女性恶性肿瘤患者生育前治疗对生育功能的影响

恶性肿瘤治疗有可能损害恶性肿瘤患者的生育功能,保留生育功能的治疗可以提高生育前恶性肿瘤生存者的生育力。近年来,众多学者对女性恶性肿瘤患者生育前治疗对生育功能的影响、后代的影响以及妊娠后的复发情况进行了大量的研究。本文对此进行综述,并讨论了女性相关恶性肿瘤生存者的生育情况。     

滋养细胞肿瘤患者再妊娠相关问题

妊娠滋养细胞肿瘤（GTN）包括侵蚀性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤。由于GTN多发生于育龄妇女,治疗的同时保留患者的生育功能显得尤为重要。文章详细阐述了保留生育功能治疗GTN的方法（包括化疗、栓塞治疗、保守性手术、放疗等）及其对生育功能的影响,并对治疗后再妊娠的结局进行了阐述。     

早期宫颈癌根治性宫颈切除术治疗新进展

近年来早期宫颈癌的发病率越来越高且日益趋向年轻化,如何在手术切除病灶的同时,保留患者的生育功能,符合宫颈癌治疗的个体化、微创化、人性化的趋势,目前尚有争议。本文复习了有关早期宫颈癌保留生育功能治疗的相关文献,讨论适合保留生育功能治疗的适应证、手术方式比较,以及评估各种术式治疗后的肿瘤结局及妊娠结局。     

早期子宫内膜癌和子宫内膜非典型增生患者保留生育功能治疗后的助孕策略研究进展

近年来,早期子宫内膜癌及子宫内膜非典型增生在年轻女性中的发病率逐渐升高,大剂量孕激素保留生育功能治疗为年轻患者提供了生育机会.本文将围绕近年的研究分析此类患者保留生育功能治疗后合适的妊娠时机及助孕方式,探讨适合此类患者安全有效的助孕策略,旨在提升此类患者保育治疗后的妊娠成功率.     

子宫内膜癌保留生育功能的治疗

未生育的年轻子宫内膜癌患者常常寻找保留生育功能的治疗方法。本文的主要目的是复习有关子宫内膜癌患者保留生育功能治疗的相关文献,探讨适合进行保留生育功能治疗的患者特征、治疗前的评估、治疗方案、疗效以及妊娠率。     

子宫内膜癌保留生育功能治疗的临床探讨

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。     

早期子宫内膜癌保留生育功能治疗中特殊问题处理的研究进展

子宫内膜癌保留生育功能治疗的适应证为高分化子宫内膜癌Ⅰa期,且其疗效已得到肯定。随着社会经济发展的影响以及我国人口发展战略“二孩”政策的实施,更多患者保留生育功能的愿望更加急迫;针对临床治疗中所面临的新挑战,近年来部分研究者开始探索治疗方式的优化,以及对某些有特殊问题（包括初次保留生育功能治疗后复发、中分化及子宫肌层浸...     

卵巢恶性肿瘤治疗后的生育和助孕策略

正恶性肿瘤保留生育功能的手术治疗(fertility sparing surgery,FSS)及术后的生育、助孕问题,属于肿瘤-生殖医学(onco-fertility)的范畴,是门交叉学科,涉及妇科、生殖、肿瘤、产科、儿科、伦理学。其中,卵巢恶性肿瘤的生育力保存是极具挑战性的,因为涉及重要生殖器官,且早期诊断难,易复发。目前卵巢恶性肿瘤保留生育功能治疗的主要方法有:FSS、术中或术后生育力保存技术、手术后的生育指导及辅助妊娠。卵巢肿瘤FSS是指全面分期的     

早期卵巢上皮性癌和交界性肿瘤保留生育功能相关问题

文章分别对早期卵巢上皮性癌（EOC）及交界性卵巢癌（BOT）年轻患者要求保留生育功能治疗的术式、选择病例标准、术中注意事项、术后相关问题及妊娠结局进行讨论。在对EOC及BOT患者进行保留生育功能手术（FSS）治疗前应与患者充分讨论和交流，使患者充分理解此种术式治疗后的生育潜在可能性和安全性。手术应由有经验的妇瘤医师施行，保证分期手术的准确性；术后多学科（妇科肿瘤医师、生殖医学专家、产科医师）会诊，共同治疗、随访，是获得妊娠良好结局和患者安全的保证。     

