早期子宫内膜癌及子宫内膜重度不典型增生给予口服大剂量孕激素的妊娠结局分析

Pregnancy outcome of giving large doses of oral progesterone in early endometrial cancer and endometrial severe dysplasia

目的探讨大剂量孕激素保守治疗早期子宫内膜癌及子宫内膜重度不典型增生的妊娠结局及相关影响因素。方法2008年6月至2013年1月收治的早期子宫内膜癌（58例）及子宫内膜重度不典型增生（33例）共91例患者，采用连续口服大剂量孕激素治疗，每3个月诊刮了解子宫内膜变化情况，病理检查证实完全缓解后给予个体化的后续治疗。回顾性分析其妊娠结局及相关影响因素。结果91例中87．9％（80／91）患者获得完全缓解，迫切要求生育且随诊时间满12个月者有61例。共有29例患者成功妊娠35次，妊娠率为47．5％（29／61）；22例获得活产儿，生育率为36．1％（22／61）。妊娠与否与患者年龄、治疗前合并症、治疗时间及治疗前子宫内膜病理诊断结果（子宫内膜重度不典型增生还是子宫内膜癌）无关（P〉0．05）。采用体外受精-胚胎移植助孕、口服促排卵药物及未助孕治疗期待自然妊娠者妊娠率分别为13／13，12／29和4／19，三者比较差异有统计学意义（P〈0．05）。结论连续口服大剂量孕激素保守治疗早期子宫内膜癌及子宫内膜重度不典型增生可获得较高的完全缓解率；助孕技术可显著提高治疗后的妊娠率。

Objective To explore the pregnancy outcome of large doses of progesterone conservative treatment in early endometrial cancer and endometrial severe dysplasia and analyze the pregnancy-relating factors. Methods Fifty-eight cases with early endometrial cancer and 33 cases with endometrial severe dysplasia from June 2008 to January 2013 were selected. They were given large doses of oral progesterone, endometrial curettage was used to evaluate the therapy response of endometrium after every 3 months of administration. Individualized maintained treatment was given to patients after achieving complete remission of the endometrium. Pregnancy outcome and pregnancy-relating factors were analyzed retrospectively. Results All of the 91 patients 87.9% （80/91） achieved complete response. Of the 61 cases who desired to conceive after complete response, 29 of them had 35 pregnancies, the pregnant rate was 47.5 % （29/61）, and 22 women obtained healthy live birth baby,the fertility rate was 36.1% （22/61）. Age, pre-treatment complications, treatment time and treatment before endometrial biopsy result （endometrial severe atypical hyperplasia or endometrial cancer） was not correlated with pregnancy （P 〉 0.05）. The pregnant rate of patients who received in vitro fertilization-embryo transfer,ovulation promotion,or no treatment was 13/13,12/29 and 4/19 , respectively , and there was significant difference （P 〈0.05）. Conclusions Conservative treatment for early endometrial cancer and endometrial severe dysplasia with large doses progesterone could achieve higher response rate. Assisted reproductive technologies could significantly increase the chance of conception.