中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
18期
24-27
,共4页
子宫内膜肿瘤%子宫内膜增生%孕激素%妊娠结局
子宮內膜腫瘤%子宮內膜增生%孕激素%妊娠結跼
자궁내막종류%자궁내막증생%잉격소%임신결국
Endometrial neoplasms%Endometrial hyperplasia%Progestins%Pregnancy outcome
目的 探讨大剂量孕激素保守治疗早期子宫内膜癌及子宫内膜重度不典型增生的妊娠结局及相关影响因素.方法 2008年6月至2013年1月收治的早期子宫内膜癌(58例)及子宫内膜重度不典型增生(33例)共91例患者,采用连续口服大剂量孕激素治疗,每3个月诊刮了解子宫内膜变化情况,病理检查证实完全缓解后给予个体化的后续治疗.回顾性分析其妊娠结局及相关影响因素.结果 91例中87.9％(80/91)患者获得完全缓解,迫切要求生育且随诊时间满12个月者有61例.共有29例患者成功妊娠35次,妊娠率为47.5％(29/61);22例获得活产儿,生育率为36.1％(22/61).妊娠与否与患者年龄、治疗前合并症、治疗时间及治疗前子宫内膜病理诊断结果(子宫内膜重度不典型增生还是子宫内膜癌)无关(P＞0.05).采用体外受精-胚胎移植助孕、口服促排卵药物及未助孕治疗期待自然妊娠者妊娠率分别为13/13,12/29和4/19,三者比较差异有统计学意义(P＜0.05).结论 连续口服大剂量孕激素保守治疗早期子宫内膜癌及子宫内膜重度不典型增生可获得较高的完全缓解率;助孕技术可显著提高治疗后的妊娠率.
目的 探討大劑量孕激素保守治療早期子宮內膜癌及子宮內膜重度不典型增生的妊娠結跼及相關影響因素.方法 2008年6月至2013年1月收治的早期子宮內膜癌(58例)及子宮內膜重度不典型增生(33例)共91例患者,採用連續口服大劑量孕激素治療,每3箇月診颳瞭解子宮內膜變化情況,病理檢查證實完全緩解後給予箇體化的後續治療.迴顧性分析其妊娠結跼及相關影響因素.結果 91例中87.9％(80/91)患者穫得完全緩解,迫切要求生育且隨診時間滿12箇月者有61例.共有29例患者成功妊娠35次,妊娠率為47.5％(29/61);22例穫得活產兒,生育率為36.1％(22/61).妊娠與否與患者年齡、治療前閤併癥、治療時間及治療前子宮內膜病理診斷結果(子宮內膜重度不典型增生還是子宮內膜癌)無關(P＞0.05).採用體外受精-胚胎移植助孕、口服促排卵藥物及未助孕治療期待自然妊娠者妊娠率分彆為13/13,12/29和4/19,三者比較差異有統計學意義(P＜0.05).結論 連續口服大劑量孕激素保守治療早期子宮內膜癌及子宮內膜重度不典型增生可穫得較高的完全緩解率;助孕技術可顯著提高治療後的妊娠率.
목적 탐토대제량잉격소보수치료조기자궁내막암급자궁내막중도불전형증생적임신결국급상관영향인소.방법 2008년6월지2013년1월수치적조기자궁내막암(58례)급자궁내막중도불전형증생(33례)공91례환자,채용련속구복대제량잉격소치료,매3개월진괄료해자궁내막변화정황,병리검사증실완전완해후급여개체화적후속치료.회고성분석기임신결국급상관영향인소.결과 91례중87.9％(80/91)환자획득완전완해,박절요구생육차수진시간만12개월자유61례.공유29례환자성공임신35차,임신솔위47.5％(29/61);22례획득활산인,생육솔위36.1％(22/61).임신여부여환자년령、치료전합병증、치료시간급치료전자궁내막병리진단결과(자궁내막중도불전형증생환시자궁내막암)무관(P＞0.05).채용체외수정-배태이식조잉、구복촉배란약물급미조잉치료기대자연임신자임신솔분별위13/13,12/29화4/19,삼자비교차이유통계학의의(P＜0.05).결론 련속구복대제량잉격소보수치료조기자궁내막암급자궁내막중도불전형증생가획득교고적완전완해솔;조잉기술가현저제고치료후적임신솔.
Objective To explore the pregnancy outcome of large doses of progesterone conservative treatment in early endometrial cancer and endometrial severe dysplasia and analyze the pregnancy-relating factors.Methods Fifty-eight cases with early endometrial cancer and 33 cases with endometrial severe dysplasia from June 2008 to January 2013 were selected.They were given large doses of oral progesterone,endometrial curettage was used to evaluate the therapy response of endometrium after every 3 months of administration.Individualized maintained treatment was given to patients after achieving complete remissionof the endometrium.Pregnancy outcome and pregnancy-relating factors were analyzed retrospectively.Results All of the 91 patients 87.9％ (80/91) achieved complete response.Of the 61 cases who desired to conceive after complete response,29 of them had 35 pregnancies,the pregnant rate was 47.5 ％ (29/61),and 22 women obtained healthy live birth baby,the fertility rate was 36.1％ (22/61).Age,pre-treatment complications,treatment time and treatment before endometrial biopsy result (endometrial severe atypical hyperplasia or endometrial cancer) was not correlated with pregnancy (P ＞0.05).The pregnant rate of patients who received in vitro fertilization-embryo transfer,ovulation promotion,or no treatment was 13/13,12/29 and 4/19,respectively,and there was significant difference (P ＜0.05).Conclusions Conservative treatment for early endometrial cancer and endometrial severe dysplasia with large doses progesterone could achieve higher response rate.Assisted reproductive technologies could significantly increase the chance of conception.
