The Value Of Hysteroscopic In Patients With Recurrent Endometrial Polyps Or Cesarean Scar Pregnancy

Hysteroscope was introduced in 1980's,the past 10 years,which has been widely applied in gynecological clinic. Endometrial polyps is inflammatory polyps that endometrial hyperplasia of the basal layer.The The diagnosis depended on ultrasound or curettage ,which is low. hysteroscopy that have visualization system and magnification imaging system make the diagnosis of endometrial polyps more clearly than ultrasound.The traditional treatment of endometrial polyps is curettage operation. Curettage ,due to residual "roots"organization ,can not do a thorough treatment of endometrial polyps,which can increase the recurrence of endometrial polyps .Hysteroscope with the visualization, which making up for the blindness of traditional curettage surgery , reduceing recurrence of endometrial polyps, improving and enhancing the pregnancy and birth outcome in patients with infertility and reducing the patient's physical and mental pains ,has also contributed to the treatment of endometrial polyps.Cesarean scar pregnancy is the process of implantation in the previous cesarean uterine scar which belongs to ectopic pregnancy. Cesarean scar pregnancy that the potential for long-term after cesarean section complications can lead to uterine rupture, serious bleeding and even death. With increasing of the cesarean rate,the incidence of cesarean scar pregnancy has also increased. Hysteroscopy with the help of the ultrasound can clearly observe the Tpregnancy tissue ,such as the specific location, size, and the relationship between the myometrium ,and give the differential diagnosis among normal uterine or cervical pregnancy, embryos residues and esarean scar pregnancy. iCesarean scar pregnancy is diagnosed more frequently than they were previously because of the widespread use of ultrasound as a supplement to gynecological examination. With the development of clinical hysteroscopic technology, hysteroscopy gradually is applied to the diagnoisis and the treament of CSP, combined with the preoperative of drug treatment, which avoid the trauma of laparotomy and the risk of hysterectomy, retain the integrity of the uterus and improve satisfaction. there is a new method of the treatment of CSP,which is hysteroscopy .The clinical datas of recurrent endometrial polyps and cesarean scar pregnancy were retrospectively analyzed to explore the diagnosis and treatment value of hysteroscopy about these two diseases. Objective:1. To study the value of hysteroscopy in the diagnosis and treatment of recurrent endometrial polyps .2. To study the value of hysteroscopy in the diagnosis and treatment of cesarean scar pregnancyMaterials and Methods:1. The medical records of eighty patients with recurrent endometrial polyps that had been diagnosed in our department from 2001 to 2009 were collected and reviewed, which following the standards:previous hysteroscopy and histological diagnosis of endometrial polyps treated by simple curettage treatment,non-breast cancer patients to continue treatment of oral tamoxifen,no intrauterine adhesions, uterine septum, uterine abnormalities, uterine fibroids and other uterine submucosal lesions, No serious medical disease complications, no malignant endometrial lesions, people can be reviewed and followed up by telephone. By treatment of the patients were divided into A, B groups. Group A is simple curettage with orientation of hysteroscopy and group B is hysteroscopic resection of endometrial polyps. Compared polyp recurrence after postoperative two years and pregnancy, childbirth results of infertility patients between the two groups.2. The medical records of twenty-five patients with cesarean scar pregnancy that had been diagnosed in our department from 2001 to 2009 were collected and retrospectivly analysised.Results:1. In group A ,12 of 40 patients treated with simple curettage under hysteroscopic positioning found endometrial polyps after 2 years of surgery,such as 7 to 9 months after surgery in 1 case, 10 to 12 months in 2 cases, 13 to 15 months in 3 cases, 16 to 18 months in 4 cases, 19 to 21 months in 2 cases. 40 patients with recurrent endometrial polyp in B group treated by hysteroscopic after 2 years found only 2 cases, time was 18 months and 23 months.2. A set of simple curettage after 1 year and 2 years polyp recurrence rate respectiely was 32.5% (13/40), 60% (24/40). B set of hysteroscopic resection of endometrial polyps, no recurrence within 1 year, 2 years, only 2 cases of recurrence, the recurrence rate of 4%.By comparing the analysis of two surgical treatments for patients with recurrent endometrial polyps after 2 years ,the recurrence rate of polyps were significantly different((P=0.0382, P<0.05). 3. 8 in 12 cases of infertility patients had spontaneous pregnancy, accounting for 66.67%. In group A ,1 patients had spontaneous abortion at 3 months of pregnancy, 7 cases of group B had successful delivery, accounting for 87.50%.4. The 23 cases were managed by drug therapy combined with hysteroscopic.22 cases were successful, accounting for 95.56%,but one underwent a hysterectomy.5. Serum hCG time of 17 cases followed-up return to normal about 1~ 10 weeks after surgey, including 15 cases mass completely disappeared about 5 ~ 6 months after surgery, accounting for 93.33%.1 case after surgey 1 year and 3 months by ultrasound can still found the mass of a diameter of 1.0cm in the anterior wall of the incision caesarean sectionConclusions:1. Hysteroscopic resection ,which have effective clinical treatment, low recurrence rate in patients with recurrent endometrial polyps, can be used as the preferred treatment of endome- trial polyps .2. Hysteroscopic surgery can effectively improve the pregnancy rate and live birth rates in infertility in patients due to endometrial polyps.3. Women with a history of cesarean section or abortion due to menopause, the drug flow, irregular vaginal bleeding after curettage treatment, ultrasound can be use to check the location of gestational sac .If the he location of gestational sac is lower or suspected cases of cesarean scar pregnancy, Hysteroscopy was applied to make the diagnosis of cesarean scar pregnancy. Hysteroscopy can be used as the main method of cesarean scar pregnancy.4. Drug therapy combined with hysteroscopic resection can be used as the main method for the treatment of cesarean scar pregnancy to avoid hysterectomy.