摘要
目的:为了分析子宫内膜增生症患者使用左炔诺孕酮宫内缓释系统和(或)高效孕激素保守治疗的完全缓解率、复发率、顺利分娩情况及预后的相关影响因素。方法:回顾性分析郑州大学第一附属医院2013年1月至2016年1月,经本院病理确诊为子宫内膜增生不伴不典型增生(EH)和(或)子宫内膜不典型增生(AH)并使用左炔诺孕酮宫内缓释系统和(或)高效孕激素治疗的109例患者的临床资料。EH患者每6个月、AH患者每3个月进行一次宫腔镜探查和子宫内膜诊刮病理检查,评价子宫内膜逆转情况及相关影响因素。结果:109例患者中完全缓解90例(82.57%),完全缓解后复发9例(10.00%);完全缓解中EH患者51例(56.67%),暂无生育要求15例(29.41%),顺利分娩30例(58.82%),AH患者39例(43.33%),暂无生育要求17例(43.59%),顺利分娩12例(30.77%)。其中,体质量指数(BMI)<30 kg/m^2(OR 0.08,P<0.05)、使用左炔诺孕酮宫内缓释系统治疗的患者(OR 4.86,P<0.05)更易达到完全缓解;BMI<30 kg/m^2(OR 30.60,P<0.05)、使用左炔诺孕酮宫内缓释系统治疗(OR 0.07,P<0.05)均可降低复发率;BMI<30 kg/m^2(OR 3.81,P<0.05)、病理类型为EH(OR 83.99,P<0.05)、应用辅助生殖技术(OR 43.36,P<0.05)的患者完全缓解后更易顺利分娩,AH的患者应用辅助生殖技术可改善完全缓解后顺利分娩的结局。结论:对于强烈要求保留生育功能的子宫内膜增生症患者,使用左炔诺孕酮宫内缓释系统和(或)高效孕激素保守治疗可取得较满意的疗效,推荐优先使用左炔诺孕酮宫内缓释系统;肥胖患者在治疗期间应同时减重,有胰岛素抵抗和糖代谢障碍的患者建议同时口服二甲双胍;完全缓解后有妊娠意愿的患者应用辅助生殖技术可提高顺利分娩成功率。
Objective:To analyze the factors affecting the complete remission rate,recurrence rate,live birth status and prognosis of patients with endometrial hyperplasia treated with levonorgestrel intrauterine sus-tained-release system and/or high-efficiency progesterone.Methods:Retrospective analysis was performed with-clinical data of 109 patients with endometrial hyperplasia without atypia(EH)and/or endometrial atypical hyperpla-sia(AH)who were treated with levonorgestrel intrauterine sustained-release system and/or high-efficiency pro-gesterone therapy in The First Affiliated Hospital of Zhengzhou University from January 2013 to January 2016.EH and AH patients undergo a hysteroscopic or endometrial pathological examination for every 6 and 3 months re-spectively to evaluate endometrial condition.Results:In 109 cases,90 cases(82.57%)were completely relieved and 9 cases(10.00%)were relapsed.In EH group 51 cases(56.67%)had complete remission,15 cases(29.41%)had no fertility requirements and 30 cases(58.82%)of successful childbirth.In AH group 39 patients(43.33%)had complete remission,17 patients(43.59%)had no fertility requirements and 12 cases(30.77%)of successful childbirth.Patients who using levonorgestrel intrauterine sustained-release system(OR 4.86,P<0.05)and BMI<30 kg/m 2(OR 0.08,P<0.05)were more likely to achieve complete remission;Patients who using levonorgestrel intrauterine sustained-release system(OR 0.07,P<0.05)and BMI<30 kg/m 2(OR 30.60,P<0.05)could reduce the recurrence rate.Patients who with EH(OR 83.99,P<0.05),assisted reproductive tech-nology(OR 43.36,P<0.05)and BMI<30 kg/m 2(OR 3.81,P<0.05)were more likely to diliver successfully after complete remission and assisted reproductive technology in patients with AH can improve live birth chance after remission.Conclusions:For patients with endometrial hyperplasia who strongly require fertility preservation,the use of levonorgestrel intrauterine sustained-release system and/or conservative treatment with high-efficiency pro-gestins can achieve satisfactory results.levonorgestrel intrauterinesustained-release systemismorerecommended;obese patients should lose weight at the same time during treatment,patients with insulin resistance and glucose metabolism disorders are recommended to take oral metformin at the same time;patients with a willingness to be-come pregnant after complete remission can use assisted reproductive technology to improve the rate of success-ful delivery.
作者
任芳
马源蔚
李彩瑜
杨思远
韩品
张飞跃
温静
REN Fang;MA Yuanwei;LI Caiyu(Department of Gynecology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450052,Chi-na)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2020年第11期843-847,共5页
Journal of Practical Obstetrics and Gynecology
基金
国家自然科学基金项目青年科学基金项目(编号:81903114)
河南省医学科技攻关计划项目(编号:201702057)。
关键词
子宫内膜增生症
左炔诺孕酮宫内缓释系统
妊娠
Endometrial hyperplasia
Levonorgestrel intrauterine sustained-release system
Pregnancy
