Analysis Of Factors Related To Conservative Treatment Of Endometrial Hyperplasia And Delivery Outcome

BackgroundEndometrial hyperplasia is a kind of non-physiological and non-invasive endometrial hyperplasia,which can cause changes in the size and shape of glands and the ratio of glands to stroma(>1:1),resulting in an increase in the endometrium,belonging to Precancerous lesions of endometrial cancer.Different types and degrees of endometrial hyperplasia have different risks of eventually developing into endometrial cancer.Accurate diagnosis and effective treatment can reduce the risk of endometrial hyperplasia transforming into endometrial cancer.Endometrial cancer is one of the three common gynecological tumors.According to the 2014 China Cancer Registry Annual Report of the National Cancer Center,the incidence rate of uterine cancer,which is mainly endometrial cancer,is 961/10,000,ranking 9th among female malignant tumors.Bit.In the past,high-efficiency progesterone therapy and hysterectomy were the standard treatments for patients with endometrial hyperplasia,but the specific regimen and dosage of progesterone therapy have not yet been unified.After hysterectomy,the fertility of patients with fertility requirements is deprived and the patient The quality of life has had a serious impact,contrary to the wishes of patients who still have fertility requirements.In recent years,young patients have become more common in endometrial hyperplasia,and because of the general increase in the age of marriage and childbirth in society,women suffering from endometrial hyperplasia have more and more needs for retaining fertility.Therefore,high-efficiency progesterone and levonorgestrel intrauterine sustained-release system rings have gradually increased in clinical applications.PurposeIn-depth discussion of the best and effective treatment methods for endometrial hyperplasia,and analysis of the factors related to the efficacy of conservative treatment and delivery outcome in patients with endometrial hyperplasia have important clinical research significance.This study analyzed the efficacy of the levonorgestrel intrauterine sustained-release system ring and high-potency progesterone in the treatment of endometrial hyperplasia,and analyzed the related factors influencing complete remission,recurrence,and smooth delivery.Hopefully,endometrial hyperplasia Conservative treatment of disease provides a more accurate and effective treatment plan.MethodsThis study collected 109 patients diagnosed with endometrial hyperplasia in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2016.Among them,58 cases of endometrial hyperplasia without dysplasia and endometrial atypical hyperplasia were collected.51 cases of hyperplasia were analyzed retrospectively.The main complaints of patients are mostly prolonged menstrual period,irregular menstruation,inexhaustible dripping or infertility.The follow-up period ended in January 2019.The levonorgestrel intrauterine sustained-release system ring was placed 3 to 7 days after diagnostic curettage,and progesterone was taken orally(megestrol 80 mg/d to 160 mg/d).Patients with insulin resistance or abnormal glucose metabolism were also given oral metformin.Statistics of relevant clinical data of patients:age,menstrual abnormalities,Body Mass Index(BMI),history of infertility,polycystic ovary syndrome(PCOS),insulin resistance,treatment plan,post-treatment efficacy,time to complete remission,Recurrence and smooth delivery.After the patient started conservative treatment,patients with endometrial dysplasia and patients with endometrial hyperplasia without dysplasia should undergo an endometrial biopsy every 6 months to evaluate endometrial reversal.After treatment,it is divided into complete remission,partial remission,stable disease,disease progression,and relapse according to the histopathological response.After the patient’s endometrial reversal reaches complete remission,treatment is continued until the endometrial biopsy is negative for two consecutive times.If the patient is not completely relieved or the disease is stable or the disease progresses after 12 months of treatment,the patient and his family should be informed of the current treatment status and the risk of continued conservative treatment or surgical treatment,and follow the patient’s wishes for follow-up treatment.Patients who relapse after complete remission can be treated surgically for patients with endometrial dysplasia according to pathological classification,and patients with endometrial hyperplasia without dysplasia can be treated with surgery or a second conservative treatment after evaluation according to the patient’s wishes.Patients with endometrial dysplasia who are completely relieved after conservative treatment are recommended to remove the uterus after completing the pregnancy.All conservatively treated patients,even if they achieve complete remission for a long time,should be followed up regularly for 1-2 years to prevent recurrence.Resultsl.The general clinical data of 109 