乳腺癌患者三苯氧胺治疗后妇科良性疾患的随访研究

Follow-up of benign gynecologic diseases in patients treated with tamoxifen for breast cancer

目的 探讨乳腺癌患者三苯氧胺治疗后发生妇科良性疾患的特点.方法 采用随访性研究方法对北京朝阳医院2000年1月1日至2007年7月31日间确诊并手术治疗、术后辅助或未辅助三苯氧胺治疗并且经过妇科检查及妇科随访的163例乳腺癌患者的妇科疾病进行随访分析.结果 随访时间12～96个月,中位随访时间31个月.乳腺癌患者术后症状性子宫肌瘤的发生率9.20%,其子宫肌瘤的发生同服用三苯氧胺呈显著负相关性（P〈0.05）,未服用三苯氧胺患者子宫肌瘤的发牛率明显高于服用者（32.72%比17.59%）,生育期服用三苯氧胺的乳腺癌患者子宫肌瘤的发生率明显低于未服用者（P〈0.05）,绝经后子宫肌瘤的发生与三苯氧胺无相关性（P〉0.05）.绝经后服用三苯氧胺患者子宫内膜病变的发生率显著高于未服用者（P〈0.05）.生育期服用三苯氧胺的患者附件囊肿的发生率明显高于未服用者（P〈0.05）.结论 乳腺癌患者三苯氧胺应用是绝经后子宫内膜病变、生育期附件囊肿发生的危险因素,是生育期患者子宫肌瘤的保护性因素.

Objective To explore the pattern of benign gynecologic diseases in patients treated with tamoxifen for breast cancer.Methods A total of 163 cages with breast cancer were followed up by gynecologists.The incidence rates of several benign gynecologic conditions were determined and were compared among women receiving tamoxifen and those not taking it.Results For a follow-up of 12-96 months,the incidence rates of leiomyomas requiring therapy Was 9.20%.Compared with women not taking tamoxifen,the patients taking tamoxifen had a lower incidence rate of leiomyomas （17.59% vs 32.72%） （P〈0.05）,the menopausal women taking tamoxifen had a greater incidence of endometrial lesions （P〈0.05） and the premenopausal women taking tamoxifen had a greater incidence of ovarian cysts （P〈0.05）.Conclusion Tamoxifen is a high risk factor for an increased risk of endometrial lesions for menopausal women and ovarian cysts for premenopausal women.But it acts as a protective factor for decreasing the incidence rate of leiomyomas.