摘要
目的探讨不孕症合并子宫内膜非典型增生(AEH)及早期高分化子宫内膜样腺癌(EC)药物保守治疗后体外受精(IVF)助孕时机、疗效及安全性。方法回顾性分析本中心不孕症合并AEH及EC保守治疗后行IVF助孕患者的临床资料,根据患者首次子宫内膜病理证实病变完全消退(CR)后开始IVF助孕时间分为≤3个月组(A组,n=35)和>3个月组(B组,n=25),比较组间患者的临床结局。结果共纳入60例患者,AEH患者45例,EC患者15例,首次CR后随访时间(39.6±26.9)个月。共行95个取卵周期,新鲜胚胎移植(IVF-ET)67个周期,周期妊娠率为38.8%(26/67),冻融胚胎移植(FET)54个周期,周期妊娠率为25.9%(14/54)。共有36例患者妊娠47次,25例患者分娩32个活婴。患者IVF-ET周期妊娠率及FET周期妊娠率组间比较差异均无统计学意义,而B组复发率(48.0%)明显高于A组(17.1%,P=0.022)。多因素分析显示仅IVF助孕时间与复发有关(P=0.002,OR=1.078,95%CI=1.027~1.132)。随访期间总复发率为30.0%(18/60),无疾病进展及死亡不良事件。结论不孕症合并AEH及早期EC患者药物保守治疗后IVF助孕是相对安全有效的,复发与首次CR后IVF助孕时间有关,为降低复发宜尽早行IVF助孕。
Objective To investigate the timing, efficacy and safety of in vitro fertilization（IVF） in infertility patients with conservative treatment of atypical endometrium hyperplasia（AEH） and early well-differentiated endometrial adenocarcinoma（EC）. Methods The clinical data of infertility patients with conservative treatment of AEH and early high differentiation EC, who underwent IVF treatment were retrospectively analyzed according to the time to start IVF after endometrial pathology confirmed that the lesion completely response（CR）, the patients were divided into ≤ 3 months（group A, n=35） and 3 months（group B, n=25）. The clinical outcomes of the two groups were compared. Results A total of 60 patients were included, 45 with AEH and 15 with EC. The follow-up time from the first time to achieve CR was（39.6±26.9） months. Totally 95 IVF cycles were performed, including 67 fresh embryo transfer cycles, the rate of pregnancy per cycle was 38.8%（26/67）, and 54 frozen-thawed embryo transfer（FET） cycles, the rate of pregnancy per cycle was 25.9%（14/54）. A total of 36 patients were pregnant 47 times, 25 patients delivered 32 live births. There were no statistical differences in the IVF-ET cycle pregnancy rate and FET cycle pregnancy rate between the two groups, and the recurrence rate was significantly higher in group B（48.0%） than in group A（17.1%, P=0.022）, with a statistical significance. Multifactorial analysis showed that only the time of IVF treatment after the first CR was related to recurrence（P=0.002, OR=1.078, 95% CI=1.027-1.132）. The total recurrence rate was 30.0%（18/60） during the follow-up period, with no disease progression and adverse events. Conclusion Infertility patients with conservative treatment of AEH and early well-differentiated EC undergoing IVF treatment is relatively safe and effective. Recurrence is associated with the time of IVF treatment after the first time to achieve complete response, in order to reduce recurrence, IVF should be used as soon as possible.
作者
杜晓果
宋雪凌
李蓉
李红真
乔杰
Song Xueling;Li Rong;Li Hongzhen;Qiao Jie(Reproductive Medical Center,Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2018年第9期741-747,共7页
Chinese Journal of Reproduction and Contraception
