Effect and evaluation of hysteroscopy on fertility-preserving treatment of endometrial atypical hyperplasia early endometrial adenocarcinoma in polycystic ovary syndrome patients

Objective To explore the clinical efficacy and safety of hysteroscopy in the treatment of endometrial atypical hyperplasia (EAH) or early endometrioid adenocarcinoma (EEC) in young patients with polycystic ovary syndrome (PCOS). Methods This was a retrospective study. The patients were divided into 2 groups, 1) drug treatment group: a total of 12 cases (9 cases of EAH, 3 cases of EEC) were treated with Diane-35 (1 tablet per day, for 21 d per month) combined with metformin (1 000 mg, qd) in the treatment, every 3 months by curettage + pathological evaluation; 2) hysteroscopic treatment group: a total of 32 cases (21 cases of EAH, 11 cases of EEC) were treated with Diane-35 combined with metformin, every 3 months by hysteroscopic surgery under the lesion excision and curettage+pathological evaluation. Results All patients were pathologically confirmed that endometrial lesions were successfully reversed, atypical endometrial hyperplasia of the patients in drug treatment group was successfully reversed in (6.6±3.1) months; atypical endometrial hyperplasia of the patients in hysteroscopy treatment group were successfully reversed in (4.1±1.3) months, the difference was statistically significant (P=0.025); early endometrial adenocarcinoma of the patients in group of drug treatment successfully reversed in (6.3±2.8) months; EEC of the patients in hysteroscopy treatment group was successfully reversed in (4.7±1.7) months, the difference was statistically significant (P=0.020). In drug treatment group, 2 cases with natural conception and full-term delivery in EAH; in hysteroscopy treatment group, 9 cases (5 cases of EEC, 4 cases of EAH) of full-term delivery, another 8 cases in pregnancy. Conclusion The drug treatment of Diane-35 combined with metformin can completely reverse endometrial precancerous lesion and EEC of PCOS with insulin resistance (IR), hysteroscopy, which could radically resect endometrial lesions, can achieve th goal of "Disease-free " , so it can significantly shorten the therapeutic time of drugs. Key words: Hysteroscopy; Endometrial precancerous lesions; Early endometrial carcinoma (EEC); Diane-35; Metformin