宫腔镜联合孕激素治疗年轻患者早期子宫内膜癌的疗效及预后分析

Outcomes and Prognosis of Early Endometrial Carcinoma in Young Patients with Hysteroscopy Combined Progesterone Therapy

目的:探讨宫腔镜联合孕激素治疗年轻早期子宫内膜癌患者的疗效及预后。方法:回顾性分析四川大学华西第二医院2008年1月至2014年12月自愿接受宫腔镜联合孕激素治疗的年轻早期子宫内膜癌16例患者的临床资料,且随访资料完整。所有患者行宫腔镜下刮宫或宫腔镜下病灶切除+刮宫,其中7例联合口服醋酸甲羟孕酮(250 mg/d,MPA组),9例联合醋酸甲地孕酮(160 mg/d,MA组)治疗。比较两组患者缓解、复发及生育等情况。结果:随访中位时间为54个月(17~90个月),其中12例(75.0%)完全缓解,3例(18.8%)部分缓解,1例(6.2%)无反应,MPA组和MA组的完全缓解率分别为71.4%(5/7)和77.8%(7/9),差异无统计学意义(P>0.05)。16例患者中有3例在完全缓解后复发(MPA组1例,MA组2例),复发平均时间为42个月。16例患者中有8例(50.0%)完成了妊娠(其中1例2次妊娠),有6次(66.6%)妊娠顺利生产,3次(33.3%)流产。结论:宫腔镜联合孕激素治疗对于年轻早期子宫内膜癌患者保守治疗是有效的,其中MPA和MA的治疗效果无明显差异,但均存在着一定的复发风险,所以应对其进行严格的筛选和严密的随访。

Objective：To explore the therapeutic effect and prognosis of young patients（ 〈40 years old） with early endometrial carcinoma by hysteroscopy combined progesterone therapy. Methods：A retrospective analysis of the clinical pathological and follow-up data was conducted,including 16 young patients with early endometrial carcinoma voluntarily treated by hysteroscopy combined progestogen in West China Second University Hospital from January 2008 to December 2014. All patients were treated by uterine curettage under hysteroscopy or lesion resection and uterine curettage under hysteroscopy,7 patients took medroxyprogesterone acetate（MPA） 250 mg/d and the rest took megestrol acetate（MA） 160mg/d. After treatment and under follow-up, remission rates, recurrence rates and fertility circumstance of all patients were compared. Results： Median follow-up time was 54 months（17-90 months）. The therapeutic effect resulted in 12 patients（75.0%） with complete remission,3 patients（18.8%） with partial remission, 1 patient（6.2%） with non-reaction, and 3 patients（18.8%） with recurrence. The complete remission rate of medroxyprogesterone acetate and megestrol acetate group was 71.4% （5/7） and 77.8% （7/9）, respectively, with no statistical difference （ P 〉 0.05）. 3 patients recurred after complete remission（1 in MPA,2 in MA） ,the average recurrence time was 42 months. 8 patients（50.0%） had pregnancy （1 with gemellary pregnancy） ,6 of 9 （66.6%） delivered and 3 of 9 （33.3%） had abortion. Conclusions： Hysteroscopy combined progestogen therapy for young patients with early endometrial carcinoma is effective,and the therapeutic effect of MPA and MA has no significant difference. However,all patients should be treated with strict selection and follow-up due to the certain risk of recurrence.