高分化子宫内膜癌或非典型子宫内膜增生患者保守治疗后妊娠结局影响因素分析

The factors analysis on pregnant outcomes between well-differentiated endometrial cancer and atypical endometrial hyperplasia after conservative treatment

目的探讨对于高分化子宫内膜癌(EC)或非典型子宫内膜增生(AEH)患者醋酸甲羟孕酮(MPA)保守治疗后妊娠建立的影响因素。方法回顾性研究65例EC/AEH患者,分为妊娠组(34例)和非妊娠组(31例),统计学分析妊娠建立的影响因素。结果妊娠组和非妊娠组相比临床基本特征均无统计学差异(P>0.05);妊娠组的MPA治疗的持续时间、病变消失时间、妊娠允许年龄、复发、行刮宫术次数和排卵期间子宫内膜厚度与非妊娠组相比存在统计学差异(P<0.05);Logistic回归分析显示复发(OR=2.323,P=0.015)、排卵期间子宫内膜厚度(OR=0.283,P<O.001)和允许妊娠年龄(OR=2.524,P=0.039)是影响妊娠结局的显著性因素。结论复发、排卵期子宫内膜厚度和怀孕时年龄是MPA保守治疗后妊娠建立的影响因素;MPA治疗肿瘤消失后即采用辅助生殖技术(ART)保育治疗可能有助于肿瘤复发、薄型子宫内膜或高妊娠年龄的患者保留生育力。

Objective To identify factors that might affect establishing pregnancy following conservative treatment by medroxyprogesterone acetate （ MPA）for well -differentiated endometrioid adenocarcinoma （ EC） or a-typical endometrial hyperplasia（AEH）.Methods A retrospective study of 65 patients with EC/AEH were divid-ed into a pregnancy group （ n=34 ） and a non -pregnancy group （ n=31 ） .The influent factors on establishing pregnancy were detected by statistical analysis .Results There was no significant difference in clinical character-istics between pregnancy group and non -pregnancy group .There were significantly different between pregnancy group and non-pregnancy in the duration of MPA administration ,the time to disappearance of lesions ,the age of pregnancy permission ,the number of D＆amp;C procedures performed ,and endometrial thickness during ovulation （ P〈0.05）.The multivariate logistic regression analysis identified that the recurrence （OR=2.323,P=0.015）,endo-metrial thickness during ovulation （OR=0.283,P 〈0.001）,and age of pregnancy permission （OR=2.524,P=0.039） were significant factors affecting pregnancy outcomes .Conclusion Recurrence, endometrial thickness during ovulation ,and the age of the pregnancy permission were considered to affect pregnant establishment follow -ing conservative treatment with MPA .Assisted reproductive technology immediately after achieving tumor disap-pearance by MPA would therefore be beneficial for patients with disease recurrence ,thin endometrium ,or a higher age of pregnancy permission .