子宫内膜不典型增生及子宫内膜癌患者保留生育功能后曼月乐维持治疗的疗效分析  

Efficacy of LNG-IUS as a maintenance treatment after fertility preserving therapy for atypical complex hyperplasia or endometrial cancer

作　　者：单莹[1] 金滢[1] 蔡艳 尹婕[1] 李艳[1] 顾宇[1] 王巍[1] 潘凌亚[1] SHAN Ying;JIN Ying;CAI Yan;YIN Jie;LI Yan;GU Yu;WANG Wei;PAN Ling-ya(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Clinical Research Center for Obstetric&Gynecologic Diseases,Beijing 100730;Beijing Cancer Hospital,Beijing 100142)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,国家妇产疾病临床研究中心,北京100730 [2]北京肿瘤医院,北京100142

出　　处：《生殖医学杂志》2021年第8期1055-1061,共7页Journal of Reproductive Medicine

摘　　要：目的分析子宫内膜不典型增生(ACH)或早期子宫内膜癌(EEC)患者保留生育功能后使用曼月乐宫内节育系统维持治疗的效果。方法收集2003年1月至2020年6月北京协和医院收治的151例ACH/EEC患者为研究对象,纳入患者均要求保留生育功能,接受大剂量孕激素治疗获得完全缓解(CR)后放置曼月乐作为维持治疗。回顾性分析这些患者的临床资料,采用cox多变量分析疾病复发的危险因素。结果患者平均年龄(31.9±4.9)岁,平均体质量指数(BMI)(26.1±4.6)kg/m^(2)。34例(22.5%)合并多囊卵巢综合征(PCOS),22例(14.6%)孕激素治疗达到CR时间超过12个月。达到CR后53例(35.0%)患者试孕,98例未试孕,平均曼月乐维持治疗时间分别为(15.6±13.1)个月和(33.5±23.3)个月。在53例试孕患者中,38例选择体外受精-胚胎移植(IVF-ET)试孕,15例选择自然试孕。IVF-ET试孕患者在胚胎移植前获得曼月乐额外保护时间平均为(11.5±10.9)个月。试孕患者曼月乐维持治疗的总妊娠率为35.8%(19/53),复发率9.9%(15/151),5年无复发生存率85.3%。cox回归模型分析得出,肥胖(BMI≥30 kg/m^(2))、多囊卵巢(PCO)以及达到CR时间长(>12个月)是疾病复发的危险因素(P<0.05)。结论对于ACH/EEC患者,大剂量孕激素保守治疗保留生育功能后使用曼月乐维持治疗可以获得比较满意的治疗效果和妊娠结局,尤其对于选择IVF-ET助孕的患者,建议在IVF期间保留曼月乐直至胚胎移植前再取出。Objective:To analyze the efficacy of levonorgestrel releasing intrauterine system(LNG-IUS)as a maintenance treatment after preserving fertility therapy for atypical complex hyperplasia(ACH)and early endometrial cancer(EEC).Methods:A total of 151 ACH/EEC patients received LNG-IUS treatment in Peking Union Medical College Hospital from January 2003 to June 2020 were selected as the research objects.All patients were required to preserve fertility function,and LNG-IUS was placed as maintenance treatment after complete remission(CR)in receiving high-dose progesterone treatment.The clinical data of these patients were retrospectively analyzed.Cox multivariate analysis was used to analyze the risk factors of disease recurrence.Results:The mean age of the patients was(31.9±4.9)years,with a mean BMI of(26.1±4.6)kg/m^(2).Among them,34(22.5%)had polycystic ovary syndrome(PCOS),and 22(14.6%)patients achieved complete remission with a treatment period over 12 months.After the patients achieved complete remission,53(35.0%)patients attempted to conceive,98 patients did not.The mean maintenance treatment time(MMT)was(15.6±13.1)months and(33.5±23.3)months respectively.In 53 patients who attempted to conceive,38 patients underwent IVF-ET,and 15 patients chose natural pregnancy.The patients in IVF-ET group obtained the mean time of extra protection was(11.5±10.9)months.The pregnancy rate was 35.8%(19/53)in the patients who attempted to conceive and treated with LNG-IUS for maintenance therapy.The recurrence rate was 9.9%(15/151),and the 5-year recurrence-free survival rate was 85.3%.Analysis of cox regression model showed that obesity(BMI≥30 kg/m^(2)),polycystic ovary(PCO)and long time to reach CR(>12 months)were risk factors for disease recurrence(P<0.05).Conclusions:In ACH/EEC patients,after high dose progesterone treatment for preserve fertility function,the use of LNG-IUS as a maintenance treatment contributed promising satisfactory treatment effect and pregnancy outcomes,especially for the patients attempted to conceiv

关 键 词：子宫内膜癌 子宫内膜不典型增生 曼月乐 生育功能 

分 类 号：R711.6[医药卫生—妇产科学] R711.74[医药卫生—临床医学]