宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗早期子宫内膜癌及子宫内膜不典型增生的临床分析

目的 分析与探讨采用宫腔镜病灶电切术联合左炔诺孕酮宫内缓释系统(LNG-IUS)治疗早期子宫内膜癌(EC)及子宫内膜不典型增生(EAH)的临床效果。 方法 收集2017年1月—2018年3月期间宁夏回族自治区人民医院收治的早期子宫内膜样腺癌及子宫内膜不典型增生患者共34例,根据治疗方案不同分为对照组及观察组,每组17例。对照组采用诊断性刮宫联合大剂量孕激素治疗,观察组采用宫腔镜下病灶电切术联合LNG-IUS治疗。观察2组治疗效果、不良反应、并发症情况,检测对比治疗前后2组患者血清糖类抗原125(CA125)及人附睾蛋白4(HE4)水平。采用SPSS 20.0统计学软件进行分析。 结果 观察组完全缓解率为82.35%(14/17),治疗总有效率为100.00%(17/17),高于对照组[70.59%(12/17)、94.12%(16/17)],但2组比较差异无统计学意义(均P>0.05)。观察组药物不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。对照组继发宫腔粘连3例,差异无统计学意义(P>0.05)。2组治疗前、后同一时间点,CA125及HE4水平比较差异无统计学意义(均P>0.05);2组治疗后6个月及12个月CA125及HE4水平较术前均明显下降,与术前比较差异有统计学意义(均P<0.05)。 结论 宫腔镜病灶电切术联合LNG-IUS用于早期EC及EAH的治疗,临床效果确切,药物不良反应及宫腔操作并发症少,有望成为早期EC及EAH保留生育功能治疗的常规方案,值得临床推广。 

Clinical analysis of the hysteroscopic lesion electrotomy combined with LNG-IUS in the treatment of early endometrial cancer and endometrial atypical hyperplasia

Objective To analyze and explore the clinical effect of hysteroscopic lesion electrotomy combined with levonorgestrel releasing intrauterine system(LNG-IUS) treatment of early endometrial cancer(EC) and endometrial atypical hyperplasia(EAH). Methods A total of 34 patients with early EC and EAH admitted to our hospital from January 2017 to March 2018 were collected, They were divided into two groups according to different treatment schemes, 17 cases in each group. The control group was treated with diagnostic curettage combined with high dose progesterone, while the observation group was treated with hysteroscopic lesion electrotomy combined with LNG-IUS. Therapeutic effects, adverse reactions and complications of two groups were observed. The serum carbohydrate antigen 125(CA125) and human epididymis protein 4(HE4) levels were detected and compared. SPSS 20.0 statistical software was used for analysis. Results The complete remission rate was 82.35%(14/17) in the observation group and the total effective rate was 100.00%(17/17), which was higher than 70.59%(12/17) and 94.12%(16/17) in the control group, but there was no significant difference between the two groups(P>0.05). The incidence of adverse drug reactions in the observation group was significantly lower than that in the control groups(P<0.05). There were 3 cases of secondary intrauterine adhesions in the control group, and there was no statistical difference between the two groups. There was no significant difference in CA125 and HE4 levels between the two groups at the same time point before and after treatment(all P>0.05). The levels of CA125 and HE4 in the two groups at 6 and 12 months after treatment were significantly lower than those before operation(all P<0.05). Conclusion Hysteroscopic lesion electrotomy combined with LNG-IUS in the treatment of early EC and EAH has definite clinical effect, less adverse drug reactions and complications of uterine cavity operation, which is expected to become the routine treatment of early EC and EAH with fertility-sparing treatment, thus is worthy of clinical promotion.