绝经前子宫内膜癌保留生育功能治疗及前瞻性进展

Updates on Conservative Management and Prospective Study of Endometrial Cancer

对于未生育子宫内膜癌患者的保守治疗目前存在较多争议,首先药物剂量,给药方式,治疗时间等尚无明确标准,又因其复发率较高,患者完成分娩后是否需要切除子宫尚无定论。通过阅读大量文献及临床前瞻性研究,药物治疗主要以低剂量为主,治疗时间一般约9-12个月,治疗方面除传统单纯口服激素治疗外,近年来又逐步开展单独左炔诺孕酮宫内节育器治疗,宫内节育器与促性腺激素释放激素类似物(GnRHa)联合治疗,宫腔镜手术与激素联合治疗等。后续通过辅助生殖技术也使怀孕率逐年升高。研究表明,现阶段对于绝经前子宫内膜癌保留生育功能的治疗是非常有希望的,但仍需大量临床试验来逐步完善治疗策略。本文结合临床实践体会和文献报道,重点就其适应证选择、治疗前评估、治疗方案、疗效评价、病情监测、治疗后的生育问题等做一综述如下。

The treatment of premenopausal patients with endometrial cancer has not yet been standardized, first of all, drug dosage, drug intake, treatment time and so on, there are no clear standards. Secondly, because of the high recurrence rate, is it unclear whether the patient needs to be removed after delivery. By reading a large number of literature and clinical prospective study, the main drug treatment is given priority to with low dose, treatment time is generally about 9-12 months. In addition to the traditional simple oral hormone therapy, in recent years, the treatment of LNG-IUS, the LNG-IUS and GnRHa combined therapy, hysteroscopic surgery and hormone combination therapy are gradually carried out. And through assisted reproductive technology, the success rate of pregnancy is increasing after treatment. Research shows that the treatment of premenopausal endometrial cancer is very promising at present, but a large number of clinical trials are needed to improve the treatment strategy. In this paper, by combining with clinical practice and the lit- erature, we do a review about indication selection, pretreatment evaluation, treatment plan, curative effect evaluation, condition monitor- ing, and the problems that need to be faced after birth.