宫腔镜联合孕激素治疗子宫非典型息肉样腺肌瘤的中远期疗效  

Medium-long Term Effects in Patients With Atypical Polypoid Adenomyoma of Uterus Who Treated With Hysteroscopy Combined With Progestin Therapy

作　　者：张丽娟[1] 段爱红[1] 盛洁[1] Zhang Lijuan;Duan Aihong;Sheng Jie(Department of Gynecology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院妇科,北京100026

出　　处：《中国微创外科杂志》2018年第12期1076-1079,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨子宫非典型息肉样腺肌瘤(atypical polypoid adenomyoma,APA)宫腔镜病灶切除后孕激素治疗的远期疗效及妊娠结局。方法回顾性分析2005年6月～2017年6月我院宫腔镜联合孕激素治疗33例APA的临床资料。年龄22～52岁,平均36. 0岁。20例无妊娠史,12例合并不孕症。宫腔镜下病灶切除术后病理诊断APA,其中23例(69. 7%)合并子宫内膜病变,包括内膜增生21例,癌变2例。术后均辅助孕激素治疗,包括口服醋酸甲羟孕酮18例(54. 5%),口服炔诺酮7例(21. 2%),口服地屈孕酮或黄体酮7例(21. 2%),宫腔放置左炔诺孕酮宫内缓释系统1例(3. 0%)。结果术后随访12～119个月,(58. 3±26. 7)月。1例因原发宫颈的神经内分泌癌晚期多脏器衰竭死亡。APA复发3例(9. 1%),无一例发展为癌。妊娠12例次(包括5例辅助生殖助孕),有生育要求者中妊娠率61. 1%(11/18),其中7例为不孕症患者。结论APA经宫腔镜完整切除病灶后,孕激素长期治疗是年轻APA患者保留生育功能的可行方案。辅助生殖技术的应用有利于改善妊娠结局。Objective To analyze the long-term clinical and pregnancy outcomes in patients with atypical polypoid adenomyoma(APA)of the uterus who treated with progestin therapy after hysteroscopic excision.Methods Clinical data of 33 cases with APA treated with progestin therapy after hysteroscopic excision in our hospital from June 2005 to June 2017 were retrospectively analyzed.The mean age was 36.0 years old(range,22-52 years old).A total of 20 cases had no pregnancy history,and 12 cases suffered from infertility.All the cases underwent hysteroscopic excision,with APA pathologically diagnosed.Endometrial lesions were found in 23 cases(69.7%),including 21 cases of endometrial hyperplasia and 2 cases of carcinoma.All the patients took progestin therapy after the surgery,including oral medroxyprogesterone acetate in 18 cases(54.5%),norgestrel in 7 cases(21.2%),didrogesterone or progesterone in 7 cases(21.2%),and LNG-IUS in 1 case(3.0%).Results All the cases were followed up for 12-119 months(mean,58.3±26.7 months).One patient died of primary cervical neuroendocrine carcinoma with multiple organs failure.There were 3 cases of recurrence(9.1%),without progression to carcinoma.There were 12 times of pregnancy,including 5 cases of in vitro fertilization and embryo transfer.The rate of pregnancy in patients with fertility demand was 61.1%(11/18),7 of which were diagnosed with infertility.Conclusions Fertility-sparing surgery under hysteroscopy with long-term progesterone therapy is an alternative for young APA patients.The application of assisted reproductive technology can improve the pregnancy outcome.

关 键 词：非典型息肉样腺肌瘤 癌 宫腔镜 孕激素治疗 妊娠 

分 类 号：R737.33[医药卫生—肿瘤]