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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:

18

期数:

2018年8期

页码:

699-702

栏目:

临床研究

出版日期:

2018-10-30

文章信息/Info

Title:

On Safety of Decidual Polypectomy in Pregnancy

作者:

李嘉; 杨艳**; 杨蕊; 宋雪凌; 马彩虹

北京大学第三医院妇产科生殖医学中心国家妇产疾病临床医学研究中心，北京100191

Author(s):

Li Jia;  Yang Yan;  Yang Rui;  et al.

Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China

关键词:

蜕膜息肉; 宫腔镜; 自然流产; 体外受精-胚胎移植

Keywords:

Decidual polyps; Hysteroscopy; Spontaneous abortion; In vitro fertilization and embryo transfer

文献标志码:

A

摘要:

目的探讨妊娠期蜕膜息肉切除术的妊娠结局和手术安全性，特别是宫腔镜手术。方法回顾性分析2010年1月~2016年12月因妊娠合并蜕膜息肉行息肉切除术54例资料。自然妊娠24例，辅助生育技术助孕30例。手术孕周53~24.3周，（11.8±5.7）周。75.9%（41/54）有阴道出血，出现症状到手术间隔时间6 h~3个月。息肉直径0.8~8 cm，（293±1.60）cm。当存在以下3种情况之一时建议手术治疗：①有阴道出血或分泌物增多症状；②息肉直径≥3 cm；③息肉表面覆有脓苔。根据发现息肉的孕周，中孕期选择常规手术，早孕期选择宫腔镜手术，双极电凝术为过渡术式。常规手术24例，宫腔镜手术28例。双极电凝术2例。结果术后病理诊断蜕膜息肉。自然流产率16.7%（9/54）；2例因胎儿异常引产（1例唐氏综合征，1例脊柱裂）；活产率79.6%（43/54），分娩孕周30~41.4周，（38.1±2.1）周。早产率13.0%（7/54），其中2例34周前分娩，5例34~37周分娩，早产胎膜早破率5.6%（3/54）；足月分娩率66.7%（36/54）。宫腔镜手术28例，手术孕周5.3~9.1周，（7.1±0.7）周，术后2例因胎儿异常引产，自然流产率17.9%（5/28），流产孕周12.4~21周，（18.3±3.5）周，流产时间均在术后6周以上。结论妊娠期蜕膜息肉的切除存在风险，需慎重评估。宫腔镜下蜕膜息肉切除术作为新的手术方式尚在尝试阶段，根据目前结果认为其对妊娠结局的不良影响并不高于常规手术，但仍需谨慎把握手术指征，并在抗生素治疗等方面加强应用以进一步降低感染性流产的发生。对于蜕膜息肉的最佳的处理方案，需要进一步的前瞻性病例对照研究。

Abstract:

ObjectiveTo summarize the pregnancy outcomes of the patients who accepted decidual polypectomy, and to explore the safety of operation, especially hysteroscopy.MethodsA total of 54 patients who underwent polypectomy between January 2010 and December 2016 in our hospital were selected, including 24 cases of natural pregnancy and 30 cases of assisted reproductive technology. The week of the operation was 5.3-24.3 weeks ［(11.8±5.7) weeks］. Preoperative vaginal bleeding accounted for 75.9% (41/54) of patients, and the shortest interval between symptoms and operation was 6 hours, the longest 3 months. The diameter of polyps was 0.8-8 cm ［(2.93±1.60) cm］. When there was one of the following three situations, surgical treatment was suggested: ①vaginal bleeding or unusual discharge; ②polyp diameter more than 3 cm; ③polyps coated with pus. According to the different gestational age of polyps, patients in second-trimester were given routine surgery and patients in first-trimester were given hysteroscopy. Bipolar electrocoagulation was used as a transitional procedure. There were 24 cases of routine surgery and 28 cases of hysteroscopy. Bipolar electrocoagulation was performed in 2 cases.ResultsThe postoperative pathological diagnosis was decidual polyp. The spontaneous abortion rate was 16.7% (9/54). Two cases were induced due to fetal abnormalities (1 case of Down’s syndrome and 1 case of spina bifida). The live birth rate was 79.6% (43/54) and the gestational age was 30-41.4 weeks ［(38.1±21) weeks］. The rate of premature delivery was 13.0% (7/54), 2 of which delivered before 34 weeks and 5 of which delivered at 34-37 weeks. The rate of preterm premature rupture of membranes was 5.6% (3/54). The term delivery rate was 667% (36/54). A total of 28 patients underwent hysteroscopic surgery. The gestational age ranged from 5.3 to 9.1 weeks ［(7.1±0.7) weeks］. The spontaneous miscarriage rate was 17.9% (5/28) in 2 cases due to fetal abnormalities. The average time of miscarriage was 12.4-21 weeks ［(18.3±3.5) weeks］, which was all more than 6 weeks after operation.ConclusionsRemoval of decidual polyps during pregnancy is at risk and needs careful evaluation. Hysteroscopic decidual polypectomy as a new surgery is still in the trial stage. According to the results, its adverse effects on pregnancy outcomes are not higher than those of conventional surgery. For the best treatment of decidual polyps, further prospective case history studies are needed.

备注/Memo

备注/Memo:

基金项目：青年科学基金（81401169）**通讯作者，E-mail：sofoa@sina.com

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更新日期/Last Update: 2018-10-30