曼月乐预防他莫昔芬诱导子宫内膜息肉的可行性分析

目的 评价左诀诺孕酮释放系统(LNG-IUS)预防他莫昔芬诱导子宫内膜息肉的可行性.方法 选择2008年3月至2012年12月在重庆三峡中心医院就诊需要口服他莫昔芬的乳腺癌术后患者96例,随机分为试验组49例和对照组47例,分别给予子宫内置入LNG-IUS和空白对照,评价内膜组织学和子宫增殖情况.结果 所有患者均顺利接受治疗,无肿瘤复发病例;试验组和对照组分别有33和37、21和24、19和23、15和18例患者完成第1、2、3、4年随访;治疗后试验组良性息肉、内膜萎缩、内膜增生比例低于对照组(χ2值分别为4.30、45.77、4.35,均P<0.05),蜕膜化比例高于对照组(χ2=68.64,P<0.05),而子宫内膜炎比例组间比较差异无统计学意义(χ2=1.05,P>0.05);重复测量方差分析表明,不同组间比较结果差异有统计学意义(F=5.59,P=0.03),不同时点组间比较差异有统计学意义(F=7.00,P=0.01),时点×组间交互作用差异有统计学意义(F=9.39,P<0.00),表明两组内膜厚度和子宫重量随时间变化趋势不相同.结论 LNG-IUS能减少他莫昔芬治疗后子宫内膜息肉的生成,同时没有增加内膜恶变的风险.

Feasibility of LNG-IUS in preventing tamoxifen induced endometrial polyps

Objective To evaluate the feasibility of preventing tamoxifen induced endometrial polyps by levonorgestrel-releasing intrauterine system(LNG-IUS).Methods From March 2008 to December 2012,96 patients with breast cancer who needed oral administration of tamoxifen were randomly divided into test group(n=49)and control group(n=47).Patients in the two groups were treated with LNG-IUS and blank control to evaluate endometrial histology and uterine proliferation.Results All patients were treated successfully without any recurrence of tumor.There were 33 and 37,21 and 24,19 and 23,15 and 18 cases in test group and control group accomplishing follow-up in the first,second,third and fourth year,respectively.After treatment,the percentages of benign polyps,endometrial atrophy and hyperplasia in test group were lower than in control group(χ2value was 4.30,45.77 and 4.35,respectively,all P<0.05).The proportion of decidulization was higher in test group than control group (χ2=68.64,P<0.05).There was no significant difference in endometrial inflammation between two groups(χ2=1.05,P>0.05). Repetitive measurement and analysis of variance indicated that there was significant difference between two groups(F=5.59,P=0.03).The difference between two groups at different times was statistically significant(F= 7.00,P= 0.01).The interaction between two groups was statistically significant(F=9.39,P<0.00),indicating that endometrial thickness and uterine weight of two groups showed different trend.Conclusion LNG-IUS can reduce the formation of endometrial polyps after tamoxifen,and there is no increase in the risk of endometrial malignant.