| Background:Endometrial polyps are one of the common diseases in gynecology.They are caused by the overgrowth of the uterine lining.They may affect the occurrence of pregnancy through mechanical obstruction and inflammatory stimulation,leading to infertility.In the diagnosis and treatment of patients with endometrial polyps and infertility,TCRP has been widely used,and the pregnancy rate of patients after surgery has been significantly improved.However,the relationship between the size,number and location of endometrial polyps and the pregnancy rate after TCRP is still controversial in academic circles,and it remains to be confirmed.Objective:To study the endometrium,pregnancy status and influencing factors of patients with endometrial polyps and infertility after TCRP,and compare the coincidence rate of pure transvaginal ultrasonography,vaginal ultrasonography combined with hysteroscopy and pathological diagnosis.Diagnosis,especially for predicting the value of treatment and judging prognosis,provides a strong evidence-based medicine basis.Materials and Methods:1.A collection of 682 patients who were clinically diagnosed with endometrial polyps in the Department of Gynecology of Guangzhou First People’s Hospital from September 2018 to March 2020 were collected.All patients underwent TCRP and were diagnosed by pathology after surgery.59 patients with endometrial polyps and infertility who meet the criteria(inclusion criteria,exclusion criteria,complete clinical data and complete follow-up)were selected,including 32 patients who were willing to undergo hysteroscopy 1 month after TCRP;2.Record the preoperative condition of 59 patients,including age,menstrual history(whether regular,menstrual volume,menstrual period,etc.),birth history,years of infertility,transvaginal ultrasound examination results,and hysteroscopy results;3.Record 59 patients’ uterine cavity and endometrium during TCRP operation,including uterine cavity shape,volume,intima(color,thickness,uniformity,blood vessel shape,etc.);the number,size and location of polyps;4.Record the condition of the uterine cavity and endometrium in 32 patients undergoing hysteroscopy 1 month after surgery,including the uterine cavity shape,volume,surgical site and non-surgical site intima(color,thickness,uniformity,blood vessel shape,presence or absence Endometrial coverage,gland opening,surgical scar,etc.);5.The longest postoperative follow-up period for 59 patients was 12 months,including the menstrual status,pregnancy status,pregnancy method,and conception time of the patients;6.Statistical methods: In this study,SPSS 25.0 software was used to analyze the data.The count data was represented by rate(%),X2 test was used,and logistic regression analysis was used to analyze the influencing factors of postoperative pregnancy rate.P<0.05 is the difference There is statistical significance.Results:1.Among the 59 subjects included,31 cases had no abnormal uterine bleeding before TCRP operation,and 28 cases had abnormal uterine bleeding.There was no significant change in menstruation after TCRP in those without abnormal uterine bleeding compared with before operation;26 cases of abnormal uterine bleeding had improved(ie effective)symptoms compared with preoperative TCRP,accounting for92.86%(26/28);2.Among the 59 subjects included,In the end,41 patients had spontaneous pregnancy,and the overall pregnancy rate was 69.49%(41/59).Pregnancy rate in different time periods: the pregnancy rate within 3 months after surgery is 5.08%(3/59);the pregnancy rate within 3-6 months after surgery is 16.95%(10/59);6-9after surgery The pregnancyrate within months was 30.51%(18/59);the pregnancy rate within 9-12 months after surgery was 16.95%(10/59).According to the chi-square test,the natural pregnancy rate of patients was the highest in the 6-9months after TCRP,and the difference in pregnancy rate of patients at different time after TCRP was statistically significant(P<0.05);3.Pregnancy rate in different groups: the pregnancy rate in the 20-29 year-old group was 83.33%(20/24),which was higher than the pregnancy rate in the 30-35year-old group by 60%(21/35);the pregnancy rate in the single polyp group was87.5%(28/32)),which is higher than the pregnancy rate of the polyp group by48.15%(13/27);the pregnancy rate of the polyp diameter ≥ 1cm group is 86.96%(20/23),and the pregnancy rate is higher than the polyp diameter <1cm group by58.33%(21/36);The pregnancy rate in the wall group was 82.61%(19/23)higher than other groups.The pregnancy rate in the anterior wall group was 40%(4/10),the pregnancy rate in the lateral wall group was 44.44%(4/9),and the pregnancy rate in the uterine horn group was 82.35%.(14/17);the pregnancy rate of primary infertility group was 88.89%(24/27),which was higher than the pregnancy rate of secondary infertility group of 53.13%(17/32).According to the chi-square test,the postoperative pregnancy rate of single polyps,polyps ≥1cm in diameter,located on the posterior wall,and primary infertility is relatively high,and the difference is statistically significant(P<0.05);those aged 20-29 years are pregnant The rate is relatively high,but the difference is not statistically significant(P>0.05);4.Logistic regression analysis showed that the number,size,location,and type of infertility of endometrial polyps were correlated with postoperative pregnancy rate(P<0.05);5.32 patients underwent hysteroscopy one month after TCRP to check the uterine cavity and endometrium: the uterine cavity shape and volume of all patients were basically normal,and there was no intrauterine adhesions.Intimal conditions:81.25%(26/32)were satisfied;18.75%(6/32)were dissatisfied.Among them,22.22%(4/18)were dissatisfied in the polyp group,which was higher than 14.29%(2/14)in the single polyp group;26.32%(5/19)were dissatisfied in the polyp diameter ≥1cm group.Dissatisfied people in the group higher than the polyp diameter <1cm were 7.70%(1/13);33.33%(4/12)were dissatisfied in the uterine corner group,higher than the other groups,dissatisfied in the anterior wall group and the lateral wall group accounted for 0%,14.29%(2/14)were dissatisfied in the posterior wall group.After chi-square test,the results showed that the patients with unsatisfactory endometrium in the corner of the uterus,diameter ≥1cm and multiple polyps had a higher proportion,but the difference was not statistically significant(P>0.05);6.Comparing the coincidence rate of vaginal ultrasonography and combined hysteroscopy with pathological diagnosis: Among 59 patients who were confirmed to be endometrial polyps by pathological diagnosis,the coincidence rate of vaginal ultrasound and pathological diagnosis was 76.3%(45/59);The coincidence rate of ultrasound combined with hysteroscopy and pathological diagnosis was 93.2%(55/59).The chi-square test indicated that the accuracy of vaginal ultrasound combined with hysteroscopy was higher than that of transvaginal ultrasound alone,and the difference was statistically significant(P<0.05).Conclusion:1.The number,diameter,and location of endometrial polyps are related to the postoperative pregnancy rate.Among them,the postoperative pregnancy rate is higher in patients with single,diameter ≥1cm and located in the posterior wall;2.The pregnancy rate is highest during 6-9 months after TCRP;3.Patients with endometrial polyps and infertility who underwent TCRP one month after the operation had a high percentage of satisfactory endometrial coverage and wound repair.Patients with endometrial polyps and infertility who underwent TCRP can obtain good clinical results after surgery. |
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