本文選題：子宮內(nèi)膜癌 + 孕激素��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景：子宮內(nèi)膜癌(endometrial carcinoma，EC)是常見(jiàn)的女性生殖系統(tǒng)惡性腫瘤之一，近年來(lái)子宮內(nèi)膜癌的發(fā)病率有升高趨勢(shì)，其中年輕患者的發(fā)病率增長(zhǎng)迅速。I期子宮內(nèi)膜癌的傳統(tǒng)治療方案是全子宮雙附件切除術(shù)，必要時(shí)行盆腹腔淋巴結(jié)切除術(shù)，然而，許多尚未生育的年輕患者常強(qiáng)烈要求保留生育功能。近年來(lái)孕激素在年輕早期患者保留生育功能中的治療作用已得到肯定，但是對(duì)于孕激素治療的安全性、有效性等問(wèn)題未達(dá)成共識(shí)。 目的：利用Meta分析的方法，對(duì)年輕早期子宮內(nèi)膜癌患者孕激素治療的安全性、有效性、妊娠時(shí)機(jī)及生育后治療等問(wèn)題進(jìn)行分析，以期對(duì)子宮內(nèi)膜癌保留生育功能治療提供一定的參考依據(jù)。 方法：通過(guò)計(jì)算機(jī)檢索Pubmed數(shù)據(jù)庫(kù)、Medline數(shù)據(jù)庫(kù)、OVID數(shù)據(jù)庫(kù)、Science Direct數(shù)據(jù)庫(kù)、Cochrane Library數(shù)據(jù)庫(kù)、中國(guó)知網(wǎng)(CNKI)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、萬(wàn)方數(shù)據(jù)庫(kù)等。收集所有關(guān)于40歲以下IA期高分化子宮內(nèi)膜癌應(yīng)用孕激素治療的文獻(xiàn)，檢索語(yǔ)言限于中文和英文，檢索時(shí)間不限。納入原始研究資料，進(jìn)行資料提取并核對(duì)，剔除不符合納入標(biāo)準(zhǔn)的文獻(xiàn)，并利用R軟件（R2.13.1）做單個(gè)樣本率的Meta分析，，對(duì)疾病的完全緩解率、復(fù)發(fā)率以及治療后孕產(chǎn)情況進(jìn)行分析。 結(jié)果:根據(jù)上述檢索方法，按照嚴(yán)格的納入排除標(biāo)準(zhǔn)進(jìn)行篩選，最后共有10篇文獻(xiàn)入選，共有391例患者，提取相關(guān)資料行進(jìn)行統(tǒng)計(jì)分析。結(jié)果示:孕激素治療的總完全緩解率57.07%，CI [0.5111;0.6282]，總的復(fù)發(fā)率35.37%，CI[0.2786;0.4367]，總的妊娠率36.19%，CI [0.3046;0.4234]，總的分娩率34.22%，CI [0.2819;0.4081]。從入選的資料完整的6篇文獻(xiàn)中，提取完全緩解后復(fù)發(fā)及治療無(wú)效后接受手術(shù)治療的患者資料，分析孕激素治療后的疾病結(jié)局，結(jié)果示：中位隨訪39.5個(gè)月，34例接受手術(shù)的患者，5.88%（2/34）出現(xiàn)疾病進(jìn)展，97.06%（33/34）的患者無(wú)瘤生存，僅2.94%（1/34）的患者術(shù)后復(fù)發(fā)。 結(jié)論 1.年輕早期子宮內(nèi)膜癌孕激素治療的總完全緩解率57.07%，總的復(fù)發(fā)率35.37%，且完全緩解后復(fù)發(fā)以及治療無(wú)效的患者在接受全面分期手術(shù)后，其預(yù)后較直接手術(shù)患者的預(yù)后無(wú)明顯差異，表明孕激素治療是安全可行的。 2.孕激素保留生育功能治療的總?cè)焉锫?6.19%，總分娩率34.22%，表明孕激素在子宮內(nèi)膜癌患者保留生育功能治療是有效的。 3.完成孕激素治療后積極應(yīng)用輔助生殖技術(shù)有望提高妊娠率及分娩率。 4.保守性手術(shù)（如宮腔鏡手術(shù)）聯(lián)合孕激素治療較單純應(yīng)用孕激素治療安全，妊娠率高。 5.完成生育后應(yīng)進(jìn)行全面分期手術(shù)，未手術(shù)者需密切隨訪，定期宮腔鏡下診刮監(jiān)測(cè)內(nèi)膜情況。
[Abstract]:Background: endometrial carcinoma (EC) is one of the most common malignant tumors in the female reproductive system. The incidence of endometrial carcinoma has been increasing in recent years. Among them, the traditional treatment for stage I endometrial cancer in young patients with rapidly growing incidence is total hysterectomy and pelvic lymphadenectomy, where necessary. However, Many young patients who have not yet given birth often urge retention of fertility. In recent years, the therapeutic effect of progesterone on the retention of reproductive function in young and early stage patients has been affirmed, but there is no consensus on the safety and effectiveness of progesterone therapy. Objective: to analyze the safety, efficacy, timing of pregnancy and postnatal treatment of progesterone in young early endometrial carcinoma patients by Meta analysis. In order to provide a certain reference for the treatment of endometrial carcinoma reserved fertility function. Methods: the Pubmed database, Medline database, Direct database, Cochrane Library database, Chinese biomedical literature database and Wanfang database were searched by computer. To collect all the literature on the treatment of highly differentiated endometrial carcinoma under 40 years of age with progesterone. The search languages are limited to Chinese and English, and the search time is unlimited. The original research data were collected and checked, and the documents that did not meet the inclusion criteria were eliminated. The Meta analysis of single sample rate was made by using R software R2.13.1. the complete remission rate, recurrence rate and pregnant and parturient status after treatment were analyzed. Results: according to the above search method, according to the strict inclusion exclusion criteria, 10 articles were selected, 391 patients were selected, and the relevant data were extracted for statistical analysis. The results showed that the total complete remission rate of progesterone treatment was 57.07 CI [0.5111 鹵0.6282], the total recurrence rate was 35.37g CI [0.2786 鹵0.4367], the total pregnancy rate was 36.19CI [0.30460.0.4234], the total delivery rate was 34.22g CI [0.28190.4081]. The data of patients with relapse after complete remission and those who received surgical treatment after complete remission and ineffective treatment were extracted from 6 articles of complete data, and the outcome of the disease after progesterone therapy was analyzed. The results showed that 34 patients with operation were followed up for a median of 39.5 months (5.88 / 34) with disease progression 97.06% 33 / 34), and only 2.94% (1 / 34) recurred after operation. Conclusion 1. The total complete remission rate was 57.07 and the total recurrence rate was 35.37 in the young early stage endometrial carcinoma treated with progesterone. The prognosis of the patients with relapse after complete remission and ineffective treatment was not significantly different from that of the patients undergoing direct operation. It shows that progesterone therapy is safe and feasible. 2. The total pregnancy rate and delivery rate were 36.19 and 34.222.The results indicated that progesterone was effective in the treatment of endometrial carcinoma. 3. Positive application of assisted reproductive technology after progesterone therapy is expected to increase pregnancy rate and delivery rate. 4. Conservative surgery (such as hysteroscopic surgery) combined with progesterone therapy is more safe than the use of progesterone alone, the pregnancy rate is high. 5. The patients without operation should be followed up closely and the endometrium should be monitored by hysteroscopic curettage.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

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