三苯氧胺对子宫内膜的影响

The effects of tamoxifen on the endometrium

目的 探讨三苯氧胺 (TAM )对子宫内膜的影响和监测方法。 方法 4 0例因乳腺癌手术及放化疗后 ,雌、孕激素受体阳性而服用TAM的患者 ,经门诊宫内膜抽吸取样、诊断性刮宫内膜病检 ,阴道超声波扫描 (TVS) ,诊断性宫腔镜 ,宫腔镜内膜病灶电切病检检查其宫内膜病变。 结果 2 8例 (70 % )有子宫内膜病变 ,包括内膜息肉或合并囊肿 2 0例 ,内膜增生合并囊肿及息肉 7例 ,黏膜下肌瘤 1例 ;萎缩性宫内膜 10例 ,正常分泌期及增殖期宫内膜 2例。宫内膜病变常呈不均衡性 ,正常内膜与萎缩内膜或囊肿、息肉并存。绝经后 35例中 ,阴道超声波扫描宫内膜厚度 >8mm 2 3例 ,其中 16例 (70 % )合并内膜病变 ;内膜厚度 <8mm 12例中 9例有内膜病变 (75 % )。 17例门诊抽吸内膜病检及盲刮取材病检均为阴性 ,但诊断性宫腔镜确诊为宫内膜增生、息肉或囊性息肉。 结论 服用TAM后 ,子宫内膜病变发生率较高 ,主要为内膜息肉、内膜腺性囊性萎缩、腺体增生和子宫肌瘤。病变的特点为不均衡性 ,各种病变可单独或并存。建议开始服用TAM前及服药后每年一次妇检 ,每半年一次TVS监查内膜变化 ,疑有内膜病变者 ,需行宫腔镜检及刮取内膜病检 ,必要时宫腔镜下息肉摘除或部分内膜切除病检。TVS仅为诊断性宫腔镜的筛选 。

Objective: To investigate abnormal uterine pathology in asymptomatic tamoxifen (TAM) users. Methods: From Sep. 2001 to April 2004, 40 tamoxifen-treated breast cancer patients were examined with endometrial aspiration, dilatation and curettage (D&C), transvaginal ultrasound (TVS), diagnostic hysteroscopy and operatival hysteroscopy for endometrial pathologies. Results: The incidence of endometrial abnormal pathologies induced by tamoxifen was high (70%). The major pathologic changes in 28 cases were endometrial polyp, cyst, proliferation with focal atypical cell, etc. In 35 postmenopausal cases, 25 were diagnosed as abnormal pathologies including 16 (70%) with endometrial thickness >8 mm, 9 cases (75%) with <8 mm by transvaginal ultrasound measurement. There were 17 patients with a negative result by endometrial sampling aspiration or D&C, but their endometrial pathologic lesions were confirmed by hysteroscopy.Conclusions: The most common endometrial pathologic changes for TAM users are endometrial polyp, glandulocystic atrophic endometrium, endometrial hyperplasia, and leiomyoma. The features of these changes are inhomogeneity. Considering these features, it may not be a good choice for the TAM users to be detected by endometrial sampling aspiration or D&C and transvaginal ultrasound only. The hysteroscopy with D&C or TCRP/TCRE is a valuable method for the detection of focal lesions and getting correct pathologic result for TAM users. It is our opinion that women taking tamoxifen should have routine TVS every half year. If endometrial disease is suspected, hysteroscopy, D&C or TCRP/TCRE may become necessary.