曼月乐环在乳腺癌术后口服他莫昔芬患者中的应用效果  

Effect of Mirena applied to patients with oral administration of tamoxifen after breast cancer surgery

作　　者：张英辉[1] 曹云桂[1] 焦家军[1] 李菊华[1] 李锐 ZHANG Ying-hui;CAO Yun-gui;JIAO Jia-jun;LI Ju-hua;LI Rui(Department of Mammary Gland,the Maternal and Child Health Hospital of Jiading District,Shanghai 201821,China)

机构地区：[1]上海市嘉定区妇幼保健院乳腺科

出　　处：《广西医学》2019年第24期3101-3105,共5页Guangxi Medical Journal

基　　金：上海市嘉定区卫生和计划生育委员会科研课题计划(2016-KY-13)

摘　　要：目的分析曼月乐环在乳腺癌术后口服他莫昔芬患者中的应用效果。方法将60例乳腺癌术后服用他莫昔芬患者,随机分为对照组和研究组。研究组患者在服用他莫昔芬前放置曼月乐环,对照组患者不放环。于诊刮前以及他莫昔芬片后1、6、12、24个月,检测患者的子宫内膜厚度以及血清雌二醇、黄体生成素(LH)、促卵泡激素(FSH)水平。记录患者诊刮前及口服他莫昔芬片24个月后内膜增生、良性息肉、内膜萎缩的发生情况,口服他莫昔芬片后6、12、24个月不规则阴道流血的发生情况,以及随访期间乳腺癌复发或转移发生情况。结果(1)对照组患者的子宫内膜厚度呈增厚的趋势,而研究组的内膜厚度呈先增厚后变薄的变化趋势,且服用后6、12、24个月的子宫内膜均薄于对照组(均P<0.05)。(2)两组的雌二醇水平差异无统计学意义,且无随时间变化的趋势(均P>0.05)。(3)服用他莫昔芬前两组均无息肉病例,而服用他莫昔芬后对照组良性息肉患者比例增高(P<0.05),而研究组仅1例出现良性息肉;服用他莫昔芬后,研究组内膜萎缩患者比例降低,且低于对照组(P<0.05)。(4)服用他莫昔芬后6个月,研究组不规则阴道出血的患者比例高于对照组(P<0.05)。(5)两组在随访期间均无乳腺癌复发或转移病例。结论对于乳腺癌术后服用他莫昔芬患者,放置曼月乐环可有效地预防或减少患者子宫内膜病变的发生,对外周血雌二醇水平影响较小,且不会引起乳腺癌术后复发,但需注意阴道流血的发生。Objective To analyze the effect of Mirena applied to patients with oral administration of tamoxifen after breast cancer surgery.Methods Sixty patients orally administered tamoxifen after breast cancer surgery were randomly divided into control group and research group.Patients in the research group received intrauterine placement of Mirena prior to oral administration of tamoxifen,whereas patients in the control group did not receive Mirena placement.Before curettage and 1,6,12 and 24 months after administration of tamoxifen,endometrial thickness as well as serum levels of estradiol,luteinizing hormone(LH)and follicle-stimulating hormone(FSH)was measured in the patients.The incidence of related events were recorded,including endometrial hyperplasia,benign polyps and endometrial atrophy before curettage and 24 months after oral administration of tamoxifen,irregular vaginal bleeding 6,12 and 24 months after oral administration of tamoxifen,and the recurrent or metastatic breast cancer during the follow-up period.Results(1)The endometrial thickness of the control group tended to grow thicker,whereas the endometrial thickness of the research group exhibited a tendency of increasing first and then decreasing,and was thinner than that of the control group 6,12 or 24 months after administration of tamoxifen(all P<0.05).(2)The estradiol levels of the two groups showed no statistically significant difference,not exhibiting any tendency to change over time(all P>0.05).(3)No polyps cases were found in the two groups before administration of tamoxifen,but after administration of tamoxifen,the proportion of patients with benign polyps increased in the control group(P<0.05),while only one case suffering from benign polyps was observed in the research group;after administration of tamoxifen,the proportion of patients with endometrial atrophy in the research group decreased,and was lower than the control(P<0.05).(4)Six months after administration of tamoxifen,the research group had a higher proportion of patients with irregular

关 键 词：乳腺癌 术后 他莫昔芬 曼月乐环 子宫内膜病变 性激素 阴道流血 

分 类 号：R737.9[医药卫生—肿瘤]