乳腺癌术后发生子宫内膜病变的影响因素分析  

Analysis of influencing factors of endometrial disease of patients with breast cancer after operation

作　　者：潘宁萍[1] 周微笑 唐婧 周坚红[1] 李娟清[1] Pan Ningping;Zhou Weixiao;Tang Jing;Zhou Jianhong;Li Juanqing(Department of Obstetrics and GynecologyWomen s Hospital School of Medicine Zhejiang University Hangzhou 310006,China;Department of Obstetrics and Gynecologyt Yuhang District Maternal and Child Health Hospital,Hangzhou 311100,China)

机构地区：[1]浙江大学医学院附属妇产科医院妇产科,杭州310006 [2]杭州市余杭区妇幼保健院妇产科,311100

出　　处：《中华妇产科杂志》2019年第12期848-853,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨乳腺癌患者术后发生子宫内膜病变的影响因素。方法收集2006年6月—2018年1月浙江大学医学院附属妇产科医院收治的因乳腺癌术后发生子宫内膜病变进行相关妇科手术治疗的212例患者的临床病理资料,回顾性分析乳腺癌患者术后发生子宫内膜病变的影响因素。结果乳腺癌患者术后发生的子宫内膜病变的严重程度与患者有无异常子宫出血及子宫内膜厚度有关(P<0.05),异常子宫出血、子宫内膜增厚是影响乳腺癌患者术后发生子宫内膜癌的独立危险因素(P<0.05)。当子宫内膜厚度≥0.49 cm时,预测子宫内膜癌的敏感度为78%,特异度为25%。子宫内膜息肉术后接受选择性ER调节剂治疗患者的子宫内膜厚度[(0.56±0.39)cm]显著高于接受芳香酶抑制剂治疗患者[(0.33±0.23)cm]及未治疗患者[(0.44±0.28)cm,P<0.05];选择性ER调节剂治疗患者的子宫内膜病变复发率及二次手术率(分别为26.2%、14.3%)高于芳香酶抑制剂治疗患者(分别为9.5%、4.8%)及未治疗患者(分别为21.6%、4.9%),但分别比较,差异均无统计学意义(P>0.05)。结论有异常子宫出血、子宫内膜增厚是乳腺癌患者术后发生子宫内膜癌的高危因素。子宫内膜厚度对乳腺癌患者术后发生子宫内膜癌具有良好的预测价值。子宫内膜息肉患者术后接受选择性ER调节剂治疗可使子宫内膜增厚,同时增加子宫内膜病变的复发率及二次手术率。Objective To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation.Methods A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women’s Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases.Results The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer,and they were independent risk factors for breast cancer patients to have endometrial cancer(P<0.05).When the diagnostic cut off value of endometrial thickness was≥0.49 cm,the sensitivity and specificity to endometrial cancer were 78%and 25%,respectively.The average endometrial thickness was(0.56±0.39)cm in patients who were treated by selective estrogen receptor modulator(SERM)after gynecological surgery,which was significantly thicker than that of aromatase inhibitor(AI)group[(0.33±0.23)cm]and no treatment group[(0.44±0.28)cm,P<0.05].The endometrial disease recurrent rate and reoperation rate in SERM group were(26.2%,14.3%)slightly higher than that of AI group(9.5%,4.8%)and no treatment group(21.6%,4.9%),but there were not significant differences(all P>0.05).Conclusions The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer.The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer.The SERM treatment increases the endometrial thickness,recurrent rate and reoperation rate in post-operation patients.

关 键 词：乳腺肿瘤 子宫疾病 子宫内膜 疾病严重程度指数 

分 类 号：R73[医药卫生—肿瘤]