子宫腺肌瘤与生育相关问题的研究进展

子宫腺肌瘤是子宫腺肌病的一种特殊类型,生育期妇女患病率逐年增高。近年来随着女性生育年龄的推迟,生育政策的放开,子宫腺肌瘤患者生育相关的问题日益凸显,有关治疗及治疗后妊娠相关并发症的问题越来越成为临床关注的焦点。目前对于子宫腺肌瘤的治疗主要采用药物、手术及HIFU治疗。药物治疗创伤小,但停药后复发率较高;手术治疗创伤大,且影响生育能力;HIFU治疗有较高的症状缓解率,似乎是安全有效的,但现有证据仍不足。已有研究表明,子宫腺肌瘤合并妊娠时,早产、流产等产科并发症的风险增加;手术治疗后,妊娠期间发生无症状子宫破裂的风险也增加。鉴于目前不同治疗方案对生育结局的疗效及安全性的数据有限,且治疗标准程序尚未建立,治疗方案建议个体化。同时,建立完善的子宫腺肌瘤合并妊娠的产前管理,有助于减少产前并发症的发生,以提高生育期妇女最终抱婴率。     

绝经后子宫内膜增厚的阴道超声诊断进展

随着我国女性健康意识的提高,绝经后子宫内膜增厚越来越受到重视。子宫内膜癌是女性生殖器官常见恶性肿瘤之一,在绝经后妇女中常表现为子宫内膜增厚和绝经后阴道出血。经阴道超声测量绝经后妇女的子宫内膜厚度是常用的子宫内膜癌早期筛查手段。在医学上,对于无阴道出血症状的绝经期女性,子宫内膜厚度与子宫内膜癌相关性尚不明确。无症状绝经期子宫内膜增厚的患者要根据是否存在高危因素个体化评估患子宫内膜癌的风险。适当的诊断不仅对子宫内膜病变的早发现早治疗有重要意义,也可避免造成绝经女性的过度恐慌和减少不必要的有创诊疗,在临床中有现实意义。综述绝经后子宫内膜增厚疾病的特点以及经阴道超声检查的评估价值。     

Preserving fertility before assisted reproduction in women with endometrial carcinoma: case report and literature review

Fertility-preserving treatment with progestin may be considered in nulliparous women with well-differentiated endometrial carcinoma. Recently, assisted reproductive treatments have been performed to achieve a rapid pregnancy in such cases. This report evaluates a 39-year-old woman who admitted with menorrhagia and primary infertility. Owing to persistent menstrual irregularity and thick endometrium, a diagnostic office hysteroscopy with endometrial biopsy was performed and revealed a well-differentiated adenocarcinoma. Although the woman wished to retain her childbearing potential with conservative management followed by an assisted reproduction cycle, the repeated endometrial biopsies during progestin treatment revealed persistent adenocarcinoma. Complementary surgery was performed due to persistent endometrial malignancy, which noted well-differentiated endometrioid adenocarcinoma without myometrial invasion or extrauterine disease. A review of cases with endometrial carcinoma that have been treated with conservative management and a subsequent assisted cycle is also presented here. To date, there are 14 such reports, including 15 women and 21 healthy infants. However, obtaining remission and maintaining the reproductive capability may not always be possible, even in early-stage cases. Therefore, patient and physician should always consider carefully if fertility-preserving management is preferred after diagnosis of endometrial carcinoma.     

Ovarian metastasis in a nulliparous woman with endometrial adenocarcinoma failing conservative hormonal treatment

BACKGROUND: There have been several reports about successful fertility-preserving treatment of endometrial carcinoma with subsequent pregnancy. However, conservative hormonal treatment for early-stage endometrial cancer still entails some risk. CASE: We present a 36-year-old nulliparous woman, initially diagnosed as clinical stage IA, grade 1 endometrial adenocarcinoma, receiving 6-month conservative treatment with remission achieved at 4 months from diagnosis. Recurrence at the endometrium was documented at the end of treatment. She underwent a definitive surgery including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. The final pathology revealed well-differentiated endometrioid adenocarcinoma with inner one-third myometrial invasion and right ovarian metastasis. CONCLUSION: This case report signals a warning that negative preoperative imaging studies are not reassuring for a relapsing low-grade, early-stage endometrial carcinoma failing conservative treatment.     

Nulliparity in women with double primary cancers in both breast and endometrium

A hospital-based diagnostic index revealed 340 women with endometrial carcinoma diagnosed over the 5-year period 1974 to 1979. On later review, 12 had histological evidence of a separate primary in the breast, developing either prior or subsequent to the endometrial primary. Fifty-eight per cent (n = 7) of these women were nulliparous, which was significantly greater than the nulliparity rate of 23% observed in a sample of the remaining women with endometrial cancer. The results from this small study suggest that the association of nulliparity with double primary cancers is greater than with endometrial cancer alone, though the findings need confirmation from the study of a larger series of such patients.     

