乳腺癌患者术后口服三苯氧胺致子宫内膜病变相关因素分析  

Analysis of factors associated with endometrial diseases in postoperative breast cancer patients receiving tamoxifen therapy

作　　者：张正茂[1] 李霞[2] 杨雪梅[1] 张敏洁[1] 肖爽[1] 康山 单保恩[3] 

机构地区：[1]河北医科大学第四医院妇科,河北石家庄050011 [2]河北省沧州市中心医院妇一科,河北沧州061001 [3]河北医科大学第四医院科研中心,河北石家庄050011

出　　处：《肿瘤》2013年第7期629-633,共5页Tumor

摘　　要：目的:探讨乳腺癌术后服用三苯氧胺患者子宫内膜的病理变化以及与子宫内膜病变相关的因素。方法:收集2008年7月1日—2009年12月31日在河北医科大学第四医院妇科因妇科问题接受住院治疗的82例乳腺癌术后口服三苯氧胺患者,对临床病理资料进行回顾性分析。结果:82例患者中,接受随访74例,失访4例,死亡4例。子宫内膜病变包括子宫内膜息肉样增生16例(21.6%)、子宫内膜息肉14例(18.9%)、子宫内膜肌瘤或腺肌瘤11例(14.9%)、子宫内膜不典型增生4例(5.4%)和子宫内膜癌9例(12.2%)。乳腺癌术后口服三苯氧胺致子宫内膜病变与绝经相关,绝经后患者更易罹患子宫内膜癌。口服三苯氧胺持续时间与子宫内膜癌的发生呈正相关,尤其是口服三苯氧胺≥5年的患者。B超测量的子宫内膜厚度与子宫内膜癌的发生也呈正相关。结论:乳腺癌术后患者口服三苯氧胺治疗可能引发子宫内膜病变,绝经后以及口服三苯氧胺时间≥5年的患者更易引发子宫内膜癌。宫腔镜联合B超检查可作为诊断乳腺癌患者术后口服三苯氧胺引发子宫内膜病变的常规检测手段。Objective： To investigate the pathological change of endometrium and the related factors in postoperative breast cancer patients receiving tamoxifen therapy. Methods： Eighty-two postoperative breast cancer patients receiving tamoxifen therapy, who were admitted to gynecologic ward of Hebei Medical University Forth Hospital from July 1, 2008 to December 31, 2009 due to their gynecologic problems, were collected, and their clinicopathological information were anaylzed retrospectively. Results： Of 82 patients, 74 were followed-up, 4 were lost, and 4 were dead. The types of endometrial pathology of patients receiving tamoxifen included endometrial polypoid hyperplasia （n = 16, 21.6%）, endometrial polyps （n = 14, 18.9%）, adenomyoma （n = 11, 14.9%）, atypical hyperplasia （n = 4, 5.4%） and endometrial carcinoma （n = 9, 12.2%）. The related factors analysis revealed that endometrial diseases were positively associated with menopause, which meant that the postmenopausal patients were more likely to suffer from endometrial cancer. Moreover, there was a positive correlation between the duration of tamoxifen use and endometrial cancer, especially for the patients receiving tamoxifen for 5 years or more. The endometrial thickness by B-ultrasonic examination was also positively correlated with endometrial cancer. Conclusion： Tamoxifen therapy in postoperative breast cancer patients can lead to endometrial diseases. Postmenopausal patients and the patients receiving tamoxifen for 5 years or more are more likely to develop endometrial cancer. Combination of B-ultrasonic examination and hysteroscopy is an effective way to find endometrial lesions induced by tamoxifen therapy.

关 键 词：乳腺肿瘤 内分泌治疗 三苯氧胺 子宫内膜病变 

分 类 号：R737.9[医药卫生—肿瘤]