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研究

Prognosis of Endometrial Complex Dysplasia and Early Reproductive Endometrial Cancer Patients with Reproductive Function

[目的]探讨子宫内膜复杂性不典型增生及早期子宫内膜癌患者保留治疗的完全缓解率、复发率和妊娠情况。[方法]回顾性分析2015年1月至2018年10月我院妇产科收治106例子宫内膜复杂性不典型增生或早期子宫内膜癌患者保守治疗情况,分析其治疗疗效、复发和妊娠情况,并分析影响子宫内膜复杂性不典型增生及早期子宫内膜癌患者保守生育功能治疗后完全缓解、复发和妊娠的因素。[结果]经保守治疗后完全缓解率为83.96%(89/106),完全缓解后复发率为23.60%(21/89),妊娠率为35.96%(32/89)。BMI≥30kg/m^2是影响完全缓解(OR=2.031,95%CI:1.163~6.032)和完全缓解后复发(OR=1.325,95%CI:1.033~4.251)、完全缓解后妊娠(OR=1.625,95%CI:1.235~5.621)的独立因素。BMI<30kg/m^2(OR=1.705,95%CI:1.511~4.981)、采用辅助生殖技术(OR=2.009,95%CI:1.735~6.235)可提高完全缓解后妊娠率。[结论]子宫内膜复杂性不典型增生及早期子宫内膜癌患者采用保守治疗可获得满意疗效。肥胖是影响保守治疗疗效、复发的主要因素,积极控制肥胖,采取辅助生殖技术可提高妊娠率,降低复发。

[Objective] To investigate the complete remission rate,recurrence rate and pregnancy status of patients with endometrial complex dysplasia and early endometrial cancer retention therapy. [Methods] A total of 106 cases of endometrial complex dysplasia or early endometrial cancer patients treated with obstetrics and gynecology in our hospital from January 2015 to October 2018 were enrolled to analyze efficacy,recurrence,pregnancy and the factors affecting endometrial complex dysplasia and early remission,recurrence and pregnancy after conservative fertility treatment in patients with endometrial cancer. [Results] The complete remission rate was 83.96%(89/106) after conservative treatment,the recurrence rate after complete remission was 23.60%(21/89),and the pregnancy rate was 35.96%(32/89).BMI≥30 kg/m^2 was independent factor affecting complete remission(OR=2.031,95%CI:1.163~6.032),the recurrence rate after complete remission(OR=1.325,95%CI:1.033~4.251) and pregnancy rate after complete remission(OR=1.625,95%CI:1.235~5.621). BMI <30 kg/m^2(OR=1.705,95%CI:1.511~4.981)and using assisted reproductive technology(OR=2.009,95%CI:1.735~6.235) could improve pregnancy rate after complete remission. [Conclusion] Endometrial complex dysplasia and early endometrial cancer patients with conservative treatment can achieve satisfactory results,obesity is the main factor affecting the efficacy and recurrence of conservative treatment. Actively control obesity and adopting assisted reproductive technology can improve pregnancy rate and reduce recurrence.