Endometrial carcinoma in a 15-year-old obese patient with persistent uterine bleeding

Endometrial carcinoma is the most common malignancy of the upper female genital tract but is rare in teenagers. Here, we report the case of a 15-year-old, nulliparous, morbidly obese female with complaints of asthenia and menometrorrhagia lasting for six months. On examination, the patient had an enlarged uterus approximately 14 gestational weeks in size, and ultrasound revealed an intrauterine mass and polycystic ovaries. An endometrial biopsy performed during hysteroscopy revealed endometrioid adenocarcinoma, and magnetic resonance imaging showed myometrial invasion. The patient underwent a laparotomy involving total abdominal hysterectomy, right salpingo-oophorectomy, wedge-shape dissection of the left ovary, and pelvic and para-aortic lymphadenectomy. We analyze the pathogenesis of endometrial carcinoma in this case and discuss the risk factors for endometrial carcinoma, especially in young women. Gynecologists should be vigilant for persistent abnormal uterine bleeding and other signs of endometrial carcinoma in young women, especially those who have risk factors for the disease.     

Endometrial cancer and fertility

PURPOSE OF REVIEW: Endometrial cancer can affect reproductive-age women who may desire fertility preservation. This article discusses the current, available data about conservative management of endometrial cancer in young women. RECENT FINDINGS: Reproductive-age women with well differentiated endometrial carcinoma have an overall favorable prognosis provided that the tumor is identified at an early, noninvasive stage; however, advanced disease can be present. This article discusses current modalities to evaluate and clinically stage endometrial cancer including hysteroscopy, dilation and curettage, pelvic ultrasound, abdominopelvic computed tomography scan, pelvic magnetic resonance imaging, tumor marker CA125 level, and surgical exploration with laparoscopy or laparotomy. Thorough evaluation is critical as 10 to 29% of young women with endometrial cancer have a synchronous ovarian malignancy. Detailed counseling about the risks and benefits of conservative management, and expectations for fertility after treatment, surveillance, and definitive surgical management is essential. Multiple effective protocols exist for conservative treatment of endometrial cancer, and the initial response rates are as high as 57 to 75%. Successful pregnancies have occurred after conservative management, spontaneously, and with assisted reproductive technologies. SUMMARY: There are no standard recommendations for selection of appropriate women, treatment protocols, or long-term surveillance for conservative management of clinical stage I endometrial adenocarcinoma, and larger prospective clinical studies are warranted.     

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。     

Clinical aspects of uterine papillary serous carcinoma

PURPOSE OF REVIEW: We review the demographic and clinicopathologic characteristics, and prognosis of women diagnosed with uterine papillary serous carcinoma, with a focus on clinical management. RECENT FINDINGS: Pathologic evaluation of postmenopausal bleeding is preferred for patients who fit the profile of a high-risk endometrial cancer such as uterine papillary serous carcinoma. Women diagnosed with endometrial cancer who fit this profile and all women with uterine papillary serous carcinoma should undergo comprehensive surgical staging and aggressive cytoreduction of extrauterine disease. Adjuvant therapy remains controversial. Several recent investigations reported on the potential benefit of adjuvant chemotherapy, with many recommending additional loco-regional radiation. SUMMARY: Despite the lack of randomized trials on uterine papillary serous carcinoma, several recent reports have provided insight into the diagnosis, surgical management, and adjuvant treatment of this high-risk endometrial cancer.     

Experience and results with a lactate dehydrogenase marker in vaginal secretions of women at high risk for endometrial cancer

The authors present and discuss the results obtained with 202 Gynaegnost experiments in 161 women, between 45 and 65 years, nulliparous, or having experienced a late pregnancy, with menopause occurring after the age of 52 and undergoing or not estrogen-therapy after menopause, and presenting high blood pressure, obesity or diabetes. The purpose of this multicenter study, to be continued, was to demonstrate the efficacy of this tumor marker, in the early diagnosis of endometrial carcinoma, in high-risk women.     

New pelvic sonoangiography for detection of endometrial carcinoma: a preliminary report.

Pelvic sonoangiography (PSAG) using transvaginal color Doppler was done on 16 postmenopausal patients with abnormal uterine bleeding. Seven women had no endometrial carcinoma and nine had carcinoma. No flow was detected around and within the endometrium in noncancer patients. PSAG showed a feeder artery (blood flow with pulsation that runs into and clings to the tumor) in all patients with endometrial carcinoma, and intratumor blood flow (a mixture of pulsating and constant flow within the tumor) was evident in 7 of 9 patients with endometrial carcinoma. These findings were confirmed by conventional pelvic angiography. In the diagnostic evaluation of PSAG for endometrial carcinoma, both sensitivity and specificity were 100%. We conclude that PSAG with transvaginal color Doppler can be used to detect endometrial carcinoma in postmenopausal women with abnormal uterine bleeding and that this method might be applicable to selecting patients who really require diagnostic surgery for endometrial cancer.