宫腔镜刨削系统治疗多发性子宫内膜息肉的临床效果评价

陈果; 应杰; 田璐; 朱雨婷; 陈顺霞; 姚顺; 周曙光

doi:10.16766/j.cnki.issn.1674-4152.003031

宫腔镜刨削系统治疗多发性子宫内膜息肉的临床效果评价

doi: 10.16766/j.cnki.issn.1674-4152.003031

安徽省妇幼保健院妇科，安徽合肥 230001

基金项目:

安徽省高校自然科学研究重点项目 KJ2021A0352

详细信息

通讯作者:
周曙光，E-mail：zhoushuguang@ahmu.edu.cn

中图分类号: R711.32 R713.4
计量
- 文章访问数: 267
- HTML全文浏览量: 181
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-15
- 网络出版日期: 2023-08-26

Clinical effect evaluation of the integrated bigatti shaver for the treatment of multiple endometrial polyps

Department of Gynecology, Maternal and Child Health Hospital, Hefei, Anhui 230001, China

摘要

摘要: 目的比较宫腔镜刨削系统(IBS)与传统宫腔镜电切术对多发性子宫内膜息肉的治疗价值。方法回顾性分析安徽省妇幼保健院2020年1月—2021年6月108例多发性子宫内膜息肉患者。IBS宫内刨削系统切除多发性子宫内膜息肉的48例患者作为研究组(IBS组)，选择同期行宫腔镜电切术治疗的患者60例作为对照组(电切组)。比较一般资料、术中情况、术前术后生化指标、安全性、卫生经济学效益、治疗后随访的临床疗效等，分析IBS宫内刨削系统的临床治疗价值。结果 (1) 术中情况比较：IBS组镜体插入宫腔次数明显少于电切组，手术时间短，灌流液使用量少，术中出血少，差异均有统计学意义(均P < 0.05)。(2)术前术后血液生化指标比较差异均无统计学意义(均P>0.05)。(3)安全性比较：IBS组手术并发症发生率为2.08%(1/48)，低于电切组的16.67%(10/60)，差异有统计学意义(P < 0.05)，2组均无水中毒及子宫穿孔发生。(4)卫生经济学效益比较：IBS组住院时间与电切组相比更短(P < 0.05)。(5)临床疗效比较：IBS组阴道流血时间较电切组短，排卵期子宫内膜厚度较电切组高，差异有统计学意义(均P < 0.05)。结论应用IBS宫内刨削系统治疗多发性子宫内膜息肉具有较高的安全性及有效性，可以最大化地保护子宫内膜，值得在临床上更为广泛的推广。
- IBS宫内刨削系统 /
- 宫腔镜电切术 /
- 多发性子宫内膜息肉 /
- 临床效果
Abstract: Objective To compare the clinical effect of the integrated bigatti shaver (IBS) intrauterine shaving system and the hysteroscopic electrosurgery for the treatment of multiple endometrial polyps. Methods A total 108 patients with multiple endometrial polyps in Anhui Maternal and Child Health Hospital from January 2020 to June 2021 were retrospectively analyzed. The 48 patients with multiple endometrial polyps removed by IBS intrauterine shaving system were selected as the study group (IBS group), and 60 patients undergone hysteroscopic electrosurgery were set as the control group (electrotomy group). The clinical effect evaluation was analyzed by comparing general clinical information, intraoperative conditions, preoperative and postoperative biochemical indicators, safety, health and economic benefits, and clinical efficacy of follow-up after treatment. Results (1) Intraoperative conditions: the frequency of endoscopic insertion into the uterine cavity in the IBS group was significantly less than that in the electrotomy group, the operation time was shorter, and the amount of perfusate used was less (all P < 0.05). (2) There was no statistically significant difference in blood biochemical indicators before and after surgery (all P>0.05). (3) Comparison of security: the incidence of surgical complications in the IBS group was 2.08% (1/48), lower than that in the electrotomy group (16.67%, 10/60), the difference was statistically significant (P < 0.05), and no water poisoning and uterine perforation occurred in both groups. (4) Health and economic benefits: the hospitalization time in the IBS group was shorter than that in the electrotomy group (P < 0.05). (5) Comparison of clinical efficacy: the vaginal bleeding time of the IBS group was shorter than that of the electrotomy group, and the endometrial thickness during ovulation was higher than that of the electrotomy group, with statistical significance (all P < 0.05). Conclusion The application of IBS intrauterine shaving system in the treatment of multiple endometrial polyps has high safety and efficacy, can maximize the protection of the endometrium, and is worthy of wider clinical promotion.
- Integrated bigatti shaver /
- Hysteroscopic electrosurgery /
- Multiple endometrial polyps /
- Clinical effect

