宫腔镜在治疗多囊卵巢综合征合并子宫内膜不典型增生或早期子宫内膜样腺癌后对其生育功能保留的作用及评估  

Effect and evaluation of hysteroscopy on fertility-preserving treatment of endometrial atypical hyperplasia early endometrial adenocarcinoma in polycystic ovary syndrome patients

作　　者：苏椿淋[1,2] 李昕 黄茹飞[3] 陆慧娟 林金芳 Su Chunlin;Li Xin;Huang Rufei;Lu Huijuan;Lin Jinfang(Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Key Laboratory of Female Reproductive Endocrinologieal Diseases of Shanghai,Shanghai 200011,China;Shanghai Institute of Planned Parenthood Research,Shanghai 200032,China;Fudan Clinical Pathology Diagnosis Center,Shanghai 200032,China)

机构地区：[1]复旦大学附属妇产科医院,上海200011 [2]上海市女性生殖内分泌相关疾病重点实验室,200011 [3]上海市计划生育科学研究所,200032 [4]复旦大学临床病理会诊中心,上海200032

出　　处：《中华生殖与避孕杂志》2018年第7期536-541,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨宫腔镜在治疗年轻的多囊卵巢综合征(PCOS)合并子宫内膜不典型增生(EAH)或早期子宫内膜样腺癌(EEC)患者的临床疗效及安全性。方法本研究为回顾性研究,患者分为2组,早期12例患者(9例EAH,3例EEC)采用单纯药物治疗(单纯药物组):达英-35联合二甲双胍,每3个月采用诊断性刮宫+病理检查,了解子宫内膜病变转化情况;后期32例患者(21例EAH,11例EEC)采用宫腔镜治疗(宫腔镜治疗组):达英-35联合二甲双胍,每3个月行宫腔镜直视下病灶完全切除+全面诊断性刮宫+病理检查了解子宫内膜病变转化情况。结果所有患者经病理证实子宫内膜病变均成功转化,单纯药物组EAH成功转化时间为(6.6±3.1)个月;宫腔镜治疗组(4.1±1.3)个月,组间比较差异有统计学意义(P=0.025);单纯药物组早期EEC成功转化时间为(6.3±2.8)个月;宫腔镜治疗组为(4.7±1.7)个月,组间比较差异有统计学意义(P=0.020)。单纯药物组2例EAH已足月分娩获活婴,此2例为自然受孕;宫腔镜治疗组9例(5例EEC,4例EAH)已足月分娩均获活婴,另外有8例EEC转化成功者目前仍在妊娠中。结论达英-35联合二甲双胍药物治疗能使PCOS合并胰岛素抵抗(IR)的子宫内膜癌前病变及EEC完全转化,宫腔镜能准确、彻底切除子宫内膜病灶,能最大可能达到"无瘤"的治疗要求,所以能明显缩短药物的转化时间(P<0.05),并能增加子宫内膜病灶对药物保守治疗的反应性,从而保留了此类患者的生育能力。Objective To explore the clinical efficacy and safety of hysteroscopy in the treatment of endometrial atypical hyperplasia （EAH） or early endometrioid adenocarcinoma （EEC） in young patients with polycystic ovary syndrome （PCOS）. Methods This was a retrospective study. The patients were divided into 2 groups, 1） drug treatment group： a total of 12 cases （9 cases of EAH, 3 cases of EEC） were treated with Diane-35 （1 tablet per day, for 21 d per month） combined with metformin （1 000 mg, qd） in the treatment, every 3 months by curettage ＋ pathological evaluation; 2） hysteroscopic treatment group： a total of 32 cases （21 cases of EAH, 11 cases of EEC） were treated with Diane-35 combined with metformin, every 3 months by hysteroscopic surgery under the lesion excision and curettage＋pathological evaluation. Results All patients were pathologically confirmed that endometrial lesions were successfully reversed, atypical endometrial hyperplasia of the patients in drug treatment group was successfully reversed in （6.6±3.1） months; atypical endometrial hyperplasia of the patients in hysteroscopy treatment group were successfully reversed in （4.1±1.3） months, the difference was statistically significant （P=0.025）; early endometrial adenocarcinoma of the patients in group of drug treatment successfully reversed in （6.3±2.8） months; EEC of the patients in hysteroscopy treatment group was successfully reversed in （4.7±1.7） months, the difference was statistically significant （P=0.020）. In drug treatment group, 2 cases with natural conception and full-term delivery in EAH; in hysteroscopy treatment group, 9 cases （5 cases of EEC, 4 cases of EAH） of full-term delivery, another 8 cases in pregnancy. Conclusion The drug treatment of Diane-35 combined with metformin can completely reverse endometrial precancerous lesion and EEC of PCOS with insulin resistance OR）, hysteroscopy, which could radically resect endometrial lesions, can achieve th goal of＂Disease-f

关 键 词：宫腔镜 子宫内膜癌前病变 早期子宫内膜样腺癌(EEC) 达英-35 二甲双胍 

分 类 号：R737.33[医药卫生—肿瘤]