女性癌症病人生育功能保存策略

Strategies for fertility preservation in female cancer patients

罹患癌症對女性，特別是對青春期前少女和年輕女性（15-39歲）的生育功能構成了嚴重威脅。化療和放射治療可能會導致卵巢功能衰退，進而引發不孕，甚至卵巢衰竭導致早發性停經。手術亦可能對生殖器官造成損害，進而導致不孕。如何在有效治療癌症的同時保護女性病患的生育功能，成為當今婦產科醫師的挑戰。生育功能保存是指在進行癌症治療之前或治療中，採取的一系列措施，以保護生育能力。這些措施可能包括保守性癌症手術、冷凍卵子、胚胎或卵巢組織，或在化療期間施打GnRH agonist讓卵巢不排卵，或是骨盆放射治療前作卵巢移位手術。生育功能保存的適應症已從目前普遍共識的兒童癌症、乳癌、婦癌、淋巴癌，血癌逐漸擴展至所有癌症。不過還是以早期階段癌症分期患者為生育功能保存的對象，晚期階段癌症分期患者採取生育保存措施的效益不大。通常最佳的生育功能保存時機是在癌症治療之前。然而，即使在治療開始後，生育功能保存仍可能對病患有所幫助。在選擇生育功能保存的方法時，需考慮患者的年齡、癌症類型和治療方案。有些方法可能比其他方法更適合某些患者。醫師應與病患深入討論諮詢，做好醫病共享決策，為病患量身制定最適合的生育功能保存策略。

Cancer poses aserious threat to the reproductive function of women, especially prepubertal girls and young women (15-39 years). Chemotherapy and radiation therapy may cause ovarian function to decline, which can lead to infertility, and even ovarian failure leading to premature menopause. Surgery may also cause damage to the reproductive organs, which can lead to infertility. How to effectively treat cancer while protecting the reproductive function of female patients has become achallenge for obstetricians and gynecologists. Fertility preservation refers to aseries of measures taken before or during cancer treatment to protect fertility. These measures may include fertility sparing surgery, freezing eggs, embryo or ovarian tissue cryopreservation, or administering GnRH agonist during chemotherapy to prevent ovarian ovulation, and ovarian transposition before pelvic radiation therapy. The indications for fertility preservation have gradually extended from the current general consensus on childhood cancer, breast cancer, gynecological cancer, lymphoma, and blood cancer to all cancers. However, patients with early-stage cancers are still targeted for fertility preservation. Fertility preservation measures for patients with advanced-stage cancer are not very effective. Often the best time to preserve fertility is before cancer treatment. However, fertility preservation may still be helpful to patients who are undergoing treatment. The patient's age, cancer type, and treatment options should be considered when choosing amethod of fertility preservation. Some methods may be better for some patients than others. Physicians should have in-depth discussions and consultations with patients, make good decisions and consensus, and formulate the most suitable fertility preservation strategies for patients.