早期宫颈癌广泛性子宫颈切除术研究进展

宫颈癌是女性生殖器官最常见的恶性肿瘤之一，近年来随着人们防癌意识的不断增强和肿瘤普查的广泛开展，早期宫颈癌的发病率明显升高，并且趋向年轻化，目前，育龄期发病率已占患者总数的10％-15％。传统的宫颈癌根治手术使年轻的早期患者失去生育能力，生存质量明显下降，因此，在妇科恶性肿瘤的治疗中如何保留患者的生育、内分泌功能已成为妇科医生面临的重要课题，即在肿瘤根治的同时保存患者器官的功能，提高患者手术后生存质量。     

年轻未生育妇女子宫内膜癌保留生育功能的治疗

年轻妇女子宫内膜癌保留功能治疗,包括未生育患者保留生育功能治疗和年轻患者保留卵巢内分泌功能治疗,是近年来子宫内膜癌治疗方面的热点问题之一。本文从保留生育功能治疗的必要性、病例选择和治疗等方面进行讨论。1保留生育功能治疗的必要性子宫内膜癌是妇科常见的恶性肿瘤之一,目前在国内发病率仅次于宫颈癌。但是由于生活方式的转变,其发病率在不断升高,并且随着宫颈癌筛查及预     

宫颈癌患者生活质量研究进展

随着医疗模式的改变及癌症患者生存率的提高,提高癌症患者生活质量已越来越受到人们的关注.宫颈癌是女性第二大恶性肿瘤,患者预后较好,治疗后有较长的无瘤生存期.近年来,有关改善宫颈癌患者治疗后生活质量的研究取得很大进展.国内外妇科肿瘤医师在宫颈癌手术治疗方面,开展了保留生育功能的广泛宫颈根治手术、保留内分泌功能的手术和保留神...     

宫颈癌保留生育功能的现状及反思

随着宫颈癌筛查技术的规范与普及,越来越多年轻的宫颈癌患者在早期被发现,大多数生育年龄的宫颈癌患者有强烈的保留生育功能意愿。文章对宫颈癌患者行保留生育功能手术的适应证、手术方式、安全性及妊娠结局、相关争议等做一概述。     

宫颈癌患者保留生理功能的治疗

宫颈癌是常见的妇科恶性肿瘤,各国流行病学资料显示,目前宫颈癌的发病率和病死率有增长趋势.随着对宫颈癌筛查体系的逐步完善,许多宫颈癌患者在早期就被诊断,经过手术治疗预后良好.但是近年来宫颈癌的发病逐渐年轻化,生育年龄患者的比例持续升高,据调查大约10%～15%的宫颈癌在生育年龄时发病.许多妇女在生育前就被诊断为宫颈癌,而传统的手术方法一般采用子宫切除术或扩大子宫切除术,患者的内分泌功能得以保护,而忽视妇女的生育功能.但是随着手术技术的不断改进和发展,肿瘤患者除了需要延长寿命以外,更需要提高生活质量.因此,人们对于妇科肿瘤手术治疗强调微创性,保留器官功能,降低术后的功能失调,包括保留患者的生理功能即内分泌和生育功能,尤其是年轻的未生育的宫颈癌患者.而且最近的研究表明,宫颈癌转移到子宫体的可能性非常低,因此早期宫颈癌患者保留生理功能有了更多的机会.     

早期子宫内膜癌患者保留生殖内分泌功能治疗的研究进展

子宫内膜癌（endometrial carcinoma,EC）为女性生殖道常见三大恶性肿瘤之一,近年来发病率有上升趋势。虽然子宫内膜癌大多发生于绝经后妇女,但也有约25%的患者为绝经前女性,且3%～14%发生在40岁以下。其中未生育的年轻患者很难接受失去生育机会及卵巢内分泌功能。因此,近年来子宫内膜癌保留生殖内分泌功能的治疗,即保留年轻EC患者的生育功能或卵巢内分泌功能成为较关注的问题。近年研究表明,以孕激素为主治疗希望保留生理功能的年轻、早期、高分化子宫内膜癌患者是相对安全有效的。综述子宫内膜癌保留生育及卵巢功能的治疗现状。     

