子宫内膜切除术治疗子宫内膜非典型增生28例疗效观察

Observation on curative effect of transcervical resection of endometrium in atypical hyperplasia of endometrium on 28 cases

目的探讨宫腔镜下子宫内膜电切术(transcervica resection of endometrium,TCRE)联合高效孕激素治疗子宫内膜非典型增生的疗效。方法回顾性分析新疆医科大学第一附属医院2000年1月—2010年10月28例因子宫内膜非典型增生行TCRE术患者的临床资料,并对预后及子宫内膜转归情况进行随访。结果 26例患者均一次手术顺利,2例患者因术中怀疑内膜癌变,病理确诊为重度非典型增生后3个月行TCRE,28例患者均无严重并发症发生,术后月经及贫血均得到明显改善,总有效率为92.86%。术后1年1例患者因工作调动失访,术后2年1例患者因车祸死亡。术后6月28例患者好转率为100%(28/28);术后1年好转率为85.71%(25/28),复发率为14.29%(3/28),癌变率为0;术后2年好转率为80.76%(21/26),复发率为19.23%(5/26),癌变率为0;术后3年好转率为85%(17/20),复发率为10%(2/20),癌变率为5%(1/20);术后4年好转率为72.22%(13/18),复发率为16.67%(3/18),癌变率为11.11%(2/18)。结论对有随访条件的患者,TCRE术联合孕激素是治疗子宫内膜非典型增生的有效手段。

Objective To investigate the curative effect of atypical hyperplasia of endometrium by transcervical resection of endometrium （TCRE） and progestogen. Methods Clinical data of 28 cases with atypical hyperplasia of endometrium were analyzed retrospectively in The First Affiliated Hospital of Xinjiang Medical University from January 2000 to December 2010, who were treated by TCRE. Prognosis and outcome of endometrium were followed up. Results Twenty six cases’operation was smoothly, 2 cases were completely resected by hysteroscopy after 3 months due to intraoperative suspicion of endometrial cancer and pathology diagnosed severe atypical hyperplasia. There were no serious complication in all 28 cases. Menstruation and anemia of 28 postoperative patients were significantly improved , the total effective rate was 92.86%. After 1a in 1 patient was lost due to work mobility, 2a 1 patient died of car accident after 2a. 6 months after surgery ,the improvement rate of 28 patients was 100% （28/28）;after 1a, postoperative improvement rate was 85.71% （25/28）, the recurrence rate was 14.29% （3 / 28）,the malignant transformation rate was zero; after 2a postoperative,the improvement rate was 80.76% （21/26）, the recurrence rate was 19.23% （5 / 26）, malignant transformation rate was zero; after 3a, postoperative improvement rate was 85%（17/20）, the recurrence rate was 10% （2/20）, malignant transformation rate was 5 % （1 / 20）; after 4a ,improvement rate was 72.22% （13/18）, the recurrence rate was 16.67% （3 / 18）, malignant transformation rate was 11.11% （2/18） .Conclusion On the condition of the patients with follow-up, TCRE combined with progestin treatment of atypical endometrial hyperplasia is an effective method.