高分化子宫内膜样癌及子宫内膜重度不典型增生患者孕激素治疗的临床分析  

Outcome analysis of conservative treatment of well-differentiated endometrial adenocarcinoma and severe atypical hyperplasi a in young women

作　　者：俞梅[1] 沈铿[1] 杨佳欣[1] 黄惠芳[1] 吴鸣[1] 潘凌亚[1] 郎景和[1] 连利娟[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,100730

出　　处：《中华妇产科杂志》2006年第4期242-245,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨35岁以下高分化子宫内膜样癌及子宫内膜重度不典型增生患者采用孕激素治疗以保留患者子宫的疗效,并随访其治疗后的生育情况.方法采用回顾性分析的方法对1991年至2005年北京协和医院收治的35岁以下、接受孕激素治疗（以醋酸甲羟孕酮为主）的25例高分化子宫内膜样癌及子宫内膜重度不典型增生患者的临床病理资料进行研究.其中,子宫内膜样癌8例（内膜癌组）,子宫内膜重度不典型增生17例（不典型增生组）.孕激素治疗前对患者进行全面的分期评估,治疗后每1～6个月诊刮以评价疗效,对有生育要求者随访其生育情况.结果内膜癌组患者孕激素治疗前经全面的分期评估,证实为早期、高分化子宫内膜样癌.除1例子宫内膜样癌患者尚未评估疗效外,内膜癌组其他7例及不典型增生组17例患者治疗后有效者分别为6例（6/7）、17例（100%）;缓解者分别为5例（5/7）、14例（82%）;缓解后复发者分别为1例（1/5）、3例（21%）,复发时间为缓解后6～30个月;随访缓解后要求生育的14例患者中,内膜癌组4例患者尚未生育,不典型增生组10例患者中4例妊娠共7次.1例自然受孕后失访;3例经促排卵治疗后受孕并足月分娩,其中1例产后人工流产3次.结论对于要求保留子宫的高分化子宫内膜样癌及子宫内膜重度不典型增生的年轻患者,孕激素治疗是一种治疗选择.孕激素治疗前应对子宫内膜样癌患者进行详细全面的分期评估,辅助生殖措施的介入有望提高治疗后的妊娠率.Objective To evaluate the effect of hormonal therapy on well-differentiated endometrial adenocareinoma and severe atypical hyperplasia in young women aged 35 years and younger. Methods We retrospectively studied the clinical characteristics of 25 patients under 35 years of age （ average： 28.6） diagnosed with well-differentiated endometrial adenocarcinoma or severe atypical hyperplasia, who were treated with progestin in Peking Union Medical College Hospital from 1991 to 2005. According to pathologic results, 25 patients were divided into two groups： 8 cases of endometrial carcinoma and 17 cases of severe atypical hyperplasia. In the endometrial carcinoma group, pelvic ultrasound, MRI, chest X-r~,y and serum CAI25 were used in pretreatment evaluation. Progesterone receptors were examined with immunohistochemical method. All patients received dilation and curettage of endometrium every 1-6 months as an assessment of treatment results. For chemotherapy, most of them were treated with medroxyprogesterone acetate. Results Six cases （6/7） in endometrial carcinoma group, and 17 cases （100%） in severe atypical hyperplasia group responded to treatment respectively; among them, 5 cases （5/7） and 14 cases （82%） had complete response, which was defined as the absence of any carcinoma or hyperplasia on endometrial samplings; one case （1/5） and 3 cases （21%） recurred within 6 to 30 months after their complete response. Follow-up on 14 patients with complete response, and the desire for childbearing showed that none of the 4 cases of cndometrial carcinoma had conceived a pregnancy and 4（40% ） patients had pregnancy for totally 7 times of 10 cases of severe atypical hyperplasia. Three patients delivered full-term fetuses with induced ovulation, one of whom had artificial abortion 3 times after her delivery. One patient was lost to follow up after her spontaneous pregnancy. Conclusions Progestin therapy is a good choice for young women having fertility desires diagnosed with well-differentiated

关 键 词：子宫内膜肿瘤 子宫内膜增生 孕激素类 高分化子宫内膜样癌 子宫内膜重度不典型增生 

分 类 号：R737.33[医药卫生—肿瘤] R977.1[医药卫生—临床医学]