【摘要】 目的观察乳腺癌患者妇科并发症的临床病理特征,判断其与服用三苯氧胺(TAM)的关系。方法对90例术后服用TAM的乳腺癌患者(TAM组)及另外44例同时期无TAM服药史的乳腺癌患者(对照组)进行回顾性分析。结果两组患者的就诊原因有明显的差异,TAM组B超检查发现异常占68.9%,对照组中阴道淋漓出血或月经改变的比率明显增加为31.8%,具有统计学意义(P<0.05)。TAM组子宫内膜息肉的发生率为25.6%,明显高于对照组9.1%(P<0.05);TAM组子宫内膜增生的发生率为30.0%,明显高于对照组13.6%(P<0.05)。TAM组及对照组出现子宫内膜癌的情况为1∶3例。TAM组子宫肌瘤/腺肌症的发生率为66.2%,明显高于对照组44.1%(P<0.05)。两组患者的宫颈及卵巢病理改变无明显差异,其中宫颈的病理改变以慢性宫颈炎为主(82.8%),卵巢的病理改变以功能性卵巢囊肿为主(34.2%)。服用TAM时间的长短与某些妇科异常情况出现的频率相关,如随着TAM服药时间的延长,子宫内膜息肉与宫颈息肉的发生率明显升高,具有统计学意义(P<0.05);而服用TAM时间的长短与肌瘤的发生、肌瘤变性无明显关系(P>0.05)。134例乳腺癌患者妇科手术治疗以全子宫+双附件切除术为主,TAM组为68.9%,对照组为61.4%,上环治疗分别占10.0%与2.3%。结论乳腺癌患者服用TAM后子宫内膜病变与子宫肌瘤/腺肌症的发生增多,前者与服药时间长短有关。对所有乳腺癌患者应进行规律的妇科TVB监测或宫腔镜检查,并接受有效的低创治疗。更多还原

【Abstract】 Objective To analyze the clinic-pathology characteristics of gynecological complications in 134 women with breast cancer, and to explore the relationship between these characteristics and postoperative management of Tamoxifen (TAM).Methods The clinic-pathological features of 90 patients taken postoperative TAM and 44 without TAM were analyzed retrospectively. Results Different main complain was observed in the two groups: TAM group was the abnormalities detected by B sonography (68.9%), while vaginal irregular bleeding or the changes of menstruation in the control group (31.8%,P<0.05). Endometrial polyps were found in 25.6% of the TAM group whereas 9.1% of the control group (P<0.05). More endometrial hyperplasia was diagnosed in TAM group than in the control group, 30.0% vs. 13.6%, P<0.05. The TAM group and the contral group developed endometrial carcinoma at ratio of 1∶3. More TAM group had uterus myoma or adenomyosis than the control, 66.2% vs. 44.1%, P<0.05. No significant difference between the two groups was observed on the pathology of cervix and ovary. The most common pathological changes were chronic cervicitis (82.8%), and functional ovarian cysts (34.2%). The incidences of endometrial polyps and cervical polyps increased as the TAM taken time increased (P<0.05), while the incidences of uterus myoma or myoma degeneration was not related to the TAM taken time (P>0.05). TAH+BSO was conducted in 68.9% of the TAM group and 61.4% of the control group. The therapy by IUD was 10.0% and 2.3% in the two groups, respectively. Conclusions The incidences of endometrial diseases and uterus myoma or adenomyosis in the patients with breast cancer receiving Tamoxifen are increased. And the endometrial diseases are positively related to the TAM taken time. All breast cancer patients should be closely and routinely checked up by transvaginal sonography or hysteroscopy, and receive effective and less invasive therapy.更多还原