大剂量孕激素联合宫腔镜下切除术对早期子宫内膜癌年轻患者妊娠率的影响

Effect of High-dose Progesterone Combined with Hysteroscopic Resection on Pregnancy Rate in Young Patients with Early Endometrial Cancer

目的探讨大剂量孕激素联合宫腔镜下切除术对早期子宫内膜癌(EC)年轻患者妊娠率的影响。方法选取早期EC年轻患者68例作为研究对象,随机分为对照组(n=34)和观察组(n=34)。2组患者均行宫腔镜下切除术,术后对照组给予醋酸甲地孕酮片160 mg/次,观察组给予醋酸甲地孕酮片480 mg/次。6个月后比较2组临床疗效,治疗前后比较2组患者血清性激素[雌二醇(E2)、促黄体生成素(LH)]、肿瘤标志物[糖类抗原125(CA125)、人附睾分泌蛋白4(HE4)]水平及比较不良反应发生情况。随访1年,统计并比较2组患者妊娠率、妊娠结局。结果观察组患者ORR(94.12%)高于对照组(85.29%)(P<0.05)。与治疗前比较,对照组和观察组患者治疗后血清E2、LH、CA125和HE4水平均降低(P<0.05);治疗后,观察组患者血清E2、LH水平高于对照组,血清CA125、HE4水平均低于对照组(P<0.05)。随访1年,观察组患者妊娠率(79.41%)、足月生产率(64.71%)显著高于对照组患者妊娠率(52.94%)、足月分娩率(35.29%)(P<0.05)。观察组患者不良反应发生率(5.88%)显著低于对照组(23.53%)(P<0.05)。结论大剂量醋酸甲地孕酮联合宫腔镜下切除术对早期EC年轻患者具有积极意义,可提高患者妊娠率,改善生育功能,且不良反应少,具有临床推广价值。

Objective To investigate the effect of high-dose progesterone combined with hysteroscopic resection on the pregnancy rate of young patients with early endometrial cancer.Methods 68 young patients with early EC were selected as the research object.They were randomly divided into the control group(n=34)and the observation group(n=34)according to the method of random number table.The patients in both groups underwent hysteroscopic resection.After operation,the control group was given megestrol acetate tablets 160 mg/time,and the observation group was given megestrol acetate tablets 480 mg/time.6 months later,the clinical efficacy,serum levels of sex hormones[estradiol(E2),luteinizing hormone(LH)],tumor markers[carbohydrate antigen 125(CA125),human epididymal secretory protein 4(HE4)]and adverse reactions of the two groups were compared.The pregnancy rate and pregnancy outcome of the 2 groups were statistically compared after a 1-year follow-up.Results The ORR in the observation group(94.12%)was higher than that in the control group(85.29%)(P<0.05).Compared with that before treatment,the levels of serum E2,LH,CA125 and HE4 in the control group and the observation group decreased after treatment(P<0.05).After treatment,the levels of serum E2,LH in the observation group were higher and the levels of serum CA125 and HE4 were lower than those in the control group(P<0.05).During 1 year follow-up,the pregnancy rate of 79.41%and the term delivery rate of 64.71%in the observation group were significantly higher than those of 52.94%and 35.29%in the control group(P<0.05).The adverse reaction rate of 5.88%in the observation group was significantly lower than that of 23.53%in the control group(P<0.05).Conclusion High-dose megestrol acetate combined with hysteroscopic resection is of positive significance for the early treatment of young patients with EC.It can increase the pregnancy rate of patients,improve the fertility function,and has less adverse reactions.It has clinical promotion value.