Objective: To analyze the pregnancy outcome, influencing factors and recurrence of fertility-preserving therapy for women with atypical endometrial hyperplasia (AEH) or endometrial carcinoma (EC). Methods: The multi-center retrospective study included 107 women with AEH or EC for fertility-preserving therapy in 10 hospitals from January 1st, 2009 to December 31st, 2018. The clinical pregnancy rate, live birth rate and recurrence of 66 patients with urgent child-bearing requirements after fertility-preserving treatment were analyzed. Results: (1) Among the 66 AEH and EC women with urgent child bearing requirements, 24 women chose spontaneous pregnancy, the clinical pregnancy rate was 54.2% (13/24) and the live birth rate was 41.7% (10/24), the median time from fertility-preserving therapy withdrawal to clinical pregnancy was 5.5 months. Forty-two women chose assisted reproductive technology (ART), the clinical pregnancy rate was 59.5% (25/42) and the live birth rate was 35.7% (15/42), the median time from fertility-preserving therapy withdrawal to clinical pregnancy was 19.5 months. The time from fertility-preserving therapy withdrawal to pregnancy in women receiving ART was significantly longer than that in women with spontaneous pregnancy (P=0.048). (2) Age and intrauterine adhesions were independent factors affecting the clinical pregnancy rate (P<0.05). (3) Among 107 patients with AEH or EC, the recurrence rate was 27.1% (29/107). Among the 42 cases who chose ART, 9 of them recurred before ART treatment, who received the fertility-preserving therapy again and then ART treatment, 8 women got clinical pregnancy,5 of them delivered at least a live birth. Conclusions: Women with AEH or EC could achieved satisfactory clinical pregnancy rate and live birth rate after fertility-preserving therapy. Age and intrauterine adhesions are independent factors affecting clinical pregnancy rate. The women with recurrent AEH or EC could be treated with fertility-preserving therapy again and get a satisfactory pregnancy outcome.
目的： 探讨子宫内膜非典型增生（AEH）及子宫内膜癌（EC）患者保留生育功能治疗后的妊娠结局及其影响因素，以及复发情况。 方法： 本研究系多中心回顾性研究，收集2009年1月1日至2018年12月31日10家医院接受保留生育功能治疗的AEH及EC患者共107例，对其中66例要求尽早生育患者的妊娠、活产及其影响因素、复发情况进行分析。 结果： （1）66例要求尽早生育的AEH及EC患者中，24例采用自然妊娠方式，其临床妊娠率为54.2%（13/24），活产率为41.7%（10/24），停止保留生育功能治疗至临床妊娠的中位时间为5.5个月；42例采用辅助生殖技术（ART）助孕治疗，其临床妊娠率为59.5%（25/42），活产率为35.7%（15/42），停止保留生育功能治疗至临床妊娠的中位时间为19.5个月。ART助孕患者停止保留生育功能治疗至妊娠的时间显著长于自然妊娠患者（P=0.048）。（2）年龄、宫腔粘连是影响临床妊娠的独立因素（P<0.05）。（3）107例AEH和EC患者中，复发29例，复发率为27.1%（29/107）。42例ART助孕治疗患者中，9例患者在行ART前复发，再次保留生育功能治疗后，实施ART助孕治疗，8例获得临床妊娠，5例活产。 结论： AEH和EC患者保留生育功能治疗后有较高的临床妊娠率。年龄、宫腔粘连是影响临床妊娠的独立因素。复发患者再次进行保留生育功能治疗，仍可获得较好的妊娠结局。.
Keywords: Endometrial hyperplasia; Endometrial neoplasms; Fertility preservation; Neoplasm recurrence, local; Pregnancy outcome.