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学科主题: 临床医学
题名:
子宫内膜非典型增生患者保守治疗后妊娠结局分析
其他题名: Analysis of pregnancy outcome in women with endometrial atypical hyperplasia after conservative treatment
作者: ; 廖秦平; 杨慧霞; 左文莉; 张蕾; 毕蕙; 薛晴; 郐艳荣; 王晟
关键词: 子宫内膜增生 ; 药物疗法 ; 妊娠结局 ; Endometrial hyperplasia ; Drug therapy ; Pregnancy outcome
刊名: 中华围产医学杂志
发表日期: 2014
DOI: 10.3760/cma.j.issn.1007-9408.2014.09.003
卷: 17, 期:9, 页:585-589
收录类别: 中国科技核心期刊 ; 中文核心期刊
文章类型: Journal Article
摘要: 目的 探讨经保守治疗满意的子宫内膜非典型增生患者助孕后的妊娠结局. 方法 2009年3月1至2012年8月31日,4例子宫内膜非典型增生患者在北京大学第一医院生殖与遗传医疗中心治疗均获得妊娠,其中1例患者经历了2次妊娠.对这5例次妊娠进行分析.采用回顾性方法,记录患者妊娠前子宫内膜的病理结果、保守治疗方案、获得妊娠方式、妊娠期并发症、终止妊娠时间及分娩方式. 结果 4例患者分段诊刮术的病理诊断结果分别为:复杂性轻-中度非典型增生、复杂性中度非典型增生、复杂性非典型增生、广泛非典型增生伴子宫内膜上皮内瘤变.病例1、2和3均口服醋酸甲羟孕酮250 mg每天1次,持续时间分别为11、8和4个月.病例4口服醋酸甲地孕酮160 mg每天1次,持续8个月.停用孕激素前再次行分段诊刮术,病理证实未见子宫内膜非典型增生.病例1停用孕激素3个月后予卵泡刺激素促排卵妊娠(单胎).病例2和4均在停用孕激素当月,自然周期监测排卵妊娠(单胎).病例2的第1次妊娠于9周时胎停育,清宫术后6个月,自然周期监测排卵获得第2次妊娠(单胎).病例3予克罗米芬促排卵治疗2个周期失败后,再次因“阴道不规则出血”行分段诊刮术,病理结果为子宫内膜上皮内瘤变,改为口服醋酸甲地孕酮160 mg每天1次,持续8个月,然后行体外受精-胚胎移植妊娠(双胎),但于妊娠22+6周流产.病例1、2(第2次妊娠)和4均足月妊娠经剖宫产分娩.5例次妊娠中,1例次妊娠早期胎停育,1例次妊娠晚期流产,3例次足月妊娠,获得3个健康婴儿. 结论 子宫内膜非典型增生患者保守治疗满意后,经积极助孕,可以成功妊娠,并获得较好的妊娠结局.但妊娠期可能出现流产,应加强监护,及时发现并积极处理. Objective To determine the pregnancy outcome in women with endometrial atypical hyperplasia after conservative treatment.Methods From March 1,2009 to August 31,2012,four patients with endometrial atypical hyperplasia who had received satisfactory conservative therapy were treated in the Center of Reproduction and Genetics,Peking University First Hospital.All patients achieved clinical intrauterine pregnancies.One patient became pregnant twice.We reviewed the data of five pregnancies in these four patients.The data for each patient were recorded,including endometrium pathology diagnoses before pregnancy,fertilitysparing approaches,assisted reproductive technologies for conceiving,pregnancy complications,termination time of their pregnancies,the delivery mode and the postpartum status.Results All the patients underwent dilatation and curettage.The endometrium pathology diagnoses in each patient were complex mild-moderate atypical hyperplasia,complex moderate atypical hyperplasia,complex atypical hyperplasia and extensive atypical hyperplasia with endometrial intraepithelial neoplasia (EIN),respectively.Cases 1,2 and 3 received medroxyprogesterone acetate 250 mg/d for eleven,eight and four months,respectively.Case 4 received megestrol acetate 160 mg/d for eight months.Endometrial atypical hyperplasia was not found by dilatation and curettage after treatment.Case 1 achieved a singleton pregnancy following follicle stimulating hormone-induced ovulation three months after drug withdrawal.Case 2 and 4 achicvcd a singleton pregnancy by inspection ovulation the month after drug withdrawal.The first pregnancy in Case 2 resulted in embryo diapause at nine weeks of gestation,and the second singleton pregnancy by inspection ovulation occurred six months after curettage.Case 3 failed to conceive following clomiphene citrate-induced ovulation for two months.The patient underwent repeat dilatation and curettage due to abnormal uterine bleeding and was diagnosed with EIN.She was retreated with megestrol acetate 160 mg/d for eight months.The patient then received in vitro fertilization and embryo transfer and achieved a twin pregnancy,but aborted at 22+6 weeks.Case 1,2 (the second pregnancy) and 4 achieved full-term pregnancy.In five pregnancies,one case underwent embryo diapause in early pregnancy,one case underwent late pregnancy abortion,and three cases achieved full term pregnancies and three healthy infants.Conclusions Patients with endometrial atypical hyperplasia who receive conservative treatment can conceive successfully and have an optimistic pregnancy outcome after appropriate assisted reproductive technology.However,complications,such as abortion,are more common in these patients.Close monitoring is required during pregnancy to determine abnormal conditions and administer appropriate and timely treatment.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/46431
Appears in Collections:北京大学第一临床医学院_妇产科_期刊论文

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作者单位: 100034,北京大学第一医院生殖与遗传医疗中心

Recommended Citation:
尚,廖秦平,杨慧霞,等. 子宫内膜非典型增生患者保守治疗后妊娠结局分析[J]. 中华围产医学杂志,2014,17(9):585-589.
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