正常体质量年轻女性子宫内膜癌临床分析

Clinical analysis of endometrial carcinoma in young andnormal weight women

目的探讨年轻女性子宫内膜癌的临床特征，尤其是正常体质量患者的临床特点。方法回顾性分析复旦大学附属妇产科医院2008年1月至2011年12月收治的75例年龄≤40岁的年轻女性子宫内膜癌的临床资料，其中正常体质量及肥胖患者68例，将其分为正常体质量组（A组，32例）与肥胖组（B组，36例）进行比较分析。结果临床表现月经失调者A组81．2％，B组83．3％（P=0．822）；两组合并不孕不育者分别为31．2％及19．4％（P=0．279），平时月经稀发者分别为21．9％及30．6％（P=0．418），两组合并糖尿病、高血压或多囊卵巢综合征分别为6．2％及44．4％（P=0．001）。按国际妇产科联盟（FIGO）手术一病理分期：A、B组I期分别为68．8％及83．3％（P=0．157），Ⅱ-Ⅳ期分别为31．2％及16．7％（P=0．157）。病理分型：高危型A组8例（25．0％），B组5例（13．8％），其余均为内膜样腺癌。治疗以手术为主，两组确诊后共行孕激素治疗5例，其中2例治疗后足月妊娠，1例现孕7个月。结论年轻女性子宫内膜癌的临床表现均以月经失调为主。正常体质量患者中，合并不孕不育比例较高，合并糖尿病、高血压及多囊卵巢综合征者所占比例较小。正常体质量患者中，中晚期及病理分型为高危型的有增多趋势。对于早期患者，如有生育要求，可在严密观察下试行孕激素保守治疗。

Objective To investigate the clinical characteristics of endometrial carcinoma in young women, especially the normal weight women. Methods Seventy and five cases of endometrial carcinoma aged 40 years were treated in Obstetrics and Gynecology Hospital affiliated to Fudan University from January 2008 to December 2011. Among them, there are 68 cases of normal weight and obesity, who were divided into normal weight group（ group A, 32 cases） and obesity group （group B ,36 cases） for comparisons and analysis. Results About 81.2% of the patients were menstrual disorders in group A and 83.3% in group B （P = 0. 822） ; The merge infertility accounted for 31.2% and 19.4% （P =0. 279） respectively,and the oligomenorrhea accounted for 21.9% and 30. 6% （P = 0. 418） respectively, the patients combined diabetes, high blood pressure or PCOS were 6. 2% and 44.4% （ P = 0. 001 ） respectively. According to International Federation of Gynecology and Ostetrics（FIGO） surgery-pathologic stage, two groups of stage I were 68.8% and 83.3% （ P = 0. 157 ）, respectively. Stage II -IV were 31.2% and 16. 7% （ P = 0. 157 ）, respectively. Pathological type： 8 （ 25.0% ） cases were high-risk of pathology classification in group A, and Five cases （ 13. 8% ） in group B, others were endometrial adenocarcinoma. Operations were the main treatments. Five cases were progestogen therapied. After treatments,2 cases were full term pregnant, 1 case is now pregnant. Conclusion The clinical manifestations of endometrial carcinoma in young women were mainly menstrual disorders. There were higher percentage infertilities and lower percentage diabetes, high blood pressure and PCOS in normal body weight patients. In normal body weight patients, pathology classification for middle-late of high-risk pattern was increasing. For patients in early stage, if have birth requirement, could be treated with the trial progesterone conservative.