宫腔镜在子宫内膜癌保留生育功能治疗中的应用与存在的问题

The Status Quo and Problems of Hysteroscopy in Fertility-sparing Therapy for Endometrial Cancer

子宫内膜癌是一种常见的女性生殖道恶性肿瘤,虽然绝经后女性仍是子宫内膜癌的高发人群,但约有3%～14%的子宫内膜癌发生于40岁以下育龄期女性。子宫内膜癌的标准治疗方法为全子宫切除双侧附件切除±盆腔/腹主动脉旁淋巴结清扫,虽然治疗、预后效果较好,但同时也意味着患者将永久失去生育功能,在期望治愈癌症的同时,年轻子宫内膜癌患者也渴望保留生育功能。因此,如何安全、有效地对年轻子宫内膜癌患者行保育治疗引起临床医生重视。近年来不少临床报道证实了宫腔镜在年轻子宫内膜癌患者保留生育功能治疗及随访中的有效性及安全性,但宫腔镜作为手术方式仍存在很多问题及争议,临床使用仍需要进一步探究及规范。

Endometrial cancer is a worldwide malignant tumor of female genital tract. Although postmenopausal women are still at high risk of endometrial cancer, about 3%~14% of endometrial cancer occurs in women under 40 years old. The standard treatment of endometrial cancer is total hysterectomy plus bilateral adnexal resection plus pelvic/abdominal aortic lymph node dissection. Although the treatment and prognosis are good, patients will permanently lose reproductive function. Young endometrial cancer patients are eager to retain reproductive function while expecting to cure the cancer. Therefore, how to carry out conservation treatment for young patients with endometrial cancer safely and effectively attracts the attention of clinicians. In recent years, many clinical reports have confirmed the effectiveness and safety of hysteroscopy in conservation treatment and follow-up of young patients with endometrial carcinoma. However, as a surgical method, there are still many problems and controversies over hysteroscopy, and its clinical use still needs to be further explored and standardized.