HTML全文

图 1 IBS宫内刨削系统在多发性子宫内膜息肉中的手术治疗

注：A为刨削位于前侧壁的息肉；B为刨削位于左侧宫角的息肉；C为刨削位于后壁的息肉；D为术毕整理后的宫腔。

Figure 1. Surgical treatment of multiple endometrial polyps with IBS intrauterine planing system

下载: 全尺寸图片幻灯片

表 1 2组多发性子宫内膜息肉患者一般临床资料比较[M(P₂₅, P₇₅)]

Table 1. Comparison of general clinical data between the two groups of patients with multiple endometrial polyps [M(P₂₅, P₇₅)]

组别	例数	年龄(岁)	孕次(次)	产次(次)	经期(d)	息肉个数(个)	息肉大小(mm)
IBS组	48	33.50(30.25, 37.00)	2.00(0.25, 3.00)	1.00(0.00, 2.00)	6.50(6.00, 7.00)	6.00(4.00, 8.00)	52.50(40.75, 65.00)
电切组	60	34.50(26.00, 41.00)	1.00(1.00, 3.00)	1.00(0.00 2.00)	6.50(5.00, 7.00)	5.00(3.00, 6.00)	45.00(30.50, 60.00)
Z值		-0.009	-0.241	-1.266	-0.583	-1.911	-1.617
P值		0.993	0.810	0.206	0.560	0.056	0.106
注：息肉大小的评估是参考术前宫腔镜检查所有病灶最大径线之和。

下载: 导出CSV

表 2 2组多发性子宫内膜息肉患者手术情况比较[M(P₂₅, P₇₅)]

Table 2. Comparison of surgical outcomes between two groups of patients with multiple endometrial polyps [M(P₂₅, P₇₅)]

组别	例数	手术时间	插入宫腔次数(次)	灌流液使用量(mL)	术中出血量(mL)
IBS组	48	16.00(12.00, 20.00)	1.00(1.00, 2.00)	1 000.00(1 000.00, 1 500.00)	5.00(2.00, 5.00)
电切组	60	20.00(14.25, 25.00)	3.00(2.00, 3.00)	1 500.00(1 000.00, 2 000.00)	5.00(5.00, 8.00)
Z值		-2.292	-7.515	-3.403	-2.425
P值		0.022	< 0.001	0.001	0.015

下载: 导出CSV

表 3 2组多发性子宫内膜息肉患者术前术后生化指标比较(x ±s)

Table 3. Comparison of preoperative and postoperative biochemical indexes between two groups of patients with multiple endometrial polyps (x ±s)

组别	例数	术前生化指标				术后生化指标
组别	例数	血红蛋白(g/L)	红细胞压积(%)	血钠(mmol/L)	血钾(mmol/L)	血红蛋白(g/L)	红细胞压积(%)	血钠(mmol/L)	血钾(mmol/L)
IBS组	48	121.60±14.05	37.00±3.95	141.26±2.58	4.02±0.44	116.71±13.26	36.03±3.27	140.98±2.84	3.91±0.40
电切组	60	119.65±16.96	35.88±4.24	141.97±2.35	3.99±0.38	114.65±15.44	34.83±3.76	141.10±2.69	3.90±0.31
t值		0.641	1.405	-1.483	0.318	0.732	1.757	-0.236	0.023
P值		0.523	0.163	0.141	0.715	0.466	0.082	0.814	0.982

下载: 导出CSV

表 4 2组多发性子宫内膜息肉患者安全性比较[例(%)]

Table 4. Safety comparison of patients with multiple endometrial polyps in 2 groups[cases (%)]

