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目的探讨早期子宫内膜癌患者保留生育功能治疗的适应证和治疗方法。方法对2003年11月至2007年9月佛山市第一人民医院接受保留生育功能治疗的6例早期子宫内膜癌患者,回顾性分析其临床资料、诊疗经过、近期疗效及妊娠结局。结果6例患者接受了以高效孕激素和反复宫腔镜检查与病灶去除为主的联合治疗,患者中位年龄31岁。子宫内膜样腺癌5例(高分化2例、中分化3例),中分化腺棘癌1例,6例雌、孕激素受体均阳性。1例治疗3个月获部分缓解,1例治疗不足3个月而未评估。其余4例均在治疗3～6个月内获完全缓解,其中2例患者分别于治疗结束后第2、4个月自然妊娠,新生儿均存活,其余2例暂未受孕。结论在严格掌握适应证的前提下对年轻且有强烈生育愿望的早期子宫内膜癌患者实施保留生育功能治疗是安全可行的,宫腔镜检查和定位活检可作为首选的评估和监测方法。肿瘤控制后应尽快妊娠,完成生育后应适时行手术治疗。
Objective To investigate the indications and treatment methods of preserving the reproductive function in patients with early endometrial cancer. Methods From November 2003 to September 2007, Foshan First People’s Hospital received 6 cases of early endometrial cancer with preserved fertility function, and retrospectively analyzed its clinical data, diagnosis and treatment, immediate effect and pregnancy outcome. Results Six patients underwent combined treatment with highly effective progestin and repeated hysteroscopy and focal lesion removal. The median age was 31 years. 5 cases of endometrioid adenocarcinoma (well-differentiated in 2 cases, moderately differentiated in 3 cases), moderately differentiated adenocarcinoma in 1 case, 6 cases of estrogen and progesterone receptors were positive. One patient was partially relieved at 3 months and 1 patient was treated less than 3 months without evaluation. The remaining 4 cases were completely relieved within 3 to 6 months of treatment. Two of them were naturally pregnant at the 2nd and 4th month after the treatment, all newborns survived, while the remaining 2 cases were not yet pregnant. Conclusion It is safe and feasible to carry out fertility-preserving treatment in early stage of endometrial cancer patients with young and strong desire for childbearing under the strict indications of indications. Hysteroscopy and biopsy may be the first choice for evaluation and monitoring. Tumor control should be as soon as pregnancy, after completion of childbirth should be timely surgical treatment.