大剂量孕激素治疗子宫内膜不典型增生及早期子宫内膜癌的疗效及妊娠结局分析

Efficiency and Pregnant Outcomes of High Dose Progestin in the Treatment of Endometrial Atypical Hyperplasia and Early Endometrial Carcinoma

目的:探讨大剂量孕激素治疗子宫内膜不典型增生及早期子宫内膜癌的疗效及妊娠结局。方法:选择2014年1月至2018年12月广州医科大学附属第三医院就诊的年轻且有生育要求的子宫内膜不典型增生患者24例及早期子宫内膜样腺癌患者6例,分析应用大剂量孕激素保守治疗的临床效果及妊娠结局。结果:24例子宫内膜不典型增生患者中完全缓解20例(83.33%),部分缓解0例,疾病稳定1例(4.17%),疾病进展1例(4.17%),疾病复发2例(8.33%);20例完全缓解中1例未婚,余19例中成功妊娠10例(52.63%),其中4例足月分娩,3例孕中期双胎流产,2例孕早期流产,1例孕早期随访中;2例疾病复发患者继续药物治疗后均完全缓解,其中1例自然受孕后足月分娩。6例早期高分化子宫内膜样腺癌完全缓解3例(50.00%),部分缓解0例,疾病稳定2例(33.33%),疾病进展0例,疾病复发1例(16.67%);疾病稳定2例最终行子宫内膜癌全面分期手术,余4例保留生育功能患者目前未成功妊娠。结论:密切随访下,大剂量孕激素治疗子宫内膜不典型增生和早期子宫内膜癌是安全有效的。

Objective:To investigate the efficiency and pregnant outcomes of high dose progestin in the treatment of endometrial atypical hyperplasia and early endometrial carcinoma.Methods:24 cases of endometrial atypical hyperplasia and 6 cases of early endometrial carcinoma between January 2014 and December 2018 in the Third Affiliated Hospital of Guangzhou Medical University were collected.The clinical efficiency and pregnant outcome of high dose progestin conservation treatment were analyzed.Results:Among 24 cases of endometrial atypical hyperplasia,20 cases(83.33%)were complete remission,no case was partial remission,1 case(4.17%)was stable,1 case(4.17%)was progression and 2 cases(8.33%)were recurrence.Among 20 cases of complete remission,1 was unmarried,and in the remained 19 cases 10 cases(52.62%)were successfully pregnant,in which 4 cases with full-term delivery,3 twin pregnant cases with second trimester abortion,2 cases with first trimester abortion,and 1 case were still followed up in the first trimester.2 recurrent patients were all completely relieved after continue medication,and one were in term delivery.Among 6 cases of early high differentiated endometrial adenocarcinoma,3 cases(50.00%)were complete remission,no case was partial remission,2 cases(33.33%)were stable,no case was progression and 1 case(16.67%)was recurrence.2 stable case finally underwent surgery for endometrial carcinoma,and the remained 4 case with preservation of fertility were not pregnant at present.Conclusions:Large dose of progestin is safe and effective in the treatment of endometrial atypical hyperplasia and early endometrial carcinoma with close follow-up.