腹腔镜根治性宫颈切除术的进展

近年来宫颈癌发病呈年轻化趋势,许多正值生育年龄的妇女被诊断为宫颈癌,患者对保留生育功能的要求越来越高。根治性宫颈切除术充分体现了个体化的治疗原则,是早期宫颈浸润癌行保留生育功能的新的里程碑。腹腔镜根治性宫颈切除术(LRT)宫旁组织切除得更宽,且具有腹腔镜微创的优势,手术并发症发生率较低,术中常见的并发症是输尿管损伤,典型的保留生育功能手术并发症是宫颈口狭窄,LRT术后最严重的产科并发症是早产和未足月胎膜早破。LRT安全、可行,是年轻需要保留生育功能的宫颈癌患者的又一选择。     

年轻女性宫颈癌诊治新进展

年轻女性宫颈癌患者通常指35岁以下者,近年其发病率呈增长趋势。年轻女性宫颈癌较年长者进展迅速,可能与年轻女性雌激素水平高、易发生阴道微环境紊乱等因素有关。年轻患者非鳞癌比例高,诊断难度大,近年影像学诊断及分子生物学标志物等辅助手段的应用,明显提高了年轻女性宫颈癌的诊断率。在治疗方面,年轻患者对生育功能及生活质量要求较高,因此在传统手术基础上催生了微创手术、子宫移植等多种新型治疗方式,提高了年轻患者术后的生活质量。而中晚期患者的治疗以放化疗为主,三维适行放疗、调强放疗等新型放疗能够有效增加对肿瘤细胞的杀灭,同时可减少对正常组织的损伤,可明显改善患者预后。     

年轻子宫内膜癌女性保留生育及卵巢功能的治疗进展

子宫内膜癌（endometrial carcinoma,EC）是女性生殖系统三大恶性肿瘤之一,年轻育龄期EC患者相对少见,但随着子宫内膜癌发病率的逐渐上升,以及现代生活习惯的改变,EC出现明显年轻化趋势。EC的标准治疗方案使得女性永久性失去生育功能以及绝经前女性提前进入更年期,严重影响年轻患者的生活质量。故年轻EC患者保留生育功能或保留卵巢功能的治疗方案逐渐受到重视。现有的保留生育功能方案主要有：孕激素、芳香化酶抑制剂、二甲双胍等药物治疗以及宫腔镜下EC病灶切除术。多项研究已经证实,肥胖与EC发生发展相关,保留生育功能治疗期间体质量管理同样也至关重要。现就年轻EC女性保留生育及卵巢功能治疗以及治疗期间体质量管理等的研究进展进行综述。     

年轻子宫内膜癌女性保留生育及卵巢功能的治疗进展

子宫内膜癌(endometrial carcinoma,EC)是女性生殖系统三大恶性肿瘤之一,年轻育龄期EC患者相对少见,但随着子宫内膜癌发病率的逐渐上升,以及现代生活习惯的改变,EC出现明显年轻化趋势。EC的标准治疗方案使得女性永久性失去生育功能以及绝经前女性提前进入更年期,严重影响年轻患者的生活质量。故年轻EC患者保留生育功能或保留卵巢功能的治疗方案逐渐受到重视。现有的保留生育功能方案主要有:孕激素、芳香化酶抑制剂、二甲双胍等药物治疗以及宫腔镜下EC病灶切除术。多项研究已经证实,肥胖与EC发生发展相关,保留生育功能治疗期间体质量管理同样也至关重要。现就年轻EC女性保留生育及卵巢功能治疗以及治疗期间体质量管理等的研究进展进行综述。     

年轻宫颈癌患者治疗中的过度与不足

近年来宫颈癌发病呈年轻化趋势。以手术和放疗为主的综合治疗对年轻宫颈癌患者生活质量及生理功能产生的影响远较其他年龄宫颈癌更大。因而应特别注意避免对年轻宫颈癌患者在诊断、治疗方式、术后辅助治疗等几方面存在的过度与不足。     

Fertility Sparing Surgery in Gynecologic Cancer

Fertility preservation is one of the major concerns of young patients diagnosed with gynecological cancer. With newer treatment regimens and better surgical techniques, survival rates after cancer treatment have improved, hence preservation of fertility has recently become an important issue in the treatment of gynecological cancers. Fertility sparing surgery may be an option for early-stage cervical cancer with the development of loop excision techniques and radical trachelectomy which allows a radical approach to cervix cancer at the same time preserving the uterus and thus fertility. Fertility preservation is possible in Stage 1 epithelial ovarian cancers, germ cell ovarian tumors, and borderline cancers. Hormonal therapy with progestin agents is effective in early endometrial cancer. In patients desiring future pregnancy, fertility sparing options must be explored before starting treatment for gynecologic cancers.     

