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目的探讨宫腔镜下子宫内膜电切术(transcervica resection of endometrium,TCRE)联合高效孕激素治疗子宫内膜非典型增生的疗效。方法回顾性分析新疆医科大学第一附属医院2000年1月—2010年10月28例因子宫内膜非典型增生行TCRE术患者的临床资料,并对预后及子宫内膜转归情况进行随访。结果 26例患者均一次手术顺利,2例患者因术中怀疑内膜癌变,病理确诊为重度非典型增生后3个月行TCRE,28例患者均无严重并发症发生,术后月经及贫血均得到明显改善,总有效率为92.86%。术后1年1例患者因工作调动失访,术后2年1例患者因车祸死亡。术后6月28例患者好转率为100%(28/28);术后1年好转率为85.71%(25/28),复发率为14.29%(3/28),癌变率为0;术后2年好转率为80.76%(21/26),复发率为19.23%(5/26),癌变率为0;术后3年好转率为85%(17/20),复发率为10%(2/20),癌变率为5%(1/20);术后4年好转率为72.22%(13/18),复发率为16.67%(3/18),癌变率为11.11%(2/18)。结论对有随访条件的患者,TCRE术联合孕激素是治疗子宫内膜非典型增生的有效手段。
Objective To investigate the effect of hysteroscopic endoscopic resection of endometrium (TCRE) combined with high-effective progestin on atypical hyperplasia of the endometrium. Methods The clinical data of 28 patients with TCRE due to endometrial atypical hyperplasia from January 2000 to October 2010 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The prognosis and the outcome of endometrium were followed up. Results Twenty-six patients underwent a successful operation. Two patients were diagnosed as having endometrial carcinomatosis due to intraoperative and pathological diagnosis of TCRE. The TCRE was performed 3 months after severe atypical hyperplasia. No serious complication occurred in 28 patients, and postoperative menstruation and anemia Obvious improvement, the total effective rate was 92.86%. One patient was lost to follow-up after 1 year of operation. One patient died of a car accident after 2 years. The rate of improvement in one year was 85.71% (25/28), the recurrence rate was 14.29% (3/28) and the rate of canceration was 0% in 28 cases (28/28) After 2 years of improvement rate was 80.76% (21/26), the recurrence rate was 19.23% (5/26), the rate of canceration was 0; 3 years after the improvement rate of 85% (17/20), the recurrence rate was 10% (2/20), the rate of canceration was 5% (1/20), the rate of 4-year improvement was 72.22% (13/18), the recurrence rate was 16.67% (3/18) / 18). Conclusion For patients with follow-up conditions, TCRE combined with progestin is an effective treatment of atypical hyperplasia of the endometrium.