子宫内膜癌保留生育功能和内分泌功能的治疗探讨

Discussion of fertility-sparing treatment and ovarian preservation management for endometrial cancer

子宫内膜癌是常见的妇科恶性肿瘤,随着年轻患者的增多,保留患者生育功能的治疗和内分泌功能的治疗越来越受到重视,而如何尽可能安全地保留年轻早期患者的生理功能是当前需要解决的一个重要问题。保留生育功能的治疗主要包括:大剂量孕激素、促性腺激素释放激素激动剂(Gn RH-a)、含孕激素的宫内节育器(如曼月乐)、宫腔镜下病灶切除术等,后期的辅助生育技术的应用也至关重要;保留内分泌功能的治疗主要是指:手术时保留一侧或双侧卵巢。目前已有不少相关的研究报道,积累了一定的临床经验与处理共识,如大剂量孕激素治疗的有效性、严密随访和辅助生育技术的应用的重要性等,但在适应证、治疗方案的选择、孕激素的剂量和用药时间、完成生育后子宫切除的必要性等方面仍存在一定争议。

Endometrial cancer is a common gynecological cancer. With the increase of young patients, fertility-sparing management and ovarian preservation become more and more important in the treatment of endometrial cancer. But how to preserve the physiological function of patient safely is a problem awaiting solution right now. Fertility-sparing treatment includes high-dose of progestin, GnRH-a, levonorgestrel-releasing intrauterine device, lesion resection via hysteroscope, et al. Moreover, application of assisted reproductive technology after treatment is also very important. Ovarian preservation means preserve one ovary or both ovaries when we do the hysterectomy. Till now, there are some related studies published, and we have reached common understanding on some fields, such as the effectiveness of high-dose progestin, the importance of follow-up, and the application of assisted reproductive technology. But it is still controversial in indication, the choice of treatment, dose and duration of progestin, necessity of hysterectomy after reproduce and so on.