Bobrowska K, Pietrzak B, Jabiry-Zieniewicz Z, Cyganek A, Kaminski P, Wielgos M, Durlik M
First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2007 Nov;39(9):2756-8. doi: 10.1016/j.transproceed.2007.09.023.
The high rate of abnormal uterine bleeding associated with endometrial hyperplasia has been observed in women after kidney transplantation. The great majority of these premalignant lesions regress after conservative treatment, mostly with progestagens. There are cases, however, of persistent or recurrent hyperplasia requiring operative treatment.
We report seven cases of endometrial hyperplasia in kidney graft recipients treated with hysterectomy after failure of conservative treatment. The presence of typical risk factors of endometrial hyperplasia and cancer were analyzed as well as their clinical courses and treatment methods.
The age of the patients ranged from 35 to 50 years (mean, 42.7). Among typical risk factors, we observed obesity, diabetes, arterial hypertension, and nulliparity in the study group. All patients reported abnormal uterine bleeding and developed anemia. Women underwent two to four dilatation and curettage procedures. Progestagens (medroxyprogesterone or lynesterol) were administered for 3 to 9 months. The initial treatment was ineffective in two cases; in the remaining five cases endometrial hyperplasia recurred within 3 to 12 months. Pathologic findings after hysterectomy in all patients confirmed non-atypical endometrial hyperplasia.
Hysterectomy is the treatment of last resort for premalignant endometrial lesions. It should be considered in all cases of recurrent or persistent endometrial hyperplasia. It may protect immunocompromised kidney graft recipients from heavy bleeding, severe anemia, and most of all, the of endometrial cancer development.
肾移植术后女性中，与子宫内膜增生相关的异常子宫出血发生率较高。这些癌前病变中的绝大多数在保守治疗后会消退，主要是使用孕激素治疗。然而，也有一些病例出现持续性或复发性增生，需要手术治疗。
我们报告了7例肾移植受者在保守治疗失败后接受子宫切除术治疗子宫内膜增生的病例。分析了子宫内膜增生和癌症的典型危险因素、临床病程及治疗方法。
患者年龄在35至50岁之间（平均42.7岁）。在典型危险因素中，我们在研究组中观察到肥胖、糖尿病、动脉高血压和未育。所有患者均有异常子宫出血并出现贫血。患者接受了两到四次刮宫术。给予孕激素（甲羟孕酮或炔雌醇）治疗3至9个月。最初的治疗在2例患者中无效；其余5例患者在3至12个月内子宫内膜增生复发。所有患者子宫切除术后的病理结果均证实为非典型子宫内膜增生。
子宫切除术是子宫内膜癌前病变的最后治疗手段。对于所有复发性或持续性子宫内膜增生病例均应考虑。它可以保护免疫功能低下的肾移植受者避免大出血、严重贫血，最重要的是，避免子宫内膜癌的发生。
