Surgical Oncology Department, Claudius Regaud Comprehensive Cancer Center, Toulouse, France.
Best Pract Res Clin Obstet Gynaecol. 2012 Jun;26(3):407-24. doi: 10.1016/j.bpobgyn.2012.01.009. Epub 2012 Apr 12.
As a result of the trend toward late childbearing, fertility preservation has become a major issue in young women with gynaecological cancer. Fertility-sparing treatments have been successfully attempted in selected cases of cervical, endometrial and ovarian cancer, and gynaecologists should be familiar with fertility-preserving options in women with gynaecological malignancies. Options to preserve fertility include shielding to reduce radiation damage, fertility preservation when undergoing cytotoxic treatments, cryopreservation, assisted reproduction techniques, and fertility-sparing surgical procedures. Radical vaginal trachelectomy with laparoscopic lymphadenectomy is an oncologically safe, fertility-preserving procedure. It has been accepted worldwide as a surgical treatment of small early stage cervical cancers. Selected cases of early stage ovarian cancer can be treated by unilateral salpingo-ophorectomy and surgical staging. Hysteroscopic resection and progesterone treatment are used in young women who have endometrial cancer to maintain fertility and avoid surgical menopause. Appropriate patient selection, and careful oncologic, psychologic, reproductive and obstetric counselling, is mandatory.
由于晚婚趋势的影响，生育力保存已成为妇科癌症年轻女性的主要问题。在某些特定的宫颈癌、子宫内膜癌和卵巢癌病例中，已经成功尝试了保留生育力的治疗方法，妇科医生应该熟悉妇科恶性肿瘤患者的生育力保存选择。保留生育力的选择包括屏蔽以减少辐射损伤、在接受细胞毒性治疗时进行生育力保存、冷冻保存、辅助生殖技术和保留生育力的手术程序。腹腔镜下淋巴结切除术的经阴道根治性子宫颈切除术是一种具有良好肿瘤安全性的保留生育力的手术。它已被全世界接受为治疗小的早期宫颈癌的手术治疗方法。早期卵巢癌的某些病例可以通过单侧输卵管卵巢切除术和手术分期来治疗。对于患有子宫内膜癌的年轻女性，采用宫腔镜切除术和孕激素治疗来维持生育能力并避免手术性绝经。必须进行适当的患者选择，并进行仔细的肿瘤学、心理学、生殖和产科咨询。
