Comparative analysis of electrosurgical versus cold knife resection under hysteroscopy on endocrine function and fertility outcomes in women of reproductive age with endometrial polyps

ZHOU Yi-ying; LIU Shu-hua

doi:10.13820/j.cnki.gdyx.20250170

Abstract：Objective To analyze and compare the effects and clinical significance of hysteroscopic electrosurgi-cal resection and cold knife resection on endocrine function and fertility in women of reproductive age with endometrial pol-yps.Methods A retrospective analysis was conducted on 232 patients diagnosed with endometrial polyps at Hangzhou Hospital of Traditional Chinese Medicine from October 2020 to October 2023.Based on the surgical method,patients were divided into a control group(n=104,electrosurgical resection)and a study group(n=128,cold knife resection).Both groups were followed up for one year postoperatively.The study compared menstrual and endometrial conditions,recur-rence,hormone levels[estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),progesterone(P)],postoperative complications,and pregnancy outcomes between the two groups.Results There were no statistically significant differences between the two groups in terms of age,BMI,disease duration,gravidity,number of intrauterine surgeries,polyp diameter,or number of endometrial polyps(P＞0.05).In the perioperative period,the study group had significantly shorter operative time,less intraoperative bleeding,and shorter postoperative vaginal bleeding duration com-pared to the control group(P＜0.05),while hospitalization duration was similar(P＞0.05).Regarding menstrual and endometrial parameters,there were no significant intergroup differences in intermenstrual bleeding,time to menstrual re-covery,endometrial thickness,PBAC score before surgery,menstrual cycle length,or duration of menstruation(P＞0.05).However,both groups showed extended menstrual cycles and reduced PBAC scores and menstruation duration postoperatively,with the study group showing more significant improvement(P＜0.05).Regarding hormone levels,no significant differences were observed preoperatively(P＞0.05).Postoperatively at 1,3,and 6 months,both groups ex-hibited decreased levels of E2,FSH,and LH,and increased P levels compared to baseline,with changes more pro-nounced in the study group(P＜0.05).The incidence of complications(27.88％vs.12.50％)and recurrence(15.38％vs.7.03％)were significantly lower in the study group than in the control group(P＜0.05).The pregnancy rate among patients desiring fertility was higher in the study group(72.92％)compared to the control group(61.45％),although this difference was not statistically significant(P＞0.05).Conclusion Hysteroscopic cold knife resection of endometrial polyps provides favorable clinical outcomes,effectively reduces postoperative recurrence,improves menstrual patterns and sex hormone profiles,and may enhance fertility outcomes and perioperative recovery in women of reproductive age.