早期子宮內膜癌的治療探索

Early Endometrial Cancer: An proposal of hysteroscopic surgery algorithm

近年來微創手術技術日益成熟，儀器設備日新月異，引起傳統開腹手術轉向微創手術，尤其是早期子宮內膜手術，以內視鏡手術治療為主，合併症少，醫生、病人、健康保險都受益。台灣子宮內膜癌40 歲以前佔5-8%，逐年增加，而且年輕人希望保留子宮，生育保存的需求也愈來愈受注意，國際治療指引也鼓勵生育力保存，對於低風險的早期子宮內膜癌，不必要淋巴腺切除的觀點也被證實，因此，術前評估愈顯重要。本文探索子宮鏡的術前切片檢查，影像學評估，接著以子宮鏡手術切除病灶及其鄰近正常組織，術後高劑量黃體酮的治療3-12 個月，緊接著以人工協助生殖達成生育目的，提出個人經驗及文獻探索。

In conservative management in early endometrial cancer, it is mandatory to consider fertility sparing. Fertility specialist involvement is recommended due to the low live birth rate without IVF-ET intervention. The hysteroscopic surgery for early endometrial cancer uses a three-step technique in which each step is characterized by a pathologic analysis. The diagnostic hysteroscopies with target biopsies at 3. 6. 9. and 12 months after surgery were negative for malignancy and then IVF-ET for childbearing. These proposals need to be confirmed in a prospective study.