年轻子宫内膜癌患者孕激素保守治疗临床分析

Clinical analysis of conservative treatment with progestin in young women with endometrial carcinoma

目的：探讨年轻早期高分化子宫内膜癌患者孕激素保守治疗疗效、安全性、治疗后的妊娠率及复发率。方法：回顾性分析20010-01～2008—12-31在北京协和医院行孕激素保守治疗的2．1例年轻子宫内膜样癌患者临床病理资料，并随访患者的治疗结果。结果：24例患者中，3例患者治疗3个月后均行腹腔镜下全子宫及双附件切除（LH上BS（））．继续治疗的21例患者中15例（71．4％）患者完全缓解，3例（14．3形）患者部分缓解．3例（14．3％）患者无效。达完全缓解的中位时间为6个月（3～12个月）。醋酸甲羟孕酮（MPA）组和醋酸甲地孕酮（MA）组的完全缓解率分别为76．9形（10/13）和62．5％（5／8）．差异无统计学意义．P=0．325。10例有近期生育要求的患者中4例（40．0%）妊娠成功。3例（20．0％）患者完全缓解后复发。结论：对于年轻高分化子宫内膜样癌患者．保留生育功能的孕激素治疗是可行的，但应行全面评估。完全缓解后积极的辅助生育技术可提高妊娠率。因有一定的复发率．完全缓解后应严密随访。

OBJECTIVE： To investigate the efficacy, securi ty, pregnant rate, recurrence rate of conservative treatment with progestin in young women with earlystage well differentiated en dometrial cancer. METHODS： The medical records of young patients with endometrioid endometrial adenocarcmoma, who were treated with progestin from January 01 , 2001 to December 31 , 2008 were retrospectively analyzed. RESULTS： Three patients were treated with LH ＋BSO 3 months after progestin treatment complete remission was achieved in 1% patients （71.4%）, partial remission was achieved in 3 patients （11. 3%）. 3 patients （14.3%） had no response. The median time to complete remission was 6 months （range,3 12 months）. The complete remis sion rate in MPA and MA group were 76.9%, 62.5%, and there was no statistical difference （P=-0. 325）. Four （40.0%） of the 10 patients with CR who tried to conceive had successful preg- nancy. Three （20.0%） patients had recurrent disease. CONCLUSlONS： Conservative treatment with progestin is feasible in young patients with early-stage well differentiated endometrial cancer, but a comprehensive assessment should be done before treatment, The use of assistant reproductive technology after CR can improve pregnant rate. However, close follow-up is required because of the substantial rate of recurrence.