子宫内膜复杂性不典型增生及早期子宫内膜癌患者保留生育功能的预后分析

Prognosis analysis of fertility maintenance in women with complex endometrial hyperplasia or endometrial cancer

目的评估宫腔镜电切术联合曼月乐和(或)高效孕激素保守治疗子宫内膜复杂性不典型增生(complex endometrial hyperplasia,CEH)及早期子宫内膜癌(endometrial carcinoma,EC)患者的完全缓解率、复发率、妊娠情况并分析其预后的相关影响因素。方法回顾性分析郑州大学第一附属医院2011年1月至2015年1月由组织学病理确诊为CEH或早期EC并用宫腔镜电切术联合曼月乐和(或)高效孕激素治疗的87例患者的临床资料,对患者治疗后每3个月行宫腔镜下检查并诊刮评估子宫内膜改善情况。结果 87例患者中完全缓解77例(88.51%),复发9例(11.69%);完全缓解患者中65例有妊娠愿望,治疗后自然妊娠或应用辅助生殖技术妊娠38例(58.46%)。体质量指数(body mass index,BMI)<30 kg/m^2的患者更容易达到完全缓解;BMI<30 kg/m^2、完全缓解后妊娠可降低复发率;BMI<30 kg/m^2、应用辅助生殖技术可改善缓解后的妊娠结局。结论对于强烈要求保留生育功能的CEH及早期EC患者,采用宫腔镜电切术联合曼月乐和(或)高效孕激素的保守治疗方式可获得较满意的疗效,且在明确影响完全缓解、复发及妊娠的因素后,给予相应处理有助于改善预后。

Objective To evaluate the complete remission rate, relapse rate and pregnancy status of hysteroscopic electrotomy combined with Mirena and / or progestin and conservative treatment of complex endometrial hyperplasia （CEH） and endometrial carcinoma（EC） , and analyze the related factors of prognosis. Methods The clinical data of 87 patients who were histologically diagnosed as CEH or early EC combined with hysteroscopic electrotomy combined with Mirena and / or progestin in the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2015 were retrospectively analyzed. Hysteroscopic examination and curettage evaluation of endometrial improvement were performed every 3 months after treatment. Results In 87 cases, 77 cases （88. 51% ） were completely relieved and 9 cases（ 11.69% ） were relapsed; 65 patients with complete remission had a pregnancy expectation. After treatment 38 cases （58.46%） were of natural pregnancy or assisted reproductive technology of pregnancy. Patients with body mass index （BMI） 〈 30 kg/m2 were more likely to achieve complete remission; BMI 〈 30 kg/m2, were pregnant after complete remission can reduce the recurrence rate ; BMI 〈 30 kg/m2, the application of assisted reproductive technology could improve the outcome after remission of pregnancy. Conclusion For patients with strong demand for retention of fertility in patients with early CE and CEH, the use of hysteroscopie resection combined with Mirena and （or） high - efficiency progesterone conservative treatment can lead to more satisfactory results. After the factors that affect the complete remission, relapse and pregnancy are clearly affected, the corresponding treatment can help to improve the prognosis.