子宫内膜增殖症保守治疗的疗效观察

目的:观察并评价不同保守治疗方案对子宫内膜复杂性增生(CH)及非典型增生(AH)的治疗效果、并发症及患者可接受性。方法:前瞻性研究2009年1月至2012年12月在山东大学齐鲁医院门诊及住院收治的50岁以下、病理结果证实为CH的患者116例,将患者随机分为3组,分别接受口服孕激素(A组)、口服避孕药(B组)或LNG-IUS(C组)治疗;AH的患者共90例,将其随机分为2组,分别接受口服孕激素或GnRH-a治疗。每3个月取子宫内膜行病理检查,随访观察患者治疗后的病理缓解率及不良反应。结果:(1)CH患者:治疗6个月时,口服孕激素治疗组、口服避孕药治疗组、LNGIUS组的病理缓解率分别为77.5%、73.7%和94.7%(P=0.039),治疗期间体重增加的发生率依次为42.5%、7.9%和2.6%(P=0.001),突破性出血发生率分别为15.0%、5.2%和26.3%(P=0.023),恶心呕吐症状发生率分别为7.5%、5.2%和2.6%(P=0.624)。(2)AH患者:治疗6个月时,口服孕激素治疗组、GnRH-a治疗组的病理缓解率分别为70.5%和60.9%(P=0.197)。口服孕激素治疗组患者出现的不良反应主要包括体重增加(59.1%)、突破性出血(22.7%)、恶心呕吐(13.6%)及头晕乏力(6.8%)。GnRH-a治疗组患者出现的不良反应主要包括潮热(67.4%)、阴道干燥(34.8%)、精神状态改变(32.6%)、头痛乏力(10.9%)。患者均未出现血栓形成及肝酶升高。结论:对50岁以下的CH患者,可首选宫腔内置入LNG-IUS系统。对AH患者,若无生育要求或手术禁忌证,应首选手术治疗;对于50岁以下选择保守治疗的患者,口服孕激素和GnRH-a治疗的疗效相当。保守治疗需在严格监测下进行,以便及时发现癌变。

Efficacy of different therapies in treatment of endometrial hyperplasia

Objective： To evaluate the efficacy and safety of different conservative treatments in women with endometrial hyperplasia. Methods： 116 women younger than 50 years old,diagnosed with complex hyperplasia（ CH） in Qilu Hospital of Shandong University from January2009 to December 2012 by pathologic result were divided into three groups randomly and treated by progestins（ group A）,COCs（ group B） or LNG-IUS（ group C）. 90 women with atypical hyperplasia（ AH） were treated by progestins or GnRH-a separately. All patients underwent pathologic examination and adverse effects of drugs were recorded every 3 months since the beginning of treatment. Results：（ 1） Patients with CH： pathologic complete remission rate in the6th month of each group were 77. 5%（ group A） 、73. 7%（ group B） 、94. 7%（ group C）（ P =0. 039）. There were statistically significant differences among these three groups in uterine breakthrough bleeding（ P = 0. 023） and weight gain（ P = 0. 001）,but not in gastrointestinal symptoms（ P = 0. 624）.（ 2） Patients with AH： the pathologic complete remission rate after 6months＇ treatment were 70. 5% and 60. 9%（ P = 0. 197）. During treatment,weight gain were reported by 26（ 59. 1%） out of 44 patients,other adverse effects happened in patients treated by progestins included uterine breakthrough bleeding（ 22. 7%）,nausea（ 13. 6%） and fatigue（6.8%）. The most common side-effect of GnRH-a was hot flush（ 67. 4%）,vaginal atrophy（34.8%）,psychological changes（ 32. 6%） and headaches（ 10. 9%）. None of these patients had adverse effects of vein thrombosis and liver dysfunctions. Conclusions： LNG-IUS could be the best choice for patients with CH under 50 years old. While on the other hand,hysterectomy should be recommended to patients with AH. Both progestins and GnRH-a are considerable options to those who chose conservative treatments,which should be taken under severe surveillance.