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目的:探讨PCOS合并胰岛素抵抗的子宫内膜癌早期及癌前患者采用屈螺酮炔雌醇联合二甲双胍药物转化治疗的疗效。方法:回顾分析2010年至2015年济宁市第一人民医院、汶上县人民医院收治的接受屈螺酮炔雌醇联合二甲双胍治疗的30例胰岛素抵抗型PCOS的子宫内膜癌前及癌早期病变患者的临床资料。其中采用高效孕激素治疗失败者16例,首次确诊者14例。30例患者中,诊刮病理为子宫内膜癌前病变者20例,子宫内膜样腺癌高分化G1级者10例。治疗前对患者进行全面分期评估,治疗后每3个月诊刮以评价疗效,对有生育要求者随访其生育情况。结果:30例(100%)患者治疗3~6个月后均获得完全缓解。2例(6.7%)复发。有生育要求的13例患者中,6例(46.2%)成功妊娠。结论:对PCOS合并胰岛素抵抗要求保留子宫的子宫内膜样腺癌早期及子宫内膜不典型增生的患者,采用屈螺酮炔雌醇联合二甲双胍的治疗效果高于单一孕激素。
Objective: To investigate the efficacy of drospirenone ethinyl estradiol combined with metformin in PCOS patients with early-stage and precancerous endometrial cancer with insulin resistance. Methods: A retrospective analysis of 30 cases of insulin resistant PCOS treated with drospirenone ethinyl estradiol and metformin treated in Jining First People’s Hospital and Wenshang County People’s Hospital from 2010 to 2015 was retrospectively analyzed. The patient’s clinical data. Among them, 16 cases were failed with high-efficiency progestin and 14 cases were first diagnosed. Among the 30 patients, 20 cases of endometrial precancerous lesions and 10 cases of endometrioid adenocarcinoma with well-differentiated G1 grade. Patients before treatment for a comprehensive staging evaluation, curettage every 3 months to evaluate the efficacy of treatment, reproductive requirements were followed up their childbearing conditions. Results: Thirty (100%) patients achieved complete remission after 3 to 6 months of treatment. Two patients (6.7%) relapsed. Of the 13 patients with fertility requirements, 6 (46.2%) had successful pregnancies. CONCLUSIONS: In patients with PCOS with insulin resistance requiring uterine endometrial adenocarcinoma and endometrial dysplasia, treatment with drospirenone ethinyl estradiol combined with metformin is superior to single progestin.