| 无不典型性子宫内膜增生患者的临床特征分析 |
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| 引用本文： | 无不典型性子宫内膜增生患者的临床特征分析.无不典型性子宫内膜增生患者的临床特征分析[J].首都医学院学报,2019,40(6):863-867. |
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| 作者姓名： | 无不典型性子宫内膜增生患者的临床特征分析 |
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| 作者单位： | 1. 首都医科大学附属北京朝阳医院妇产科, 北京 100020;2. 北京市房山区妇幼保健院妇产科, 北京 102488 |
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| 基金项目： | 首都市民健康培育项目（161100000116077），北京市医管局扬帆计划重点项目（ZYLX201713）。 |
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| 摘 要： | 目的 探讨无不典型性的子宫内膜增生（endometrial hyperplasia without atypia，EH）患者临床特征、不同治疗方法选择时机及预后分析。方法 分析2011年6月1日至2018年6月30日期间，首都医科大学附属北京朝阳医院收治的因异常子宫出血行诊断性刮宫、病理诊断无不典型性的子宫内膜增生394例患者的临床资料、病理特征、不同治疗选择对预后的影响。结果 394例纳入患者依据2003年世界卫生组织（World Health Organization，WHO）子宫内膜增生的分类，子宫内膜单纯增生组258例和子宫内膜复杂增生组136例。两组无妊娠史分别是10.85%（28/258）和19.12%（26/136），差异有统计学意义（P<0.05）。两组初始治疗方式选择口服孕激素药物治疗分别占73.25%（189/258）和57.35%（78/136），子宫切除术占12.1%（31/258）和25%（35/136），两组治疗方式比较，差异有统计学意义（P<0.05）。初始孕激素口服治疗3~6个月后子宫内膜随诊显示对孕激素反应良好者两组分别为85.7%（162/189），59.0%（46/78），内膜单纯增生组明显优于复杂增生组，两组比较差异有统计学意义（P<0.05）。两组孕激素治疗方案的分布差异有统计学意义（P<0.05），单纯性增生组以孕激素周期性应用为主。单纯增生组3种孕激素治疗方案对孕激素的反应性差异无统计学意义（χ2=3.611，P=0.161），复杂增生组高效孕激素连续应用孕激素的反应率明显高于天然黄体酮连续应用者（χ2=6.390，P=0.041）。多因素分析显示子宫内膜组织病理学分组是子宫内膜对孕激素反应性的独立影响因素（P=0.001，OR=0.233）。初始治疗为子宫切除术者子宫内膜标本组织学诊断分布显著不同，复杂增生组子宫内膜不典型性增生的比率明显高于单纯增生组（χ2=35.620，P<0.001）。单纯增生组2例诊断升级，1例复杂增生，1例不典型增生。复杂增生组2例子宫内膜癌（5.71%），8例不典型增生（22.8%）。两组病理升级发生率分别6.45%（2/31）和28.57%（10/35），差异有统计学意义（P<0.05）。结论 无不典型性的子宫内膜增生患者对孕激素的反应性总体良好，单纯增生患者对孕激素后半期周期序贯疗法反应良好，可作为临床初始治疗的首选。复杂增生组高效孕激素反应性良好。复杂增生子宫内膜对孕激素的反应程度明显低于单纯性增生。诊断性刮宫病理诊断子宫内膜复杂增生患者约30%并存子宫内膜不典型增生。刮宫病理存在明显的过低诊断率。
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| 关 键 词： | 无不典型性的子宫内膜增生 子宫内膜不典型增生 子宫内膜单纯增生 子宫内膜复杂增生 诊断性刮宫 |
| 收稿时间： | 2019-09-23 |
Treatment options for patients with non-atypical endometrial hyperplasia |
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| Wang Shuzhen,Liu Wenting,Huang Wenyang,Zhang Yang,Zheng Jing,Jiang Ying.Treatment options for patients with non-atypical endometrial hyperplasia[J].Journal of Capital University of Medical Sciences,2019,40(6):863-867. |
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| Authors: | Wang Shuzhen Liu Wenting Huang Wenyang Zhang Yang Zheng Jing Jiang Ying |
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| Affiliation: | 1. Department of Gynaecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;2. Department of Gynecology and Obstetrics, Beijing Fangshan District Maternal and Child Health Hospital, Beijing 102488, China |
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| Abstract: | Objective To investigate the treatment options for patients with non-atypical endometrial hyperplasia (EH) who present the abnormal uterine bleeding (AUB). Methods We retrospectively reviewed medical charts between June 2011 and June 2018 at a tertiary hospital and identified 394 cases of AUB with non-atypical endometrial hyperplasia. Results Totally 394 patients included 258 patients with simple EH and 136 patients with complex EH. The response of simple EH group to progesterone therapy was significantly better than that of complex EH group. The distribution of three different project of progesterone in the two groups was significantly different. The proportion of periodic progesterone in the simple EH group was significantly higher than that in the complex EH group.6 patients in the complex EH group had hysterectomy because of the progress or the persistence of the lesion,while none of the patients in the simple EH group. Hysterectomy:31 patients in the simple EH group and 35 patients in the complex EH group were treated with hysterectomy. Compared with the hysterectomy specimens,the diagnostic curettage (D&C) may be the underdiagnosis for complex EH. In the complex EH from D&C,two endometrial carcinoma and 8 cases of atypical hyperplasia were misdiagnosed. Conclusion D&C is safety and effective for most patients with EH,especially for simple EH. In clinical practice,any patients should be treated with progesterone,and the lesions should be closely monitored. |
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| Keywords: | endometrial hyperplasia without atypia atypical hyperplasia simple endometrial hyperplasia complex endometrial hyperplasia diagnostic curettage |
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