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。

Clinical study on fertility - sparing treatment for endometrial carcinoma

Objective To explore the indications and treatment protocols of fertility-sparing treatment for endometrial carcinoma in young women.Methods To study the clinical characteristics of 6 cases who underwent fertility-sparing treatment for well-differentiated endometrial carcinoma from Nov.2003 to Sep.2007 in the First People's Hospital of Feshan.Results Six young patients with well-differentiated endometrial carcinoma undertook fertility-sparing treatment with high-dose medroxyprogesterone acetate and repeated hysteroscopic biopsy or resection.The median age of these patients was 31years.Among the 6 cases,5 were diagnosed as endometrioid adenocarcinoma(2 G1 and 3 G2)and 1 as adenoacarcinoma(G2),and 6 cases with positive PR and ER.Four cases got complete response within 3 to 6 months and 1 got partial response after 3 month's progestin treatment.Effect evaluation was not carried out in 1 case because of unsufficient treatment time.Successful spontaneous pregnancies were achieved in two patients at the 2nd and 4th month respectively after the therapy.Two healthy and normal infants were delivered vaginally at 34 and 40 week's gestation respectively.Conclusions Conservative treatment for early-stage endometrial carcinomas in young women who desire to preserve fertility should be safe and effective in carefully selected cases.Hysteroscopic biopsy should be considered to evaluate the treatment effect.Surgical treatment should be performed in time when an initial response is not achieved or when disease recurs.