子宫内膜样腺癌与子宫内膜复杂不典型增生患者应用孕激素治疗的病理学变化及预后观察

Pathological changes and prognosis of endometrioid adenocarcinoma patients and endometrial complex atypical hyperplasia patients after progestogen treatment

目的观察孕激素治疗Ia期子宫内膜样腺癌及内膜复杂性不典型增生患者的临床病理和预后。方法对15例Ia期子宫内膜样腺癌患者及25例子宫内膜复杂性不典型增生患者应用孕激素治疗，并对其治疗效果进行比较。结果治疗后，复杂性不典型增生有效率（22/25，88.0%）高于子宫内膜癌（13/15，86.7%），但差异无统计学意义（ P 〉0.05）。完全有效的内膜癌患者8例中有3例复发，中位复发时间9月（6～48个月）；20例癌前病变完全有效的复杂性不典型增生患者8例复发，中位复发12个月（6～52个月）。28例癌及癌前病变完全有效的患者有12例进行了3个月至半年的巩固治疗，但出现4例复发；18例未行巩固治疗，有7例复发。内膜癌患者治疗后5例正常妊娠，复杂不典型增生患者治疗后12例正常妊娠。对孕激素的反应表现为腺体狭小、萎缩、内膜间质水肿或蜕膜化；腺上皮单层胞质较为丰富，细胞核萎缩。结论 Ia期子宫腺癌及复杂性不典型增生的孕激素治疗效果良好，但进程缓慢、复发率较高，复发患者可再次使用孕激素治疗。

Objective To observe the clinical pathology and prognosis of Ia stage endometroid adenocarcinoma（ EAC）patients and endo-metrial complex atypical hyperplasia（ ECAH）patients after progestogen treatment. Methods A total of 15 Ia stage EAC patients and 25 ECAH patients admitted to our hospital were selected as the subjects,who all received progestogen treatment. The effectiveness of treatment was com-pared. Results After accepted with progesterone treatment,total effective rate of ECAH grou（88. 0%）was higher than primary EAC group（86. 7%）（ P 〉0. 05）. Among the 8 cases showing complete response,3 cases showed recurrence,and the median recurrence time was 9 months（6~48 months）;among the 20 cases of ECAH showing complete response,8 cases showed recurrence,and the median recurrence time was 12 months（6~52 months）. Among the 28 cases showing complete response,12 cases received 3 months to half year of consolidation treatment,but 4 cases showed recurrence;18 cases did not receive consolidation treatment,and 7 cases showed recurrence. After treatment,5 cases of EAC and 12 cases of ECAH had normal pregnancy. The responses to progestogen were gland narrowness,atrophy,endometrial interstitial edema or decidual-ization;abundant cytoplasm of glandular epithelium monolayer and nuclear atrophy. Conclusion The progestogen treatment has good effects on Ia stage EAC and ECAH,but the course is slow and the recurrence rate is high. The progestogen treatment can be used again for recurrence.