组别	例数	宫腔粘连	术后感染	水中毒	子宫穿孔	总发生
IBS组	48	0	1(2.08)	0	0	1(2.08)
电切组	60	7(11.67)	3(5.00)	0	0	10(16.67)
χ²值		4.218	0.081			9.507
P值		0.040	0.776			0.009

下载: 导出CSV

表 5 2组多发性子宫内膜息肉患者卫生经济学效益比较[M(P₂₅, P₇₅)]

Table 5. Comparison of health economic benefits between two groups of patients with multiple endometrial polyps [M(P₂₅, P₇₅)]

组别	例数	住院时间(d)	住院费用(元)
IBS组	48	4.00(4.00, 5.00)	8 391.93(7 609.21, 9 453.97)
电切组	60	5.00(4.00, 5.00)	8 278.72(7 834.44, 8 895.82)
Z值		-2.230	-0.699
P值		0.026	0.485

下载: 导出CSV

表 6 2组多发性子宫内膜息肉患者术后随访情况比较

Table 6. Comparison of postoperative follow-up of patients with multiple endometrial polyps between the two groups

组别	例数	阴道流血时间[M(P₂₅, P₇₅)，d]	月经恢复时间[M(P₂₅, P₇₅)，d]	早卵泡期子宫内膜[M(P₂₅, P₇₅)，mm]	术后6月复发[例(%)]	术后12月复发[例(%)]
IBS组	48	3.00(2.00, 4.00)	27.00(26.00, 28.00)	6.00(4.00, 7.00)	1(2.08)	2(4.17)
电切组	60	4.00(3.00, 4.00)	27.00(26.00, 28.00)	5.00(3.00, 6.00)	3(5.00)	4(6.67)
统计量		-4.372^a	-0.869^a	-2.527^a	0.081^b	0.020^b
P值		< 0.001	0.385	0.011	0.776	0.888
注：^a为Z值，^b为χ²值。

下载: 导出CSV

参考文献(16)

