CAJ | 학술논문

目的了解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因素.方法 1996年6月至2010年1月北京协和医院收治的年轻早期子宫内膜癌(38例)及子宫内膜重度不典型增生患者(13例)共51例,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因素.结果 51例患者的中位年龄为29岁.有45例(88％,45/51)患者获得完全缓解,迫切要求生育且随诊满3个月者有34例.共有16例患者成功妊娠22次,妊娠率为47％(16/34)；12例获得活产儿,生育率为35％(12/34).年龄＞35岁和≤35岁者妊娠率分别为0/2和50％(16/32),治疗前有和无不孕症病史者妊娠率分别为40％ (8/20)和8/14,子宫内膜癌和重度不典型增生患者妊娠率分别为40％(10/25)和6/9；分别比较,差异均无统计学意义(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7/7、6/16和3/11,3者比较,差异有统计学意义(P＜0.01).结论大剂量连续口服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；辅助生殖技术可显著提高治疗后的妊娠率.
목적 료해대제량잉격소보수치료조기자궁내막암급자궁내막중도불전형증생적임신결국급상관인소.방법 1996년6월지2010년1월북경협화의원수치적년경조기자궁내막암(38례)급자궁내막중도불전형증생환자(13례)공51례,채용련속구복대제량잉격소치료,매3개월진괄료해자궁내막변화정황,병리검사증실완전완해후급여개체화적후속치료.회고성분석기임신결국급상관인소.결과 51례환자적중위년령위29세.유45례(88％,45/51)환자획득완전완해,박절요구생육차수진만3개월자유34례.공유16례환자성공임신22차,임신솔위47％(16/34)；12례획득활산인,생육솔위35％(12/34).년령＞35세화≤35세자임신솔분별위0/2화50％(16/32),치료전유화무불잉증병사자임신솔분별위40％ (8/20)화8/14,자궁내막암화중도불전형증생환자임신솔분별위40％(10/25)화6/9；분별비교,차이균무통계학의의(P＞0.05).채용체외수정-배태이식조잉、구복촉배란약물급미조잉치료기대자연임신자임신솔분별위7/7、6/16화3/11,3자비교,차이유통계학의의(P＜0.01).결론 대제량련속구복잉격소보수치료조기자궁내막암급자궁내막중도불전형증생가획득교고적완전완해솔；보조생식기술가현저제고치료후적임신솔.
Objective To summarize the pregnant rate of patients with early endometrial carcinoma and severe atypical hyperplasia after fertility-preserving treatment and analyze their pregnancy-relating factors.Methods Endometrial curettage was used to evaluate the therapy response of endometrium after every 3 months of administration of high-dose progestin as fertility-sparing treatment for 51 patients with stage Ⅰ endometrial carcinoma or severe endometrial atypical hyperplasia from Jun.1996 to Jan.2010.Individualized maintained treatment was given to patients after achieving complete remission of the endometrium.Pregnant results and pregnancy-relating factors were analyzed retrospectively.Results The median age of all the 51 patients was 29 years old.Forty-five (88％,45/51) achieved complete response.Of the 34 cases who desired to conceive after complete response,16 of them had 22 pregnancies,the pregnant rate was 47％ (16/34) ; and 12 women obtained healthy live birth baby,the fertility rate was 35％ (12/34).The pregnant rate of patients at age ＞35 or ≤35 was 0/2 and 50％ (16/32) respectively (P ＞0.05).The pregnant rate of patients with or without infertility was 40％ (8/20) and 8/14,with endometrial cancer or severe atypical hyperplasia was 40％ (10/25) and 6/9,respectively (all P ＞ 0.05).The pregnant rate of patients who received in vitro fertilization-embryo transfer,ovulation promotion,or no treatment was 7/7,6/16 and 3/11 respectively (P ＜ 0.01).Conclusions Fertility-preserving treatment for early endometrial cancer and severe atypical hyperplasia with high-dose progestin could achieve higher response rate.Assisted reproductive technologies could significantly increase the chance of conception.