Clinical Study On The Pathogenetic Characteristics And The Prevention Of Recurrence Of Endometrial Polyps

ObjectiveTo investigate the factors associated with endometrial polyps and the effects of different treatments for preventing the recurrence of them after hysteroscopic electrotomy,in order to strengthen the understanding of the clinical characteristics of endometrial polyps,and to provide theoretical basis for the better choice of clinical treatment options for the prevention of recurrence of endometrial polyps(EPs).MethodsFirstiy,this study selected 1746 patients with endometrial polyps as the study subjects and 680 patients without them as the control group for analyzing retrospectively whom admitted to The First Affiliated Hospital of Jinan University from January 2013 to December 2017.The statistical information include: age,BMI,gravidity,parity,mode of delivery,abortion method,gynecological complications(ovarian cysts,uterine leiomyoma,endometriosis,polycystic ovary syndrome,infertility,adenomyosis,abnormal uterine bleeding,pelvic inflammatory disease,diabetes,hypertension),contact information,and record the number and size of polyps.Secondly,4 groups of patients were analyzed retrospectively for counting the recurrence rate of endometrial polyps and the pregnancy rate of patients with fertility intention after surgery,including the TCRP group,IUD group,COC group and progesterone group.Beside,the effect of the Mirena group was statistically analyzed in the prospective study,and the improvement of dysmenorrhea and oral drug compliance.Result1.Among the factors related to the incidence of endometrial polyps,a statistically significant association with age,gravidity,parity,BMI(22.43±3.47 kg/m2),cesarean section,artificial abortion.About the gynecological complications,endometriosis(OR=2.241,95%CI 0.807)and diabetes(OR=0.349,95%CI-1.052)were significantly associated with the incidence of endometrial polyps.The total malignant rate of EP was 1.26%,the following factors were related with the malignancy of EP:BMI(24.90±3.91kg/m2,OR=1.169,95%CI 0.156),uterine leiomyoma(OR=0.277,95%CI-1.284).2.Retrospective studies have respectively shown that the recurrence rate of the 4groups of EP were18.1%,23.5%,2.2% and 7.9%(P<0.05).However,not only there was no statistically significant difference between the COC group and the progesterone group,but also the TCRP group and the IUD group have showed the same result(P>0.0125).Within 1 year after the TCRP surgery,the pregnancy rate of progesterone group(62.37%)was significantly higher than that of TRCP group(27.44%),P<0.05.3.Prospective have respectively shown that the recurrence rate of the 5 groups of EP were 19.7%,26.3%,6.3%,7.2% and 0.0%(P<0.05).Not only there was no statistically significant difference between the TCRP group and the IUD group,but also the COC group and the progesterone group OR the LNG-IUS group have showed the same result(P>0.010).Within 8 months after the operation,the pregnancy rate of the observation group was significantly higher than that of the control group(P<0.05).Except the IUD group,the improvement rates of dysmenorrhea of the other 4 groups were 21.2%,73.2%,51.2% and 87.2%(P<0.0125).There was statistically significant difference between the progesterone group and the LNG-IUS group(P<0.0125),but there is no difference in improving the effect of dysmenorrhea between the COC group and progesterone group or LNG-IUS group(P>0.0125).The COC group(81.0%)was better than the progesterone group(66.7%)in oral medication compliancet(P<0.05).Conclusion1.Endometrial polyps were prone to recrudesce,and the pathogenetic characteristics of endometrial polyps were included: reproductive age,cesarean section,BMI<25kg/㎡,artificial abortion,endometriosis,diabetes,etc.Maternal birth and transvaginal trial delivery might be the protective factor for EP.BMI≥25kg/㎡,uterine leiomyoma might easily promote EP malignant transformation.2.Among the measures to prevent the recurrence of endometrial polyps,LNG-IUS was the most effective treatment that could prevent the recurrence of EP,the used of contraceptives or progesterone were also worked,but the treatment of IUD might bemore likely to detect the recurrence of endometrial polyps after hysteroscopic polypectomy.LNG-IUS or COC could improve dysmenorrhea,and the effect of LNG-IUS was better than oral progestogen drugs.Within a short period of time,the compliance of oral contraceptive is better than that of progestogen,and oral progesterone therapy may be more suitable for patients with pregnancy intention after operation,which is of clinical significance.