子宫内膜息肉应用宫腔镜切除术治疗的疗效及患者复发的影响因素研究

Study on the efficacy of transcervical resection of polyps for endometrial polyps and influencing factors for postoperative recurrence

摘要

目的 分析子宫内膜息肉(EMP)应用宫腔镜切除术(TCRP)治疗的疗效及患者复发的影响因素。方法 选择2020年1月至2023年2月太原市妇幼保健院收治的598例EMP患者,回顾性收集临床资料,依据手术方式纳入观察组(n=304,TCRP)和对照组[n=294,宫腔镜下刮宫术(D&C)治疗]。研究对象术后随访2年,根据术后复发情况分为复发组(n=61)、未复发组(n=537)。分析两组围手术期指标、并发症及复发发生情况,采用Logistic回归法分析EMP患者术后复发的危险因素。结果 观察组和对照组手术时间、住院时间、术中出血量差异无统计学意义(P＞0.05)。住院期间,两组并发症发生率无统计学差异(P＞0.05),术后2年观察组复发率低于对照组(χ²=4.686,P＜0.05)。598例EMP患者术后复发61例,复发率为10.20%。多因素Logistic回归分析结果显示,年龄升高、手术治疗方案为D&C、体质量指数升高、息肉类型为多发、合并子宫内膜异位症为EMP患者术后复发的危险因素(OR介于1.833到2.132之间,P＜0.05);术后孕激素治疗为EMP患者术后复发的保护因素(OR=0.583,P＜0.05)。结论 与宫腔镜下刮宫术治疗比较,宫腔镜切除术治疗子宫内膜息肉并未影响围手术期指标,安全性良好,且复发率更低,子宫内膜息肉患者术后复发危险因素包括年龄升高、手术治疗方案为宫腔镜下刮宫术、体质量指数升高、息肉类型为多发、合并子宫内膜异位症,保护因素为术后孕激素治疗。

Abstract

Objective To analyze the efficacy of transcervical resection of polyps (TCRP) in the treatment of endometrial polyps (EMP) and to investigate the influencing factors for postoperative recurrence. Methods A total of 598 patients with EMP admitted to Taiyuan Maternal and Child Health Hospital from January 2020 to February 2023 were retrospectively enrolled.Clinical data were collected retrospectively,and patients were divided into an observation group (n=304,treated with TCRP) and a control group[n=294,treated with hysteroscopic dilation and curettage (D&C)]according to the surgical method.All patients were followed up for 2 years after surgery and were divided into a recurrence group (n=61) and a non-recurrence group (n=537) according to postoperative recurrence status.Perioperative indicators,complications,and recurrence rates were compared between the two groups,and Logistic regression analysis was performed to identify risk factors for postoperative recurrence in patients with EMP. Results There were no statistically significant differences between the observation group and the control group in terms of operative time,length of hospital stay,or intraoperative blood loss (P＞0.05).During hospitalization,there was no significant difference in the incidence of complications between the two groups (P＞0.05).However,the 2-year postoperative recurrence rate was significantly lower in the observation group than in the control group (χ²=4.686,P＜0.05).Among the 598 patients with EMP,61 cases of postoperative recurrence were observed,yielding an overall recurrence rate of 10.20%.Multivariate Logistic regression analysis revealed that advanced age,surgical treatment with D&C,increased body mass index,multiple polyps,and concomitant endometriosis were independent risk factors for postoperative recurrence in patients with EMP (OR ranging from 1.833 to 2.132,P＜0.05).Postoperative progestin therapy was identified as a protective factor against postoperative recurrence in patients with EMP (OR=0.583,P＜0.05). Conclusion Compared with hysteroscopic D&C,TCRP for the treatment of EMP does not adversely affect perioperative outcomes,demonstrates good safety,and is associated with a lower recurrence rate.

关键词

子宫内膜息肉 / 宫腔镜切除术 / 疗效 / 复发 / 影响因素

Key words

endometrial polyp / transcervical resection of polyp / efficacy / recurrence / influencing factor

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基金资助

太原市“六个一批”卫生健康人才能力提升专项行动2022年度科研项目(Y2022007)