子宮內膜癌患者行保留生育治療後懷孕併發植入性胎盤：案例報告

Pregnancy with placenta accreta following fertility-preserving treatment in a patient with endometrial cancer: a case report

子宮內膜癌常見於絕經後女性，但近年來，絕經前婦女的發病率逐漸上升。合併子宮鏡腫瘤切除術及黃體素使用是最有效的保留生育能力的治療方法。建議的治療持續時間為6-12個月，需要至少間隔3個月進行兩次連續子宮內膜切片顯示完全緩解，才能認為保留生育治療是成功的。達到完全緩解後，建議立即積極懷孕。然而無論是子宮鏡內膜切片術或子宮內膜擴刮術，皆會導致子宮壁子宮內膜-肌層界面受損，造成植入性胎盤風險提高。故而於產檢時期提早運用超音波診斷，並於生產時合併多科團隊照顧十分重要。本文報告一例子宮內膜癌患者經歷多次子宮鏡息肉切除手術及子宮內膜擴刮術後，懷孕併發植入性胎盤之個案。

Endometrial cancer is common in postmenopausal women, but in recent years, the incidence of premenopausal women has gradually increased. Combining hysteroscopic tumor resection with progesterone is the most effective fertility-sparing treatment. The recommended duration of treatment is 6-12 months, and two serial endometrial biopsies taken at least 3months apart showing complete remission are required for fertility-sparing treatment to be considered successful. However, both hysteroscopic endometrial sectioning and endometrial curettage will cause damage to the endometrium-myometrium interface of the uterine wall, resulting in an increased risk of placenta accreta. Therefore, it is crucial to use ultrasound diagnosis early in prenatal checkups and combine multidisciplinary team care during delivery. This article reports acase of placenta percreta during pregnancy in apatient with endometrial cancer who underwent multiple hysteroscopic polypectomies and endometrial curettage.