两种药物分别联合宫腔镜电切治疗早期子宫内膜癌的疗效及对生育功能的影响

Efficacy of two medications combined with hysteroscopic electrotomy on early endometrial cancer and its effects on reproductive function

目的观察甲羟孕酮和地屈孕酮分别联合宫腔镜电切治疗早期子宫内膜癌的疗效及对生育功能的影响。方法根据用药方案的不同将82例行宫腔镜电切治疗的早期子宫内膜癌患者分为甲羟孕酮组(n=41)和地屈孕酮组(n=41),比较两组患者的术后2年生存率和复发率,并对两组患者治疗前后的血清肿瘤标志物[血清糖类抗原125(CA125)、人附睾分泌蛋白4(HE4)]水平、不良反应发生情况及再次妊娠情况进行比较。结果甲羟孕酮组和地屈孕酮组患者的2年生存率分别为95.12%、97.56%,2年复发率分别为7.32%、12.19%,组间比较,差异均无统计学意义(P﹥0.05)。治疗3个月后、治疗后12个月,两组患者的血清CA125、HE4水平均低于本组治疗前(P﹤0.05);治疗后12个月,两组患者的血清CA125、HE4水平均低于本组治疗3个月后(P﹤0.05);治疗3个月后,甲羟孕酮组患者的血清CA125、HE4水平均低于地屈孕酮组(P﹤0.05);治疗后12个月,两组患者的血清CA125、HE4水平比较,差异均无统计学意义(P﹥0.05)。两组患者的不良反应发生率、成功受孕率、足月生产率比较,差异均无统计学意义(P﹥0.05)。结论甲羟孕酮联合宫腔镜电切治疗早期子宫内膜癌的近期效果良好,但其不良反应发生率较高,临床治疗中应根据具体情况选择用药。

Objective To observe the efficacy of medroxyprogesterone or dydrogesterone combined with hysteroscopic electrotomy on early endometrial cancer and its effects on reproductive function.Method A total of 82 patients with early endometrial cancer treated by hysteroscopic electrotomy were divided into medroxyprogesterone group(n=41)and dydrogesterone group(n=41)according to the different combined medication regimens.The survival rate and recurrence rate in 2 years after surgery were compared between the two groups.The levels of serum tumor markers[serum carbohydrate antigen 125(CA125),human epididymis secretory protein 4(HE4)]before and after treatment,occurrence of adverse reactions and second pregnancy were compared between the two groups.Result The 2-year survival rates of the patients in medroxyprogesterone group and dydrogesterone group were 95.12%and 97.56%,and the 2-year recurrence rates were 7.32%and 12.19%,respectively,with no statistically significant intergroup differences noted(P>0.05).After 3 months and 12 months of treatment,the levels of serum CA125 and HE4 in the two groups were notably lower compared to that before treatment(P<0.05);in 12 months after treatment,the levels of serum CA125 and HE4 in the two groups were lower than those observed in 3 months after treatment(P<0.05);after 3 months of treatment,the levels of serum CA125 and HE4 in medroxyprogesterone group were lower compared to dydrogesterone group;while after 12 months of treatment,no significant differences regarding the levels of serum CA125 and HE4 were noted between the two groups(P>0.05).Similarly,there were no significant differences in the incidence rates of adverse reactions,successful conception rate and full-term delivery rate between the two groups(P>0.05).Conclusion Medroxyprogesterone combined with hysteroscopic electrotomy for early endometrial cancer delivers fairly good short-term efficacy,with higher incidence rate of adverse reactions,therefore,patients’practical conditions should be considered during clinical treatment when it comes to determine the appropriate medication.