patients with conservative treatment of endometrial hyperplasia in this study showed that the two groups of endometrial hyperplasia without dysplasia and endometrial hyperplasia without dysplasia were in age,BMI,history of infertility,There were no statistically significant differences in menstrual abnormalities,insulin resistance,polycystic ovary syndrome,treatment methods,treatment effects,time to complete remission,recurrence,and fertility(P>0.05).In the endometrial hyperplasia without dysplasia group,25 patients were given high-efficiency progesterone and 33 patients with levonorgestrel sustained-release intrauterine system.In the endometrial dysplasia group,29 patients were given high-efficiency progesterone and levonorgestrel.There was no significant difference in treatment methods in 22 cases of intrauterine slow-release system(P>0.05).In the endometrial hyperplasia without dysplasia group,51 patients had complete remission,38 patients had complete remission time ≤6 months,and 13 patients had complete remission time>6 months;39 patients in endometrial dysplasia group had complete remission,and complete remission time 27 cases were ≤6 months,and 12 cases had complete remission time>6 months.There was no significant difference in complete remission rate and remission time between the two groups(P>0.05),and both were higher than 70%.2.Among the 109 conservatively treated endometrial hyperplasia patients in this study,90 patients were in complete remission,of which 81 patients did not relapse after complete remission.The median time for complete remission was 6 months(3 to 12 months).Among them,65 patients achieved complete remission within 6 months,and 25 patients achieved complete remission after 6 months of treatment.19 patients with incomplete remission after 12 months of treatment,of which 5 patients with endometrial dysplasia achieved partial remission,5 patients with endometrial dysplasia and 6 patients with endometrial hyperplasia without dysplasia Histopathological examination of the endometrium was unchanged before treatment.One case of endometrial hyperplasia without dysplasia developed into endometrial dysplasia,and 2 cases of endometrial atypical hyperplasia.Histopathology progressed to early endometrial cancer.The 19 patients mentioned above all underwent laparoscopic hysterectomy.The results of univariate analysis and logistic regression showed that the use of levonorgestrel intrauterine sustained-release system ring and BMI<30kg/m2 were superior factors for complete remission.3.Nine of the 90 patients with complete remission relapsed,including 3 cases of endometrial hyperplasia without dysplasia,and 6 cases of endometrial dysplasia.The recurrence time is 6-24 months after complete remission.Among the relapsed patients,3 patients with endometrial hyperplasia without dysplasia still chose conservative treatment,and all resolved again after 6 months of treatment;all 6 patients with endometrial dysplasia were treated surgically,and the pathology after surgery showed that they were all uterines.Intimal dysplasia.According to univariate analysis and logistic regression results,the use of levonorgestrel intrauterine sustained-release system ring and BMI<30kg/m2 are the dominant factors for complete remission.4.Of the patients in complete remission,58 cases were willing to become pregnant,42 cases gave birth smoothly,and 16 cases did not give birth smoothly.Thirty patients with endometrial hyperplasia without dysplasia gave birth successfully,and 12 patients with endometrial hyperplasia without dysplasia gave birth successfully.Among the patients who gave birth successfully,20 cases used assisted reproductive technology,and 22 cases had spontaneous pregnancy or oral ovulation induction drugs.According to univariate analysis and Logistic regression results,the application of assisted reproductive technology,BMI<30kg/m2 and pathological type of endometrial hyperplasia without dysplasia are the dominant factors for smooth delivery.5.Among the 9 patients who relapsed,there were no patients with both insulin resistance and glucose metabolism disorders.Conclusionl.For patients with endometrial hyperplasia who strongly require the preservation of fertility,after fully evaluating the condition and achieving conservative conditions,the use of high-efficiency oral progesterone and the prevention of levonorgestrel intrauterine sustained-release system can achieve good results.It is more recommended to use the levonorgestrel intrauterine sustained-release system ring.2.Patients with BMI≥30kg/m2 should lose weight at the same time during treatment,which can reduce the recurrence rate,improve the patient’s complete remission rate and smooth pregnancy rate.Patients with insulin resistance and glucose metabolism disorders should be given metformin at the same time.3.Patients who are willing to become pregnant should complete their pregnancy as soon as possible after complete remission.The application of assisted reproductive technology will help increase the rate of smooth delivery.