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目的评价孕激素治疗40岁以下高分化、早期子宫内膜腺癌患者的有效性和安全性。方法回顾性分析复旦大学附属肿瘤医院1996年至2004年以孕激素治疗作为初次治疗的6例40岁以下的高分化、早期子宫内膜腺癌患者的临床病理资料;同时检索近10年的国内外相关研究报道,发现相关病例56例,对以上两组资料进行综合分析。结果本组6例患者中,4例孕激素治疗有效,2例无效者行手术治疗。4例有效者中,2例分别于治疗后10个月和12个月出现复发而行手术治疗,故共有4例行子宫切除术,术后病理检查均未发现子宫外转移。6例患者随访至今均无瘤生存。文献报道的56例患者中,46例孕激素治疗有效,其中11例复发者中7例再次采用孕激素治疗,且5例再次获得完全缓解。此56例中,共有16例行手术治疗,15例无瘤生存,1例术后出现盆腔复发。本组6例患者治疗后无妊娠和分娩;文献报道的56例患者中,共有41次妊娠,并分娩40个婴儿,其中双胎4例,三胎2例。结论孕激素治疗40岁以下高分化、早期子宫内膜腺癌我们的经验尚少,虽难作评价,但国内外文献报道是安全可行的,并可达到妊娠和分娩的目的。
Objective To evaluate the effectiveness and safety of progestin in patients with well-differentiated and early endometrial adenocarcinoma under 40 years of age. Methods The clinical and pathological data of 6 patients with well-differentiated and early endometrial adenocarcinoma under 40 years old treated with progestin as primary treatment from 1996 to 2004 were retrospectively analyzed. At the same time, Foreign related research reports, found 56 cases of related cases, a comprehensive analysis of the above two sets of data. Results 6 patients in this group, 4 cases of progesterone treatment is effective, 2 cases were ineffective surgical treatment. Four of the four patients were effective, and two of them were treated by surgery after 10 months and 12 months respectively. Therefore, a total of 4 cases underwent hysterectomy, and no extrauterine metastasis was found after pathological examination. Six patients had no tumor after follow-up. Of the 56 patients reported in the literature, 46 were effective progesterone treatment, of whom 7 of the 11 relapsed patients were again treated with progestin, and 5 patients achieved complete remission again. Of the 56 cases, a total of 16 patients underwent surgical treatment, 15 had no tumor-free survival and 1 had recurrent pelvic recurrence. The group of 6 patients after treatment, no pregnancy and childbirth; reported in the literature of 56 patients, a total of 41 pregnancies and 40 babies were delivered, of which 4 were twins and 3 were 2. Conclusions Progesterone treatment of 40 years of well-differentiated, early endometrial adenocarcinoma of our experience is still small, although difficult to evaluate, but the domestic and foreign literature is safe and feasible, and can achieve the purpose of pregnancy and childbirth.