Hysteroscopic Resection and Laparoscopy in Fertility-Sparing Surgery for Early Endometrial Cancer and Complex Atypical Hyperplasia: A Single Institutional Experience

利用子宮鏡和腹腔鏡手術處理欲保留生育能力的早期子宮內膜癌和複雜非典型子宮內膜增生－單一機構經驗

劉錦成(Kim-Seng Law)

《童綜合醫學雜誌》 15卷S期 (2021/09) Pp. 55-61

https://doi.org/10.3966/20713592202109150S008

摘要

Background and purpose: To analyze the oncological and fertility outcomes in patients with early endometrial cancer (EC) or complex atypical hyperplasia (CAH) treated with hysteroscopic tumor resection with or without laparoscopic staging before progestin treatment. Methods: This study evaluated women undergoing hysteroscopic resection of tumors diagnosed as early endometrioid adenocarcinoma or CAH with or without laparoscopic evaluation of the pelvic cavity before initiating progestin treatment. Response rates were evaluated 6 months after the procedure, with conception encouraged as applicable following a complete response. Results: Six patients with early EC and three with CAH underwent surgical resection. The complete response rate was 77% (100% in CAH and 66% in early EC), with two patients showing persistent disease after 6 months of treatment. No patients showed evidence of disease after a median follow-up of 23 months (range 8-124 months). In the patients who sought conception, the live birth rate was 60%. Three recurrences were observed within an average of 24 months after the initial complete response. Discussion: Hysteroscopic resection for early EC and CAH with or without laparoscopy enables accurate staging and creates a favorable microenvironment for future childbearing without compromising the patients' oncological and reproductive outcomes.

關鍵字

endometrial cancer ； fertility-sparing surgery ； hysteroscopy ； laparoscopy ； levonorgestrel-releasing intrauterine device

並列摘要

背景及目的：分析使用黃體激素治療前以子宮鏡及或腹腔鏡處理早期子宮內膜癌（EC）或複雜非典型增生（CAH）的患者的腫瘤預後和生育的結果。方法：分析在使用黃體激素治療之前曾接受子宮鏡及或腹腔鏡進行骨盆腔評估的早期子宮內膜樣腺癌或複雜性非典型增生的婦女。術後六個月評估其疾病緩解率，並在分析其受孕率。結果：6例早期子宮內膜癌患者和3例複雜非典型增生患者在開始黃體激素治療之前接受了手術治療。完全緩解率為77%（複雜非典型增生為100%，子宮內膜癌為66%），其中有兩名患者在治療6個月後疾病依然存在。平均追蹤23個月（8-124個月）後，沒有患者有復發現象。在欲懷孕婦女當中，活產率為60%。在那些原本疾病完全緩解的病人當中，有三位於平均24個月內復發。結論：使用子宮鏡及或腹腔鏡癌症分期處理早期子宮內膜癌可得到較準確的癌症分期及創造良好的受孕環境，也不影響患者的癌症預後及活產率。

並列關鍵字

子宮內膜癌 ； 保留生育能力的手術 ； 子宮鏡 ； 腹腔鏡 ； 投藥式子宮內避孕器