| Objective:Investigate the clinical effect,pregnancy status and influence of medroxyprogesterone acetate,mirena and GnRH-a combined with mirena in the treatment of endometrial atypical hyperplasia,and to provide clinical evidence for fertility preservation treatment of endometrial atypical hyperplasia.Methods:A total of 114 patients who were pathologically confirmed with endometrial atypical hyperplasia after hysteroscopic treatment in Linyi Central Hospital from January 2014 to December 2019 and strongly requested to preserve reproductive function were collected as the research objects.According to different treatment methods,they were divided into three groups: Group A: 38 patients were treated with medroxyprogesterone acetate250mg/d,and the treatment period was 3 months.Group B: 37 patients were treated with mirena intrauterine.Group C: 39 patients received subcutaneous injection of GnRH-a(1injection every 28 days,3 times in total),while Levonorgestrelreleasing intrauterine system(LNG-IUS)was placed intrauterine.Every three months for a treatment cycle,the clinicopathological data of patients were collected,the prognosis of patients(clinical efficacy,endometrial thickness,menstruation,adverse reactions)and pregnancy were followed up,in order to evaluate the effect of treatment,pregnancy and quality of life.Results:1.PBAC scores of menstrual volume before treatment in the three groups were135.41±26.27,131.59±25.41 and 127.25±24.39,without significant difference(P>0.05);PBAC score of menstrual volume after 3 months of treatment was significantly lower than that before treatment,with statistical significance(P<0.05).PBAC scores of the three groups after 12 months of treatment were 39.24±8.93,36.42±7.94 and 29.12±7.22,and group C was lower than group A and B,the difference was statistically significant(P<0.05).2.Endometrial thickness(mm)before treatment was 19.10±5.17,18.89±4.74,17.69±4.57 in the three groups,without significant difference(P>0.05);Endometrial thickness of 12 months after treatment was thinner than that before treatment,with statistical significance(P<0.05).After 12 months of treatment,the endometrial thickness(mm)of the three groups were 5.18±2.06,4.38±2.21,3.75±1.78,group C was significantly lower than that of group A and B,with statistical significance(P<0.05).3.The efficiency of the three groups were 55.26%;45.95% and 58.97% at 3 months,73.68%,54.05% and 74.36% at 6 months;Compared with group B,group A and C were higher,but the difference was not statistically significant(P>0.05).After 12 months of treatment,the efficiency was 84.21%,64.86% and 89.74%.Compared with group B,group A and C were higher,and the difference was statistically significant(P<0.05).4.The cases of complete remission were 9(23.68%),8(21.62%)and 11(28.21%)in the three groups after 3 months of treatment;The cases of complete remission at 6 months were 17(44.74%),15(40.54%)and 23(58.97%).The rate of complete remission in group C was higher than that in group A and B,but there was no significant difference(P>0.05).After 12 months of treatment,the cases of complete remission were 24(63.15%),20(54.05%)and 34(87.17%),The complete remission rate in group C was higher than that in group A and B,and the difference was statistically significant(P<0.05).5.During follow-up,the number of cancerous cases in the three groups was 4(10.53%),3(8.11%)and 0(0%).The canceration rate in group C was lower than that in group A and B,and the difference was not statistically significant(P>0.05).The number of recurrence cases was 8(21.05%),1(2.70%)and 1(2.56%).The recurrence rate of group B and C were lower than that of group A,and the difference was statistically significant(P<0.05).6.6.During the follow-up period of patients in the three groups,the number of cases with recent pregnancy intention after complete remission was 24,20,25;Among them,51cases(73.91%)chose assisted reproductive technology and 18 cases(26.09%)chose natural pregnancy.The number of pregnancy cases were 8(33.33%),7(35.0%)and 10(40.0%),respectively,and there was no statistical significance among the three groups(P>0.05).7.Comparison of pregnancy-related factors of patients,the combination of polycystic ovary syndrome and infertility history were not the factors affecting pregnancy after reversal(P>0.05);The age of patients ≥35 years old,combined with obesity,diabetes /IR affected the pregnancy rate of patients(P<0.05);The pregnancy rate using assisted reproductive technology was higher than that of natural pregnancy(43.14%vs.16.67%,P<0.05).8.Before treatment,the mean quality of life of all dimensions in three groups were59.84±9.14,60.15±7.74,61.25±8.26,without significant difference(P>0.05);After treatment,the average quality of life of all dimensions was significantly higher than before,the difference was statistically significant(P<0.05).After treatment,there was no significant difference in quality of life score of all dimensions among 3 groups(P>0.05).9.The incidence of adverse reactions in the three groups: the number of patients with abnormal uterine bleeding was 11(28.95%),9(10.81%)and 2(5.13%).The number of patients in group C was less than that in group A and B,and the difference was statistically significant(P<0.05).There were 5(13.16%),2(5.41%)and 4(10.26%)cases of hormone-related adverse reactions,such as hot flashes,nausea and weight gain,and there was no significant difference among the three groups(P > 0.05).There were 7(18.42%)patients with abnormal liver function in group A,0 in group B and 1(2.56%)in group C,and the difference was statistically significant(P<0.05).There were 5 cases of IUD descent in group B and no IUD descent in group C,and group B was higher than group C,the difference was statistically significant(P<0.05).There was no thrombosis in the three groups.The total number of adverse reactions in the three groups were 14(36.84%),13(35.14%)and 5(12.82%),and group C was lower than group A and B,the difference was statistically significant(P<0.05).Conclusion:1.Both oral progesterone and mirena can effectively treat endometrial atypical hyperplasia.2.GnRH-a combined with mirena in the treatment of endometrial atypical hyperplasia has higher effective rate and complete response rate,lower recurrence rate and lower incidence of side effects,which is an effective treatment option for young patients who have not yet given birth.3.Age≥35 years,obesity,diabetes mellitus and insulin resistance(IR)can reduce the pregnancy rate.During the follow-up period,the weight should be actively controlled to improve insulin resistance and control blood glucose.4.The application of assisted reproductive technology can obviously improve the pregnancy rate,and patients can choose assisted reproductive technology as soon as possible after the reversal of lesions. |
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