- 作者：Patrizia De Marzi ; MD ; demarzi.patrizia@hsr.it" class="auth_mail" title="E-mail the corresponding author ; Alice Bergamini ; MD ; Stefania Luchini ; MD ; Micaela Petrone ; MD ; Gian Luca Taccagni ; MD ; Giorgia Mangili ; MD ; Gabriella Colombo ; MD ; Massimo Candiani ; MD
- 关键词：Asherman syndrome ; Atypical complex hyperplasia ; Endometrial cancer ; Fertility-sparing surgery ; Intrauterine adhesions
- 刊名：Journal of Minimally Invasive Gynecology
- 出版年：2015
- 出版时间：November-December 2015
- 年：2015
- 卷：22
- 期：7
- 页码：1178-1182
- 全文大小：359 K
Design
Observational retrospective study.
Setting
Patients affected by endometrial atypical hyperplasia of the endometrium or early stage endometrial carcinoma.
Patients
Twenty-three patients, up to 45 years of age.
Intervention
Conservative treatment based on hysteroscopic resection of hyperplastic and/or cancer areas and subsequent therapy with megestrol acetate 160 mg/day.
Methods and Main Results
Approximately 5% of endometrial cancers (ECs) are diagnosed in women younger than 40 years old, usually with a good prognosis. From 2010 to 2014, 23 patients, up to age 45 years, who were affected by endometrial cancer (EC) grade 1 or atypical complex hyperplasia (ACH) and who wished to preserve fertility, underwent conservative treatment based on hysteroscopic resection of the hyperplastic and/or cancer areas and subsequent therapy with megestrol acetate 160 mg/day. Data with regard to age, body mass index, symptoms, history of infertility, and previous assisted reproductive technologies attempts, obstetrics history, previous diagnosis of intrauterine sinechiae, hysteroscopic findings, duration of therapy, follow-up reports, and reproductive outcomes were collected and analyzed. Of the 23 patients enrolled in the study, 3 patients (13%) presented with an endometrioid EC grade 1, and 20 patients (87%) had ACH. Twelve patients (52.2%) had complete remission after 3 months of progestin therapy, 9 patients (39.1%) had a complete remission after 6 months, and 2 (8.7%) patients had remission after 9 months. Six patients underwent a second hysteroscopic resection. The 3 patients with an initial diagnosis of EC had complete remission after a mean of 4 months of high-dose progestin therapy; in patients with ACH, remission occurred after a mean of 3 months. In all patients, intrauterine adhesions were not detected at any follow-up diagnostic hysteroscopy. After a median follow-up time of 25 months (range 8–37), we registered 1 (4.3%) relapse of disease. A total of 7 pregnancies in 6 patients were counted, after an average time of 7.4 months (range 3–13 months) after the end of progestin therapy.
Conclusions
Hysteroscopic resection of hyperplastic and/or cancer areas before high dosage progestin therapy seems to be a safe and effective approach in the management of ACH and in patients with early EC who wish to preserve fertility.