子宫内膜不典型增生及早期子宫内膜样腺癌患者保留生育功能治疗的研究

Study of preservation of fertility in patients with endometrial atypical hyperplasia and early endometrial adenocarcinoma

目的探讨子宫内膜不典型增生及早期子宫内膜样腺癌患者保留生育功能的治疗方案、随访及生育指导。方法选取2016年9月至2018年5月中国医科大学附属盛京医院收治的24例子宫内膜不典型增生以及早期子宫内膜样腺癌患者,A组12例患者采用宫腔镜病灶切除术联合孕激素治疗,B组12例患者采用单纯孕激素治疗,所有患者密切随访至2019年2月。结果 A组完全缓解率为83%,B组完全缓解率为33%,差异有统计学意义(P=0.036),A组获得完全缓解时间为(6.33±2.23)个月,B组获得完全缓解时间为(6.75±2.03)个月;A组的部分缓解率为17%,B组的部分缓解率为33%,上述差异均无统计学意义(P>0.05)。对影响获得完全缓解的相关因素进行分析,BMI≥30与不能获得完全缓解相关(P=0.01)。A、B两组妊娠率分别为25%和8%,两组患者的妊娠率比较差异无统计学意义(P>0.05)。结论子宫内膜不典型增生及早期子宫内膜样腺癌患者保留生育功能治疗安全有效,宫腔镜病灶切除术联合孕激素治疗方案的完全缓解率高于单纯孕激素治疗方案。肥胖(BMI≥30)是影响患者完全缓解的危险因素之一,建议患者在治疗以及随访过程中应控制体重。

ObjectiveTo explore treatment options,follow-up and fertility guidance for patients with endometrial atypical hyperplasia and early endometrioid adenocarcinoma.MethodsIn this study,24 patients with endometrial atypical hyperplasia and early endometrioid adenocarcinoma were selected:12 patients in group A underwent hysteroscopic resection combined with progestin therapy,and 12 patients in group B underwent only progestin therapy.All patients were followed up closely until February 2019.Results The complete remission rate in group A was 83%,and the complete remission rate in group B was 33%;the difference was statistically significant(P=0.036).The complete remission time in group A was 6.33±2.23 months,and the complete remission time in group B was 6.75±2.03 months;the partial remission rate in group A was 17%,and the partial remission rate in group B was 33%;the above differences were not statistically significant(P>0.05).Analysis of relevant factors affecting complete remission showed that BMI≥ 30 was closely related to patients who could not obtain complete remission(P=0.01).The pregnancy rate in group A and group B was 25% and8%,respectively.There was no significant difference in the pregnancy rate between the two groups(P>0.05).Conclusions The treatment in fertility preservation is safe and effevtive for patients with endometrial dysplasia and early endometrioid adenocarcima.The complete remission rate of hysteroscopic resection combined with progesterone therapy is higher than that of progesterone therapy alone.Obesity(BMI≥30)is one of the risk factors affecting complete remission in patients,and it is recommended that patients should control their weight during treatment and follow-up.