左炔诺孕酮宫内节育系统对他莫昔芬治疗的乳腺癌患者子宫内膜病变的影响  

Analysis of the effect and safety of levonorgestrel-releasing intrauterine system on patients with breast cancer who take tamoxifen

作　　者：刘杰[1] 赵瑾[1] 方燕飞[1] 王震宇[1] 翟梅娟[1] 王小萼[1] 赵新 Liu Jie;Zhao Jin;Fang Yanfei;Wang Zhenyu;Zhai Meijuan;Wang Xiaoe;Zhao Xin(Department of Gynecology,the First People′s Hospital of Xiaoshan District,Hangzhou,Zhejiang 311200,China)

机构地区：[1]杭州市萧山区第一人民医院妇科,311200

出　　处：《中国基层医药》2020年第6期670-675,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省杭州市科技计划项目(20150633B52);浙江省杭州市卫生科技计划一般(B类)项目(2015B23)。

摘　　要：目的:分析左炔诺孕酮宫内节育系统(LNG-IUS)对他莫昔芬治疗的绝经前乳腺癌患者子宫内膜病变的影响。方法:选择杭州市萧山区第一人民医院2014年6月至2016年6月诊治的符合纳入标准的乳腺癌患者84例,采用随机数字表法分为放置LNG-IUS组(治疗组, n=39)和不放置LNG-IUS组(对照组, n=45)。治疗前行一般状况评估,治疗前、治疗后1年、治疗后2年行子宫内膜厚度检查、血脂检查、宫腔镜检查、子宫内膜病理类型分析、子宫内膜雌激素/孕激素受体表达测定并比较。 结果:治疗前,两组一般情况、宫腔情况差异均无统计学意义(均 P>0.05)。治疗后1年,治疗组子宫内膜息肉发生率、子宫内膜增生/分泌期改变发生率、良性病变发生率、萎缩子宫内膜发生率分别为2.6%、5.1%、15.4%、76.9%,对照组分别为6.7%、20.0%、17.8%、55.6%,两组子宫内膜增生/分泌期改变发生率、萎缩子宫内膜发生率差异均有统计学意义(χ 2=4.06、4.22,均 P<0.05);治疗后2年,治疗组子宫内膜息肉发生率、子宫内膜增生/分泌期改变发生率、萎缩子宫内膜发生率分别为0.0%、2.6%、84.6%,对照组分别为11.1%、15.6%、60.0%,两组差异均有统计学意义(χ 2=4.608、4.092、6.203,均 P<0.05)。 结论:LNG-IUS能有效预防乳腺癌术后他莫昔芬治疗所引起的子宫内膜良性病变,降低子宫内膜息肉及子宫内膜增生/分泌期改变发生率,提高子宫内膜萎缩发生率,不增加乳腺癌复发风险。Objective To analyze the effect and safety of levonorgestrel-releasing intrauterine system(LNG-IUS)for the premenopausal patients with breast cancer who took tamoxifen as adjuvant therapy.Methods From June 2014 to June 2016,84 patients with breast cancer who met the inclusion criteria in the First People′s Hospital of Xiaoshan District were randomly divided into two groups according to the digital table.The treatment group(39 cases)underwent LNG-IUS insertion,while the control group(45 cases)received no LNG-IUS insertion.The general condition of patients before the use of tamoxifen and LNG-IUS was evaluated.Transvaginal ultrasound was used to measure the thickness of endometrium,hysteroscope was used for pathological examination of endometrium and the measurement of ER/PR expression,and blood lipid level was also detected.All above was done before the treatment of tamoxifen and LNG-IUS,1 year after treatment and 2 years after treatment.Results Before the therapy,there were no statistically significant differences between the two groups in general condition and uterine cavity condition(all P>0.05).After 1 year,the incidences of endometrial polyp,endometrial hyperplasia/secretion,benign lesion and endometrial atrophy in the treatment group were 2.6%,5.1%,15.4%,76.9%,respectively,which in the control group were 6.7%,20.0%,17.8%,55.6%,respectively.the differences between the two groups were statistically significant(χ^2=4.06,4.22,all P<0.05).After 2 years,the incidences of endometrial polyp,endometrial hyperplasia/secretion,benign lesion and endometrial atrophy in the treatment group were 0.0%,2.6%,84.6%,respectively,which in the control group were 11.1%,15.6%,60.0%,respectively,the differences between the two groups were statistically significant(χ^2=4.608,4.092,6.203,all P<0.05).Conclusion LNG-IUS can prevent the benign endometrial lesions of breast cancer patients caused by tamoxifen therapy after surgery,and can decrease the incidence of endometrial polyp and endometrial hyperplasia/secretion,while increase t

关 键 词：宫内避孕器 含药 左炔诺孕酮 他莫昔芬 乳腺肿瘤 绝经前期 子宫内膜 

分 类 号：R711[医药卫生—妇产科学]