高效孕激素治疗子宫内膜癌/子宫内膜非典型增生的临床疗效及妊娠结局的影响因素分析

Effect of high performance progestogen on endometrial carcinoma/endometrial atypical hyperplasia and analysis of factors affecting pregnancy outcome

目的探讨高效孕激素醋酸甲羟孕酮治疗子宫内膜癌患者和子宫内膜非典型增生患者的疗效及妊娠结局的影响因素。方法回顾性分析37例子宫内膜癌患者的临床资料(肿瘤组)和35例子宫内膜非典型增生患者的临床资料(增生组)。两组患者均在保留子宫的前提下口服高效孕激素醋酸甲羟孕酮治疗,分析两组患者的治疗效果并计算两年自然受孕率、人工受孕率、分娩率、未孕率,采用Logistic回归分析模型分析患者妊娠的影响因素。结果肿瘤组患者与增生组患者治疗的有效率、无效率、复发率分别为91.9%、8.1%、2.7%和100%、0、2.9%。肿瘤组患者两年自然受孕率、人工受孕率、分娩率、未孕率分别为45.9%、21.6%、64.9%、32.4%,受孕率为67.6%;增生组患者两年自然受孕率、人工受孕率、分娩率、未孕率分别为60.0%、22.9%、77.1%、17.1%,受孕率为82.9%。72例患者中,54例妊娠,18例未妊娠。妊娠患者具备妊娠条件的年龄小于未妊娠患者,刮宫次数、复发例数均少于未妊娠患者,治疗时间、病变消失时间均短于未妊娠患者,排卵期间子宫内膜厚度大于未妊娠患者,差异均有统计学意义(P﹤0.05);Logistic多因素分析显示,具备妊娠条件的年龄、排卵期间子宫内膜厚度、复发是子宫内膜癌患者和子宫内膜非典型增生患者妊娠的影响因素(P﹤0.01)。结论高效孕激素治疗子宫内膜癌患者和子宫内膜非典型增生患者的效果好,具备妊娠条件的年龄、排卵期间子宫内膜厚度、复发是子宫内膜癌患者和子宫内膜非典型增生患者妊娠的影响因素。

Objective To investigate the effect of high performance progestogen on endometrial carcinoma / endome- trial atypical hyperplasia and to analyze the factors affecting pregnancy outcome. Method The clinical data of 37 cases of endometrial cancer （cancer group） and 35 cases of endometrial atypical hyperplasia （hyperplasia group） were selected and were retrospectively analyzed. Patients were treated with high performance progestogen medroxyprogesterone ace- tate on the premise of retaining the uterus. The natural pregnancy rate, artificial pregnancy rate, delivery rate and unpreg- nancy rate of the two groups within two years were compared. The Logistic regression analysis model was used to ana- lyze the risk factors associated with pregnancy. Result The efficiency, inefficiency and recurrence rate of 37 patients in the cancer group were 91.9%, 8.1% and 2.7%, respectively. The efficiency, inefficiency and recurrence rate of 35 patients in the hyperplasia group were 100%, 0 and 2.9%, respectively. The natural pregnancy rate, artificial pregnancy rate, deliv- ery rate and unpregnancy rate in the cancer group were 45.9%, 21.6%, 64.9% and 32.4% respectively within two years and the pregnancy rate was 67.6%. The natural pregnancy rate, artificial pregnancy rate, delivery rate and unpregnancy rate in the hyperplasia group were 60.0%, 22.9%, 77.1% and 17.1% respectively within two years and the pregnancy rate was 82.9%. Among 72 patients, there were 54 pregnancies and 18 unpregnancies. Compared to the unpregnancy patients, the allowed pregnancy age was lower, the curettage times and recurrence cases were less, the medication time and disease disappeared time were shorter and the endometrial thickness during ovulation was higher in pregnancy patients, all these differences were statistically significant （P〈0.05）. Logistic analysis showed that the allowed pregnancy age, the endome- trial thickness during ovulation and recurrence were independent risk factors affecting pregnancy of patients with endome- trial carcinoma / endometrial atypical hyperplasia （P〈0.01）. Conclusion High performance progestogen has a significant effect in the treatment of endometrial carcinoma / endometrial atypical hyperplasia. The allowed pregnancy age, the endo-metrial thickness during ovulation and recurrence may be the independent risk factors affecting pregnancy.