子宫内膜非典型增生18例保守治疗结局分析

目的探讨孕激素治疗子宫内膜非典型增生的结局及适宜的辅助生育策略。方法回顾性分析2002年1月～2007年4月18例不孕合并子宫内膜非典型增生的患者应用大剂量孕激素保守治疗的结果及妊娠结局。结果①14例患者在应用大剂量孕激素治疗3～36个月后病灶消退，4例病灶持续存在；②3例患者在停止治疗5～15个月后发展为子宫内膜癌。内膜非典型增生病变的再现率为33．3％；③8例患者接受了辅助生育治疗．5例分别经CC＋HMG促排卵治疗3～6周期无优势卵泡发育．1例在第6个促排卵周期获宫内单胎妊娠。4例（包括1例CC＋HMG促排卵未孕者）患者接受了5个周期IVF助孕，1例输卵管妊娠。1例自然流产。另2例冻存胚胎等待移植。结论多数子宫内膜非典型增生的患者对大剂量孕激素治疗有效。对这类患者．一旦内膜病变消退，应积极助孕．可以适当放宽IVF—ET指征。

Outcomes of conservative treatment of endometrial atypical hyperplasia and strategy of assisted reproduction for these patients

Objective To explore the outcomes of conservative treatment with progestin for endometrial atypical hyperplasia and the strategy of assisted reproduction after the treatment. Methods Eighteen infertile women with endometrial atypical hyperplasia were treated with high dosage of progestin from Jan 2002 to Apr 2007. The effect of treatment and the pregnant outcomes afterward were analyzed respectively. Results ① Fourteen cases achieved regressions of the endometrial lesions after treated for 3～36 months. Four had persistent lesions. ② Three cases progressed to endometrial carcinoma in 5～15 months after the treatment completed. The recurrent rate of the atypical hyperplasia was 33.3%. ③ Six women received assisted reproductive treatment, including ovulation induction with CC/CC＋HMG for 3～6 cycles. No dominant follicles developed in 5 cases and one gained singleton pregnancy at her sixth cycle. Four women underwent 5 IVF cycles （including one was treated previously with ovulation induction and failed to be conceived）. One of them developed tubal pregnancy and one spontaneous abortion. The other two are waiting for the transfer of frozen embryos. Conelusions Most women with endometrial atypical hyperplasia respond well to the high dosage of progestin. Assisted reproductive treatment should be considered as soon as the lesion regression achieves. Moreover. it should be an indication for IVF-ET.