[1]	余平芝, 李菲菲. 子宫内膜息肉行宫腔镜联合天然孕激素治疗的效果观察[J]. 中华全科医学, 2022, 20(2): 267-269. doi: 10.16766/j.cnki.issn.1674-4152.002329 YU P Z, LI F F. Clinical effect of endometrial polyps treated by hysteroscopic surgery combined with natural progesterone[J]. Chinese Journal of General Practice, 2022, 20(2): 267-269. doi: 10.16766/j.cnki.issn.1674-4152.002329
[2]	陈雨柔, 张蔚. 子宫内膜息肉的宫腔镜手术及术后管理[J]. 实用妇产科杂志, 2019, 35(11): 803-805. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201911004.htm CHEN Y R, ZHANG W. Hysteroscopic surgery for endometrial polyps and postoperative management[J]. Journal of Practical Obstetrics and Gynecology, 2019, 35(11): 803-805. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201911004.htm
[3]	LINDHEIM S, LINCENBERG K, WOOD M, et al. The impact of hysteroscopic tissue removal systems on histopathologic analysis for benign and cancerous endometrial pathology: an ex vivo study[J]. J Obstet GynaecolIndia, 2019, 69(2): 182-187.
[4]	BIGATTI G, FRANCHETTI S, ROSALES M, et al. Hysteroscopic myomectomy with the IBS^® Integrated Bigatti Shaver versus conventional biopolar resectoscope: a retrospective comparative study[J]. Gynecol Surg, 2014, 11(1): 9-18. doi: 10.1007/s10397-013-0827-z
[5]	中华医学会妇产科学分会. 宫腔粘连临床诊疗中国专家共识[J]. 中华妇产科杂志, 2015, 50(12): 881-887. doi: 10.3760/cma.j.issn.0529-567x.2015.12.001 Chinese Medical Association Branch of Obstetrics and Gynecology. Chinese expert consensus on clinical treatment of uterine adhesions[J]. Chinese Journal of Obstetrics and Gynecology, 2015, 50(12): 881-887. doi: 10.3760/cma.j.issn.0529-567x.2015.12.001
[6]	WAHBA H, HASSAN M, KOTB M, et al. Impact of uterine scar on pain experienced during outpatient hysteroscopy: a prospective blinded comparative study[J]. J Minim Invasive Gynecol, 2017, 24(4): 626-631. doi: 10.1016/j.jmig.2017.01.018
[7]	周静, 陈静, 翁同芳, 等. 宫腔镜冷刀技术在宫内疾病治疗中的应用和优势[J]. 中国内镜杂志, 2019, 25(1): 103-107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201901021.htm ZHOU J, CHEN J, WENG T F, et al. Application and advantage of hysteroscopic cold instruments technique in treatment of intrauterine diseases[J]. China Journal of Endoscopy, 2019, 25(1): 103-107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201901021.htm
[8]	YANG B Y, XU Y H, ZHU Q, et al. Treatment efficiency of comprehensive hysteroscopic evaluation and lesion resection combined with progestin therapy in young women with endometrial atypical hyperplasia and endometrial cancer[J]. Gynecol Oncol, 2019, 153(1): 55-62. doi: 10.1016/j.ygyno.2019.01.014
[9]	MAO J, GUIAHI M, CHUNOFF S, et al. Seven-year outcomes after hysteroscopic and laparoscopic sterilizations[J]. Obstet Gynecol, 2019, 133(2): 323-331. doi: 10.1097/AOG.0000000000003092
[10]	MEULENBROEKS D, HAMERLYNCK T W O, SAGLAM-KARA S, et al. Hysteroscopic tissue removal systems: a randomized in vitro comparison[J]. J Minim Invasive Gynecol, 2017, 24(1): 159-164.
[11]	GEORGIOU D, TRANOULIS A, JACKSON T. Hysteroscopic tissue removal system (myosure) for the resection of polyps, submucosal leiomyomas and retained products of conception in an out-patient setting: a single UK institution experience[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 231: 147-151.
[12]	TSUCHIYA A, KOMATSU Y, MATSUYAMA R, et al. Intraoperative and postoperative clinical evaluation of the hysteroscopic morcellator system for endometrial polypectomy: a prospective, randomized, single-blind, parallel group comparison study[J]. Gynecol Minim Invasive Ther, 2018, 7(1): 16-21.
[13]	施君, 金悦, 叶婧, 等. 新型宫腔镜刨削系统治疗育龄女性子宫内膜息肉和黏膜下肌瘤的临床分析[J]. 实用妇产科杂志, 2019, 35(7): 509-513. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201907015.htm SHI J, JIN Y, YE J, et al. Clinical Analysis of A New Hysteroscopic Shaving System for the Treatment of Uterine Endometrial Polyps and Submucousmyoma of Childbearing Age Women[J]. Journal of Practical Obstetrics and Gynecology, 2019, 35(7): 509-513. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201907015.htm
[14]	王梓媛, 王芝, 张咏梅. 宫腔镜刨削系统治疗宫腔良性疾病患者的疗效及对生化指标的影响[J]. 中国妇幼保健, 2020, 35(23): 4610-4612. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202023065.htm WANG Z Y, WANG Z, ZHANG Y M. Efficacy of hysteroscopic shaving system in the treatment of patients with benign uterine cavity disease and the effect on biochemical indicators[J]. Maternal and Child Health Care of China, 2020, 35(23): 4610-4612. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202023065.htm
[15]	蔡玉, 刁海丹. 宫腔镜刨削系统治疗黏膜下子宫肌瘤的临床效果[J]. 中国当代医药, 2021, 28(18): 90-93. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202118024.htm CAI Y, DIAO H D. Clinical effect of submucosal uterine fibroids treated by hysteroscopic shaving system[J]. China Modern Medicine, 2021, 28(18): 90-93. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202118024.htm
[16]	刘蔚, 李小娟. 宫腔镜刨削系统在有生育要求患者胚物残留治疗中的应用[J]. 临床医学研究与实践, 2021, 6(31): 150-152. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202131047.htm LIU W, LI X J. Application of hysteroscopic shaving system in the treatment of retained products of conceptionin in patients with fertility requirement[J]. Clinical Research and Practice, 2021, 6(31): 150-152. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202131047.htm