曼月乐联合高效价孕激素用于治疗保留生育功能的子宫内膜不典型增生的临床研究被引量：9

Clinical study on LNG-IUS combined with highly potent progesterone for fertility-preserving endometrial precancerous lesions

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摘要目的探讨左炔诺孕酮宫内释放系统(LNG-IUS/曼月乐)联合高效价孕激素用于治疗保留生育功能的子宫内膜不典型增生的效果(包括子宫内膜转归率、复发率、妊娠情况等)。方法收集病理确诊、年龄≤40岁且有保留生育功能要求的子宫内膜不典型增生患者60例,按照治疗方法分为3组,其中A组20例患者选用单纯左炔诺孕酮宫内释放系统(LNG-IUS/曼月乐)治疗,B组20例选用高效价孕激素治疗(醋酸甲地孕酮片/宜利治,160 mg/d,21 d/疗程,月经或者诊刮术后第5天开始),C组20例选用曼月乐联合高效价孕激素治疗。3组患者治疗期间每3个月进行一次宫腔镜检查加子宫内膜活检术(根据子宫内膜病理评估疗效),术后三次宫腔镜下子宫内膜病理转归后建议患者自然或者辅助生殖受孕,比较3组患者治疗有效率(完全缓解转归率)、复发率、妊娠结局等情况。结果3组患者保守治疗总体反应率(完全缓解率+部分缓解率)分别为70%、70%、95%,C组较A、B组差异有统计学意义(P<0.05);3组病理起效时间及病理完全缓解时间,A组(5.67±0.64)个月、(8.53±2.18)个月,B组(4.98±1.20)个月、(8.72±1.90)个月,C组(3.97±1.24)个月、(6.27±0.89)个月,C组较A、B组差异有统计学意义(P<0.05);3组术后妊娠结局差异无统计学意义(P>0.05)。结论曼月乐联合高效价孕激素治疗子宫内膜重度不典型增生可以明显提早子宫内膜逆转/缓解,为有生育要求患者提供更多时间及机会。 Objective To investigate the efficacy and safety of levonorgestrel intrauterine release system(LNG-IUS/Mirena)combined with highly-effective progesterone in the treatment of endometrial precancerous lesions with fertility preservation(including endometrial prognosis rate,recurrence rate,pregnancy status,etc.).Methods 60 patients with endometrial atypical hyperplasia diagnosed by pathology were enrolled in the study.And 60 patients were divided into three groups according to different treatment methods(n=20).In group A:patients were treated with levonorgestrel intrauterine release system(LNG-IUS,Levonorgestrel Intrauterine System);In group B:20 patients were treated with highly effective progesterone(Megesterone acetate tablets/Yilizhi);In group C:20 patients were treated with combination of Mirena with highly effective progesterone.Hysteroscopy and endometrial biopsy were performed every 3 months in three groups during the treatment(endometrial pathology was used to evaluate the curative effect).After three consecutive times of normal pathology,natural or assisted reproductive conception was recommended.The total effective rate(complete remission rate),recurrence rate,pregnancy rate and delivery rate of the three groups were compared.Results The total response rate of conservative treatment in three groups were respectively 70%,70%and 95%.There was statistical significance between the three groups.The onset time and pathological complete response time of the three groups were divided into three groups,group A(5.67±0.64)months,(8.53±2.18)months;group B(4.98±1.2)months,(8.72±1.9)months;group C(3.97±1.24)months,(6.27±0.89)months.The pathological results of endometrial biopsy showed that the rate of endometrial recovery/remission in group C was significantly higher than that in group A and group B,and the time of recovery/remission was significantly shorter than that in group A and group B(P<0.05).There was no significant difference in pregnancy outcome among the three groups(P>0.05).Conclusion Mirena combined with highly-effective progesterone can significantly improve the clinical efficacy of patients with severe atypical endometrial hyperplasia.Compared with the use of Mirena or highly effective progesterone separately,the combined treatment can significantly advance endometrial reversal/remission,and provide more time and opportunities for patients with fertility requirements.

作者陈贵芹王显冯燕宋琢爽 CHEN Guiqin;WANG Xian;FENG Yan;SONG Zuoshuang(Department of Gynaecology,Henan Provincial People’s Hospital,Zhengzhou 450000,China;Henan University of Science and Technology,Zhengzhou 450000,China)

机构地区河南省人民医院妇科河南科技大学

出处《宁夏医学杂志》 CAS 2019年第11期977-980,共4页 Ningxia Medical Journal

关键词子宫内膜癌前病变子宫内膜不典型增生左炔诺孕酮宫内释放系统曼月乐保留生育功能保守治疗 Endometrial precancerous lesions Endometrial atypical hyperplasia Intrauterine release system of levonorgestrel Mirena Reproductive function preservation Conservative treatment

分类号 R711.71 [医药卫生—妇产科学]

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1王永学,潘凌亚,黄惠芳,沈铿,郎景和.年轻子宫内膜癌患者孕激素保守治疗临床分析[J].中华肿瘤防治杂志,2011,18(7):541-544. 被引量：26

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