宫腔镜电切术联合孕激素对早期子宫内膜癌患者保持生育功能的可行性分析

Analysis of the Feasibility of Hysteroscopy Combined with Progesterone in the Fertility Preservation of Early Endometrial Cancer

目的探讨宫腔镜电切术联合孕激素对早期子宫内膜癌患者保持生育功能的可行性。方法选择2012年6月至2013年6月西北妇女儿童医院收治的早期子宫内膜癌患者62例为研究对象,按照随机数字表法分为对照组和观察组,各31例。对照组患者给予常规手术治疗,观察组患者采用宫腔镜电切术联合宫内放置左炔诺孕酮治疗。对比两组患者临床指标(术中出血量、手术时间和缓解时间、2年内复发率);记录两组患者再次妊娠的受孕率和生产率;检测治疗前后两组患者血清糖类抗原125(CA125)水平。结果观察组患者术中出血量少于对照组[(54±6)m L比(89±13)m L],手术时间和缓解时间短于对照组[(60±9)min比(94±14)min,(3.7±0.4)个月比(7.2±1.1)个月],差异有统计学意义(P<0.01)。观察组患者复发率显著低于对照组[3.2%(1/31)比25.8%(8/31)],差异有统计学意义(P<0.05);观察组患者的受孕率显著高于对照组[80.6%(25/31)比51.6%(16/31)],且观察组患者的妊娠结局优于对照组(P<0.05)。两组患者治疗后1年、2年血清CA125呈下降趋势[观察组:(30.7±2.9)k U/L、(22.4±2.3)k U/L;对照组:(35.2±3.2)k U/L、(28.5±2.6)k U/L](P<0.05),且观察组患者治疗后1年、2年血清CA125水平低于对照组(P<0.05)。结论宫腔镜电切术联合孕激素治疗可以较大限度地保存早期子宫内膜癌患者的生育功能,且手术周期短、低创安全,值得临床推广。

Objective To investigate the feasibility of hysteroscopy combined with progesterone on the fertility of early endometrial cancer patients. Methods From Jun. 2012 to Jun. 2013,62 patients with early endometrial cancer treated in Northwest Women and Children’ s Hospital were included in the study. The patients were divided into a control group and an observation group according. The observation group was treated with hysteroscopic surgery combined with intrauterine levonorgestrel,while the control group received conventional treatment operation. For the two groups of patients,three clinical indicators: the intraoperative blood loss,the length of operation and the time of remission,the recurrence rate in 2 years were compared,the pregnancy rate and productivity of the two groups were recorded,and the serum carbohydrate antigen( CA)125 level was detected. Results Blood loss of the observation group was significantly less than the control group[( 54 ± 6) m L vs( 89 ± 13) m L],surgery length and duration of response was significantly shorter than the control group[( 60 ± 9) min vs( 94 ± 14) min,( 3. 7 ± 0. 4) months vs( 7. 2 ± 1. 1) months]( P <0. 01). The recurrence rate of the observation group was significantly lower than the control group[3. 2%( 1 /31) vs 25. 8%( 8 /31) ]( P < 0. 05); the pregnant rate of the observation group was significantly higher than the control group[80. 6%( 25 /31) vs 51. 6%( 16 /31) ]( P < 0. 05),and the pregnancy outcome of the observation group was better than the control group( P < 0. 05). After 1 year,2 years serum CA125 of both groups decreased[observation group:( 30. 7 ± 2. 9) k U / L,( 22. 4 ± 2. 3) k U / L; control group:( 35. 2 ±3. 2) k U / L,( 28. 5 ± 2. 6) k U / L]( P < 0. 05),and the observation group was lower than the control group( P < 0. 05). Conclusion The combination of hysteroscopy and progesterone therapy can considerably preserve the fertility function of patients with early endometrial cancer,which is featured with short operation period,low invasiveness and high safety,thus is worthy of clinical promotion.