不同方法治疗子宫内膜单纯性增生的疗效观察

Efficacy of different therapies in treatment of simple endometrial hyperplasia

目的:比较口服孕激素、口服避孕药及左炔诺孕酮宫内缓释系统(LNGIUS)治疗子宫内膜单纯性增生的疗效,进而对3种治疗方法进行评价。方法:前瞻性研究2010年8月至2013年6月在山东大学齐鲁医院门诊及住院收治的50岁以下、病理结果证实为子宫内膜单纯性增生的243例患者。将患者随机分为3组(每组各81例),分别接受口服孕激素(A组)、口服避孕药(B组)及LNG-IUS(C组)治疗6个月。治疗后每3个月取患者子宫内膜行病理检查,观察治疗后的病理结果。结果:治疗6个月时,口服孕激素组(A组)、口服避孕药组(B组)、LNG-IUS组(C组)的病理缓解率分别为97.5%、96.3%和100%,3组比较,无显著差异(P>0.05);治疗期间,3组的突破性出血发生率分别为16.0%、6.1%和22.2%,差异显著(P<0.025);体重质量增加发生率分别为51.9%、6.1%和4.9%,差异显著(P<0.005);恶心呕吐发生率分别为7.4%、4.9%和2.5%,差异无统计学意义(P>0.05)。3组患者均未出现血栓形成、头晕乏力、肝酶升高等不良反应。结论:对50岁以下的子宫内膜单纯性增生患者,口服孕激素、口服避孕药或左炔诺孕酮宫内缓释系统方法均可为首选。治疗方式的选择应取决于患者的依从性、身体一般状况及对药物副反应的耐受程度等。

Objective：To evaluate the efficacy and safety of hormonal therapy, oral contraceptives（OCs） and levonorgestrel-releasing intrauterine system（LNG-IUS） on simple hyperplasia in women. Methods ：243 patients, aged 50 years or younger, who were diagnosed by pathologic results were recruited in Qilu Hospital of Shandong University from August 2010 to June 2013. They were divided into three groups randomly and treated by progestins （group A） ,OCs （ group B） or LNG-IUS （ group C） for 6 months. All patients underwent pathologic examination every 3 months since the beginning of treatment. Results：Pathologic complete response rate of three groups in 6 months were 97.5 % （ group A）, 96.3 % （ group B ）, 100% （ group C ）, there was no statistical significance （P〉0.05）. On the contrary, there was significant difference in u- terine breakthrough bleeding（ 16.0%, group A ;6.1% , group B ;22.2%, group C） （P〈0. 025 ） and weight gain （51.9%, group A ; 6.1%, group B ; 4.9%, group C ） （ P〈0. 005 ）, but not in gastrointestinal symptom. None of these patients had adverse effeets of vein thrombosis and liver dysfunctions. Conclusions：All three therapies could be the first choiee for simple hyperplasia in women with 50 years old or younger. Individualized treatment should be made in consideration of patients＇ willingness, compliance and reaction to those therapies.