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子宫内膜样癌及癌前病变孕激素治疗后的病理评估及其临床意义
子宫内膜样癌( endometrioid carcinoma, EC)及其癌前病变不典型增生( atypical endometrial hyperplasia, AEH)是子宫上皮性肿瘤中重要的病变,后者发生 EC 的风险高达40%,它们在形态上有谱系性,发生多与长期无拮抗的雌激素相关[1]。尽管子宫切除仍然是EC/AEH主要的治疗方法,但近年来,孕激素治疗作为有效的保守性措施,已越来越多地用于渴望保留子宫或不适宜接受放疗与手术治疗的患者,并被列入美国全国综合肿瘤网(NCCN)2014子宫肿瘤临床实践指南中[2]。
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多囊卵巢综合征患者子宫内膜异常增生的诊治
多囊卵巢综合征(PCOS)是常见的一类生殖内分泌异常,生育期女性发病率约为4%~12%.主要临床表现包括:月经不规律、闭经、高雄激素血症、稀发排卵或不排卵,不孕,其中75%病例有胰岛素抵抗、高胰岛素血症,50%病例黄体生成激素(LH)升高[1].
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子宫内膜去除术治疗子宫内膜不典型增生5例疗效观察
子宫内膜不典型增生(atypical endometrial hyperplasia,AEH)是子宫内膜增生过长的一种,属于子宫内膜癌前病变,临床上可引起月经过多,少数病例可以缓慢发展为癌.既往AEH的治疗,对年轻妇女多采用药物治疗,而对年龄较大者(如40岁以上者)则采用子宫切除手术.而有严重内科合并症如高血压和糖尿病等患者,手术风险大,治疗较为棘手.本文报道5例因各种原因无法实施子宫切除术,而采用宫腔镜下子宫内膜去除术(transcervical resection ofendometrium,TCRE)治疗AEH的初步体会.探讨对少数特殊AEH病例,以TCRE替代子宫切除术进行治疗的可行性和效果.
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Risk factors for atypical endometrial hyperplasia in infertile women:possible association with polycystic ovarv syndrome
Objective:Endometrial hyperplasia is considered as a precursor of endometrial carcinoma,in which oncogenic potential is low in hyperplasia without atypia,but high in a-typical hyperplasia.The objective of this study was to identify the risk factors for atypical endo-metrial hyperplasia in infertile women.Methods:Fifty four infertile women with endometrial hy-perplasia,which were selected from a large cohort of 2 098 women who desired for the future childbearing in our center,were diagnosed by hysteroscopy with directed biopsies or dilation and curettage(D&C),including 44 with hyperplasia without atypia,10 with atypical hyperplasia.Clinical characteristics were recorded in terms of age,body mass index(BMI),parity,insulin resistance,polycystic ovary syndrome(PCOS).Statistical comparison was made between women with hyperplasia without atypia and atypical hyperplasia.Logistic regression analysis Was em-ployed to assess the contribution of PCOS,obesity and insulin resistance to atypical hyperplasia.Results:The incidence of endometrial hyperplasia in infertile women Was 2.57%(54/2098),which included 1 0 women(0.48%)were diagnosed as atypical hyperplasia.PCOS in women with atypical hyperplasia(70%,7/10)was significantly higher than those of hyperplasia with-out atypia(27.27%,12/44).Stepwise regression analysis showed that PCOS contributed maximally to atypical endometrial hyperplasia in infertile women.Conclusion:PCOS is an independent risk factor for atypical endometrial hyperplasia in women with infertility.The infertile women with PCOS are at an increased risk for atypical endometrial hyperplasia and endometrial cancer.
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子宫内膜增生的病理学诊断研究进展
多年来,由于对子宫内膜增生的分类及命名不统一.给临床工作带来很大的困扰.病理诊断直接影响治疗方案的选择,这不仅要求病理医生提供准确、重复性高的诊断,而且临床医生和病理医生对所用的概念要达成共识,以利于进一步治疗.
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子宫内膜增生的内分泌治疗进展
子宫内膜增生治疗取决于增生的类型、患者的年龄、症状以及是否有生育要求,其中常考虑的两个因素足增生的类型和生育要求.治疗方案包括多种激素治疗和手术.既往子宫切除术是存在细胞异形型病例的主要治疗方法,而现在越来越多的研究更趋向寻求保守疗法.
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典型子宫内膜增生临床病例解析
病例1:患者徐××,38岁,因月经稀发5年,不规则出血1个月来诊.患者平素月经不规律,3~5 d/2~5个月,量中,无痛经.G<,3>P<,1>,10年前剖宫产一男婴,末次人流为5年前,工具避孕,未定期体检.
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新型避孕环对子宫内膜增生的治疗作用
子宫内膜组织增生是临床常见的一组病变,根据子宫内膜上皮细胞有无异型性分为:单纯性增生、复杂性增生和不典型增生.单纯增生和复杂增生属于良性病变,不典型增生属于癌前病变.