【摘要】 目的 探讨利用宫腔镜手术治疗子宫内膜息肉(endometrial polyps,EP)的临床价值。方法 对2002年6月～2005年6月153例EP患者，按照妇女生理阶段、生育要求及临床症状，采用不同的宫腔镜手术方式治疗，回顾性分析治疗效果。其中生育期EP 59例，围绝经期EP 73例，绝经后期EP 21例。患者年龄22～76岁，平均随访(22±6)个月。结果 153例中，EP切除后遍刮内膜42例，遍刮内膜再施以内膜剥除13例，同时行浅层内膜切除26例，同时行全层内膜切除72例。有月经改变100例，术后治愈93例，无效7例；无效中5例合并子宫腺肌病(4例药物治疗治愈，1例行子宫切除)，2例合并子宫内膜增殖症(行二次内膜电切治愈)。痛经30例，有效23例，无效7例；无效中6例药物治疗好转，1例行子宫切除。继发贫血32例，治愈28例，好转4例。不孕症9例，治愈率77.78%。结论 (1)生育期：无明显月经改变的，切除EP后遍刮子宫内膜；有明显月经改变的，其中无生育要求且年龄>40岁的，切除EP后再行全层内膜切除；其余均切除EP后再行浅层内膜切除。(2)围绝经期：无明显月经改变的，切除EP后遍刮子宫内膜；有明显月经改变的，切除EP后再行全层内膜切除。(3)绝经后期：无阴道出血的，切除EP后遍刮子宫内膜；有阴道出血的，同时行内膜剥除。

    【关键词】 子宫内膜息肉；宫腔镜电切术

    A study on applied valuation of hysteroscopic surgery for endometrial polyps

    ZHANG Hong-wei,SHEN Rong,ZHANG Lei.

    Shanghai Yangpu Maternity and Child Health Hospital,Shanghai 200082,China

    【Abstract】 Objective To determine the clinical valuation of different ways of hysteroscopic surgery for endometrial polyps.Methods Clinical effects were analysed retrospectively on total 153 patients underwent different ways of hysteroscopic surgery according to women physiological stages,the desire of fertility and clinical symptoms during the period of June 2002-June 2005.The mean followed-up duration was 22±6 months.Results Among 153 cases,after polyps resected,meantime 42 cases underwent uterine curettage,13 cases underwent uterine cuerttage and endometria ablation,26 cases’ superficial layer of endometria were resected,72 cases’s whole layer of endometria were resected.In 100 cases menstrual change,93 cases were cured,7 cases were invalid. Of 7 invalid cases,5 cases complicated by adenomyosis(4 cases cured through drugs,1 case cured through hysterectomy),2 cases complicated by endometrial hyperplasia(cured by repeat endometrial resection).In 30 cases dysmenorrhea,23 cases were valid,7 cases were invalid.Of 7 invalid cases,6 cases recovered through drugs,1 case cured through hysterectomy.In 32 cases secondary anemia,28 cases were cured,4 cases recovered.Infertility cure rate was 77.78%(7/9).Conclusion (1)Fertile stage:uterine curettage should be undergone for patients without menstrual change after polyps resected;among patients with menstrual change,whole layer of endometria were resected for the ones (more than 40 ages)without desire of fertility and superficial layer of endometria were resected for the others after polyps resected.(2)Perimenopause:uterine curettage should be undergone for patients without menstrual change and whole layer of endometria were resected for patients with menstrual change after polyps resected.(3)Postmenopause:uterine curettage should be undergone for patients without vaginal bleeding and endometria ablation should be carried out for patients with vaginal bleeding. ......