Clinical Study Of Different Surgical Treatments For Endometrial Polyps

The endometrial polyps(EMP) to happen by the endometrium base first floor gland and the interstitial substance, is extremely common on clinical, has no symptoms,the unusual uterine hemorrhage or infertility, may occur at any age after the puberty, most in the peri-menopause.the EMP treatments have experienced several stages:the expectant treatment, the pure medicine treatment,surgery treatment. The expectant treatment is about that the function polyps follow hormone change to have the periodic change,some can voluntarily fall off at the menstrual,the pure medicine treatment aims at mature polyps, but at present the case to be less, the effect appraisal waits for the accumulation case of illness.Before the development of Hysteroscopy surgery, the treatment of the patients who medicine treatment result is not good take blindly curettage and the womb excision mainly, the former treatment has blindness, no thoroughness, the effect unsatisfactory, the clinical symptom cannot thoroughly improve, finally only excises the womb, the latter wound is big, restores slowly, also has pain of no womb, especially is puzzled to the patient of infertility in the treatment. With the Hysteroscopy surgery technology development,the level of the EMP treatment got a big enhancement, through the Hysteroscopy can look straightly at the polyps and excise the polyps from the peduncle completely,completely excise neighbor, but does not affect the normal endometrium, may prevent it to continue to exist and to recur, it no operation, the wound is slight, surgery time is short,bleeds is few, the pain of patients is few, remain potentia generandi , the restores is quick, the time in hospital is short and so on . The technique of the Hysteroscopy electricity remove has the high curative effect and security, especially is suitable to the young patients, hope retain birth abilityand the womb, or old patients have the many kinds of sickness of internal medicine。Hysteroscopy endometrial ablation have through cervix resect endomemtrium (TCRE), Roller-ball endometrial ablation(REA),laser operation to endometrium, the heat of the ball to the endometrium, microwave to endometrium, the different hospitals according to the conditions of the equipments, technological level, have also different treatmeats. This research only to aim directly at TCRE and REA to study.This research has stochastically collected 162 patients in out-patientservice and in-patient department of gynecology because of the EMP take hysteroscopic surgery from March, 2006 to October, 2007. postmenopausal EMP 22 examples, child-bearing age time EMP 140 examples. According to patient disparity in age, and whether retains the birth function, separately has adopted five different methods of treatment: 36 cases take curettage after hysteroscopy positioning;41 cases take the through cervix resect polyp (TCRP);31 cases take TCRP joint use of adjuvant (progesterone drugs); 32 cases of child-bearing age with remaining fertility take TCRP and TCRE; 22 cases of postmenopausal patients take TCRP + REA. Each patient according to the requirements after treatment back to follow up at 3,6,12month, focused on menstrual and vaginal bleeding conditions, sametime to hysteroscopy check. In order to analyse the efficacy and condition of recurrence. With a view to raise a cure rate of minimally invasive surgery in patients with endometrial polyps and to provide clinical guidance and theoretical basis.162 patients with EMP were successfully hysteroscopic surgery, to analyzing from the operation time and bleeding, the second group uses the shortest time (8.92±0.23 )min, the fourth group the longest time (30.24±0.97) min, the fourth group a maximum amount of bleeding (20.58±2.12) ml. 162 cases of patients with no a case of excessive bleeding, uterine perforation, surrounding organ damage, TURP syndrome, and other complications. 32 cases of non-reproductive requirements with TCRE +TCRP ,after treatment have 20 amenorrhea cases (62.50%), no one case of recurrence of polyps. 108 cases have reservations about reproductive requirements of the patients were taken of-three methods: the results is that the first group of 36 patients, nine cases of recurrence (25.00%), the second group of 41 patients, two cases of recurrence (4.87%), Group 3 has 1 Cases of recurrence (3.23 %). Group 1 and Group 2, Group 3 recurrence rate differences are statistically significant (P <0.05), Group 2 and Group 3 of the recurrence rate difference was not significant (P> 0.05). The five cases are pregnancy after operation in eight cases of infertility patients. 140 cases of fertility patients, 19 patients had no significant improvement because of menstruation, bleeding or recurrence of a re-intervention treatment, including conservative of drugs or surgical treatment, which again is the highest for a group of 16 cases.This study shows that: With new technologies constantly improve and apply, the treatment of endometrial polyps from the traditional method of blindly curettage, or even hysterectomy develop to minimally invasive surgical technique of hysteroscopy, and the treatment methods of the hysteroscopy have also great improvement and progress.For the patients remaining potentia generandi with single polyp the through cervix resect polyp (TCRP)is the best method. For the patients with multiple polyps at the same time with endometrial hyperplasia can take TCRP joint use of adjuvant (progesterone drugs).The patients of menopause with hormone in lower levels,can take TCRP and REA,less recurrence. For the patients of non-reproductive requirements,can take TCRE, the therapeutic efficacy is higher than those of other and the recurrence rate is lower, but this technique require higher technical level of the doctors.Therefore it is the important measures that strengthen technical training, standardize surgical operation in the preventing postoperative complications, enhancing curative effect and reducing recurrence. The hysteroscopic surgery for the patients with endometrial polyps provides a safe and effective minimally invasive surgical treatment, and periodic review is the effective measures that timely detect and treat of postoperative complications.