宫腔镜联合孕激素保守治疗子宫内膜不典型增生和早期子宫内膜癌的预后及生育结局分析

Analysis of prognosis and reproductive outcome of endometrial atypical hyperplasia and early endometrial carcinoma treated by hysteroscopy combined with progesterone

目的探讨宫腔镜联合孕激素保守治疗年轻子宫内膜不典型增生(EAH)和早期子宫内膜癌(EC)患者的预后及生育相关因素。方法收集2010年1月至2019年12月就诊于郑州大学第一附属医院的154例年龄≤40岁的EAH或Ia_(1)期EC患者的临床资料,给予宫腔镜联合口服大剂量孕激素或宫内置入左炔诺孕酮宫内缓释系统保守治疗,每3个月行宫腔镜检查并诊刮随访子宫内膜病理变化,记录患者至完全缓解(CR)所需时间,随访时间为15个月,CR后给予个体化治疗。结果154例患者中,134例达到CR,病情复发12例,病情稳定4例,病情进展4例。单变量COX回归分析表明:EAH组和Ia_(1)期EC组的累积CR率比较差异无统计学意义(HR=1.197,P=0.404),体质量指数(BMI)≤28 kg/m^(2)可缩短达到CR的时间(HR=1.882,P=0.003),多囊卵巢综合征患者的妊娠率较低(χ^(2)=4.517,P=0.034),辅助生殖技术可有效提高妊娠率(χ^(2)=9.557,P=0.002);病理类型、年龄、BMI、是否合并胰岛素抵抗等对妊娠率无明显影响(χ^(2)=0.864,P=0.353;χ^(2)=1.065,P=0.302;χ^(2)=0.603,P=0.437;χ^(2)=3.613,P=0.057)。结论宫腔镜联合孕激素可暂时保留年轻EAH和早期EC患者生育功能,辅助生殖技术可提高妊娠率。

Objective To investigate the prognosis and fertility related factors of endometrial complex dysplasia(EAH)and early endometrial cancer(EC)in young patients treated by hysteroscopy combined with progesterone.Methods The clinical data of 154 patients were collected between January 2010 and December 2019 in the first affiliated hospital of Zhengzhou university,who were under 40 years old and were diagnosed of EAH or stage Ia_(1) EC.They were given with the hysteroscopy combined high-dose oral progesterone or levonorgestrel intrauterine system treatment,hysteroscopy was performed and pathological changes of endometrium were recorded every 3 months,the time to complete response(CR)was recorded,patients with follow-up for 15 months,the individualized treatment were given after complete remission.Results Among the 154 patients,134 patients(87.0%)showed complete response(CR),12 patients showed disease recurrence,4 patients suffered stable disease,4 patients suffered progressive disease.Univariate COX regression analysis showed that there was no difference in cumulative CR rate between the EAH group and the stage Ia_(1) EC group(HR=1.197,P=0.404),body mass index≤28 kg/m^(2)could shorten the time to reach CR(HR=1.882,P=0.003),the pregnancy rate of patients with polycystic ovary syndrome was low(χ^(2)=4.517,P=0.034),the assisted reproductive technology could effectively improve the pregnancy rate(χ^(2)=9.557,P=0.002),there was no significant difference between pregnancy rate and pathological type,age,BMI or insulin resistance(χ^(2)=0.864,P=0.353;χ^(2)=1.065,P=0.302;χ^(2)=0.603,P=0.437;χ^(2)=3.613,P=0.057).Conclusion Hysteroscopy combined with progesterone can temporarily preserve the reproductive function of patients with EAH and early EC,assisted reproductive technology can improve the pregnancy rate.