Oncofertility for women with gynecologic malignancies

The emerging field of oncofertility addresses fertility and the reproductive health needs for cancer patients, a key topic in cancer survivorship. Given that the standard treatment for gynecologic malignancies involves removal of reproductive organs, pelvic radiation, or chemotherapy, the effect of such treatment on fertility and options for fertility preservation are even more relevant than for other malignancies.In young women with new diagnoses of cervical, endometrial, or ovarian cancers, viable strategies for fertility preservation without compromising oncological outcome exist and should be considered. We present here a comprehensive review of the literature as it pertains to gynecologic malignancies on 1) the effects of radiation and chemotherapy on fertility, 2) fertility-sparing surgeries and the role of assisted reproductive technology, and 3) fertility preservation in adolescent girls and women with BRCA germline mutations.     

Integration and safety of fertility preservation in a breast cancer program

Young women diagnosed with breast cancer typically face systemic treatments that may delay childbearing or permanently impair their fertility. These concerns add to the stress experienced by young cancer survivors. Timely counseling and providing fertility preservation through cryopreservation of eggs or embryos have become an important quality of life issue. We analyzed the impact of fertility preservation procedures on the initiation of treatment for breast cancer and discuss critical aspects of the process.     

Fertility preservation in men with cancer

Due to recent advances in medical technologies, cancer has become more curable and chronic, and post-treatment quality of life, including male fertility, has become an important issue. Cancer itself can affect spermatogenesis through complex interactions, and cancer treatment such as surgery, radiotherapy and chemotherapy, all have certain detrimental effects on spermatogenesis. Currently, sperm cryopreservation before cancer treatment is the mainstay of fertility preservation, and is recommended by numerous guidelines. Although fertility preservation should be discussed with all cancer patients before treatment, it still remains underused. Postpubertal patients who are unable to bank sperm may undergo testicular sperm extraction before treatment. For prepubertal boys, there is no clinically established guideline for fertility preservation. Investigations such as spermatogonial stem cell culture are ongoing, and may lead to clinical options for fertility preservation in the future.     

Fertility Preservation in Young Women with Breast Cancer

Approximately 10,000 cases of breast cancer are diagnosed in women younger than 40 years of age each year in the United States. This creates a population of young women with breast cancer who may have not started or completed their family. Given that technology and treatment have improved outcomes for these women, quality of life issues, such as fertility preservation, must be considered. This review examines breast cancer patient and physician attitudes toward fertility preservation, ovarian toxicity of chemotherapeutic agents, fertility preservation options for breast cancer patients, and the safety of subsequent pregnancies for these women.     

New approaches in the surgical management of early stage cervical cancer

Quality of life has become a very important issue in deciding the extent of surgical procedures for patients affected with a variety of cancers. In recent years, more attention has been given to preserving organ function, cosmesis, and now reproductive function. As cancer treatment has improved survival in several neoplasias, cancer survivors are becoming more interested in preserving their fertility potential. We focus here on new surgical advances in the management of early stage cervical cancer, with emphasis on the radical trachelectomy technique to preserve fertility potential and the Saling procedure to prevent premature labor. We also discuss the issue of the sentinel node localization.     

小于35岁子宫颈癌患者213例治疗与预后分析

目的分析小于35岁妇女宫颈癌的临床表现、诊断和治疗的特点。方法回顾分析1986年1月至2006年7月收治的年轻妇女宫颈癌213例的临床资料。结果年轻妇女宫颈癌占全部宫颈癌的比例呈逐年上升的趋势;其临床表现主要为接触性阴道出血(59.62%)。0期、Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期患者的5年生存率分别为100%、79.51%、43.25%、31.71%、0。13例宫颈原位癌行宫颈锥切术,1例宫颈原位癌行LEEP术,术后均无肿瘤复发。27例宫颈癌在广泛性子宫切除手术同时行卵巢移位术,术后无1例卵巢发生癌转移。21例(12例Ⅰb2期,9例Ⅱb早期)经术前介入化疗(新辅助化疗)后行广泛性子宫切除及盆腔淋巴结清扫术,5年生存率为76.25%。5例术前放疗后行广泛性子宫切除及盆腔淋巴结清扫术,5年生存率为60.00%。两者无统计学差异(P>0.05)。结论应对筛查年轻妇女宫颈癌予以重视,对有接触性阴道出血的年轻妇女应予高度警惕。治疗年轻妇女宫颈癌时应注意保留早期患者的生育功能、卵巢功能及性功能,对局部晚期患者可用术前新辅助化疗,以提高手术切除率,改善患者的生活质量。