子宫内膜不典型增生及早期子宫内膜癌保守治疗失败患者临床分析

Clinical analysis of failure of fertility-sparing management in patients with atypical endometrial hyperplasia or endometrial cancer

目的探讨年轻子宫内膜不典型增生及早期子宫内膜癌保守治疗失败患者的临床病理特点及预后。方法回顾性分析北京协和医院诊治的19例子宫内膜病变保守治疗失败患者的临床病理资料，并随访其结局。结果患者中位年龄31岁（23~43岁）。除1例未婚患者外均合并原发或继发不孕；15例（78．9％）因不规则阴道出血就诊，4例因不孕就诊；14例（73．7％）初诊为高分化子宫内膜样腺癌，5例为重度不典型增生；从初次确诊子宫内膜病变到子宫切除的中位时间27个月（3～84个月）；18例后期手术的患者中，9例保留了单侧或双侧卵巢；I期患者12例，Ⅲ期3例，Ⅳ期1例，随访的中位时间61个月（2～168个月）；I期患者5年生存率为100％；1例111a期患者无瘤生存66个月，另1例Ⅲa期患者失访，2例患者死于新发肿瘤。结论重度不典型增生及早期子宫内膜癌保守治疗有一定的潜在风险，密切随诊及其重要，有助于预防和早期发现疾病的复发和进展。全面的术前及术中探查评估后，保留卵巢并不影响年轻早期子宫内膜癌患者的预后。

Objective： To analyze clinical pathological characteristics and prognosis in young women with severe atypical endometrial hyperplasia （AH3）and endometrioid adenocarcinoma EC） at early stage after unsuccessful fertility-sparing management. Methods： The medical records and had failed in fertility-sparing manageme reviewed. athologic materials of 19 women with endometrial diseases who in Peking Union Medical College Hospital were retrospectively reviewed. Results： The median age of the patients was 31 years（23-43 years）. All the patients in the study cohort had a history of primary or secondary infertility except for one unmarried women. Fifteen（78.9%） women were presented for irregular vaginal bleeding and four women for a history of primary or secondary infertility. Fourteen （73.70/00）women were firstly diagnosed as endometrioid adenocarcinoma and five women as severe atypical hyperplasia. Median time from first diagnosis to hysterectomy was 27 months （3-84 months）. Among 18 patients performed surgery, 9 patients retained the unilateral or bilateral ovaries. Twelve women suffered from the disease at stage I ,three at stageⅢ ,one at stagelV. The median follow-up time was 61 months（2-168 months）. Five-year survival rate for patients at stage I were 100%.One patient at stage m a had survived for 66 months without signs of recurrence. Another patient at stageⅢ Ia was lost to follow-up,2 patients died of new tumors. Conclusions： Fertility-sparing treatment for AH3 and endometrial cancer at early stage has certain potential risk. Close follow-up is of paramount importance and conducive to prevent and early find recurrence and progression of the disease. Ovarian preservation has no significant impact on the overall survival of young pa.tients with endometrial cancer at early stage after a thorough preoperative evaluation and an extensive intraoperative exploration.