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目的:探讨宫腔镜下刮匙刮除术与电切除术对子宫内膜息肉型(EP型)不孕症患者激素表达水平和预后的影响。方法:随机选取2012年6月~2012年12月南阳市中心医院妇产科收治的90例EP型不孕症患者作为实验组,并根据治疗方式分为刮宫亚组(46例)和电切亚组(44例),另选取同时期因非子宫内膜息肉因素导致不孕,并经宫腔镜检查确定子宫内膜无病变的已婚妇女45例作为对照组。比较3组患者的激素表达水平,对两组宫腔镜亚组术后进行每3个月1次,为期12个月的门诊随访,月经量、子宫内膜形态变化,并对其进行12个月的电话随访,统计术后成功妊娠人数和复发人数。结果:治疗前,两组患者内膜腺上皮细胞和间质细胞中雌激素受体(ER)表达水平比较,差异无统计学意义(P>0.05),而实验组孕激素受体(PR)无论在腺上皮细胞还是在间质细胞中的表达水平,均显著低于对照组(P<0.01),这种改变在治疗后消失;两亚组术后月经量均较术前显著减少(P<0.05),电切亚组术后3个月、6个月和12个月的月经量均显著低于刮宫亚组(P<0.05);再次妊娠率,刮宫亚组为56.52%,电切亚组为84.09%,电切亚组显著高于刮宫亚组(P<0.05);复发率刮宫亚组为19.57%,电切亚组为4.55%,电切亚组复发率显著低于刮宫亚组(P<0.05);两亚组术后均未出现重大并发症。结论:子宫内膜息肉患者PR表达水平较低,治疗后PR水平升至正常,电切除术术后月经改变更明显,且效果持续时间久,再次妊娠率高,复发率低。
Objective: To investigate the effect of hysteroscopic curettage and resection on hormone expression and prognosis in patients with endometrial polyps (EP type) infertility. Methods: Totally 90 patients with EP-type infertility treated in Department of Obstetrics and Gynecology, Nanyang Central Hospital from June 2012 to December 2012 were selected randomly as experimental group and divided into curettage subgroup (n = 46) (44 cases). Another 45 cases of infertile women who were non-endometrial polyps at the same period were selected as the control group. Hormone levels were compared between the three groups. The two groups of hysteroscopic subgroups were followed up every three months for 12 months outpatient follow-up, menstrual flow, endometrial morphological changes, and 12 Month of telephone follow-up, statistics of successful pregnancy and recurrence after the number. Results: Before treatment, there was no significant difference in estrogen receptor (ER) expression level between endometrial glandular epithelial cells and stromal cells in both groups (P> 0.05) The expression of MGF in both glandular epithelial cells and stromal cells was significantly lower than that of the control group (P <0.01), which disappeared after treatment. The postoperative menstrual flow in the two subgroups was significantly decreased (P (P <0.05). The menstrual flow in the 3 months, 6 months and 12 months postoperatively in the electro-cut subgroup was significantly lower than that in the curettage subgroup (P <0.05). The recurrence rate, curettage subgroup was 56.52% The rate of recurrence in curettage subgroup was 19.57% and in cut-off subgroup was 4.55%, the recurrence rate in cut-off subgroup was significantly lower than that in curettage subgroup (P <0.05) Group (P <0.05). No major complications occurred in both subgroups. Conclusion: The PR expression in endometrial polyps is low, and the PR level rises to normal after the operation. The menstrual changes are more obvious after the resection of the resection, and the effect lasts for a long time. The pregnancy rate is high and the recurrence rate is low.