	8.2±0.8	18.6±1.9	22.2±2.7	4.5±0.7	3.6±0.4
t值		0.25	2.56	0.26	5.87	0.07	13.38	0.22	3.40
P值		0.799	0.012	0.793	<0.001	0.942	<0.001	0.829	0.001

表7 2组EP患者宫腔镜TCRP术前及术后12个月血清性激素水平比较(

±s)

组别	例数	FSH(U/L)		LH(U/L)		雌二醇(pmol/L)		AMH(ng/mL)
组别	例数	术前	术后12个月	术前	术后12个月	术前	术后12个月	术前	术后12个月
观察组	45	5.7±1.0	6.8±0.8	5.7±0.9	9.7±1.5	18.6±2.0	30.2±2.9	4.5±0.7	3.9±0.5
对照组	44	5.6±0.9	6.3±0.8	5.6±0.9	8.2±0.8	18.6±1.9	22.2±2.7	4.5±0.7	3.6±0.4
t值		0.25	2.56	0.26	5.87	0.07	13.38	0.22	3.40
P值		0.799	0.012	0.793	<0.001	0.942	<0.001	0.829	0.001

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