医学
宫内节育器
宫腔镜检查
左炔诺孕酮
子宫内膜癌
回顾性队列研究
妇科
保持生育能力
子宫内膜增生
人口
产科
子宫内膜
外科
癌症
生育率
计划生育
内科学
环境卫生
研究方法
作者
Pierluigi Giampaolino,Attilio Di Spiezio Sardo,Antonio Mollo,Antonio Raffone,Antonio Travaglino,Antonio Boccellino,Brunella Zizolfi,Luigi Insabato,Fulvio Zullo,Giuseppe De Placido,Giuseppe Bifulco
标识
DOI:10.1016/j.jmig.2018.07.001
摘要
Study Objective To evaluate safety and effectiveness of the combination of hysteroscopic endometrial focal resection with levonorgestrel-releasing intrauterine device (LNG-IUD) for International Federation of Gynecology and Obstetrics stage IA G1 early endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) in young women to preserve their fertility. Design Retrospective case series (Canadian Task Force classification II-3). Setting University Federico II, Naples, Italy. Patients The medical records of 69 consecutive patients treated from 2007 to 2017 with diagnosis of EEC (n = 14) or AEH (n = 55) meeting inclusion criteria were reviewed. Interventions Patients with focal EEC were treated by hysteroscopic resection of the lesion according to Mazzon's technique; patients with AEH were treated by superficial endometrial resection, preserving the basal layer of the endometrium. An LNG-IUD was inserted in all patients after surgery. Patients were followed for 24 months with serial hysteroscopic biopsies. Measurements and Main Results Rates of response, live birth, and recurrence were assessed. Of the 14 patients with EEC, 11 (78.6%) achieved a complete response, 2 (18.2%) of whom had subsequent relapse, 1 (7.1%) showed partial response, whereas 2 (14.3%) were nonresponders (1 stable disease and 1 progression). Of the 55 patients with AEH, 51 (92.7%) achieved a complete response, 2 (3.9%) of whom had subsequent relapse, 3 (5.5%) showed partial response, whereas only 1 (1.8%) was nonresponder with stable disease. Among 25 patients who had removed the LNG-IUD, 10 (40%) gave birth after natural conception in the last 12 months of follow-up. Conclusion The combination of hysteroscopic resection with an LNG-IUD as fertility-sparing treatment of EEC and AEH showed similar response and live birth rates compared with those reported in literature for progestins alone, but with considerably lower relapse rate. We advocate the use of this combined approach as an alternative fertility-sparing option in patients with ECC and AEH.
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