Catena U, Mirandola M, Capomacchia F M, Fanfani F, Scambia G
Facts Views Vis Obgyn. 2023 Mar;15(1):79-81. doi: 10.52054/FVVO.15.1.058.
4% of endometrial cancers are diagnosed in young women and 70% are nulliparous. Preserve fertility in these patients is of major interest. It is demonstrated that hysteroscopic resection of focal well-differentiated endometrioid adenocarcinoma, followed by progestins achieve a complete response rate of 95.3%. Recently, fertility-sparing treatment was proposed also in case of moderately differentiated endometrioid tumors, with a relatively high remission rate.
To show a new hysteroscopic approach, in case of fertility-sparing treatment of diffuse endometrial G2 endometrioid adenocarcinoma.
Stepwise demonstration of the technique with narrated video footage for the fertility-sparing management of diffuse endometrial G2 endometrioid adenocarcinoma, combining the use of a 15 Fr bipolar miniresectoscope and 'three-steps' resection technique (Karl Storz, Tuttlingen, Germany) with a Tissue Removal Device (TRD) (Truclear Elite Mini, Medtronic).
negative hysteroscopic assessment and endometrial biopsies at three and six months.
Normal endometrial cavity and negative biopsies.
Combined hysteroscopic technique, in case of diffuse endometrial G2 endometrioid adenocarcinoma, followed by double progestin therapy (Levonorgestrel releasing Intrauterine Device + Megestrole Acetate 160 mg/daily), may be associated with higher complete response rate; the use of TRD to complete the resection near tubal ostia may reduce risk of post-operative intrauterine adhesions and improve reproductive outcomes.
WHAT IS NEW?: A novel, fertility-sparing surgical approach for diffuse endometrial G2 endometroid adenocarcinoma.
4%的子宫内膜癌在年轻女性中被诊断出，其中70%未生育。保留这些患者的生育能力是主要关注点。已证实，宫腔镜切除局灶性高分化子宫内膜样腺癌，随后使用孕激素，完全缓解率达95.3%。最近，对于中分化子宫内膜样肿瘤也提出了保留生育功能的治疗方法，缓解率相对较高。
展示一种新的宫腔镜方法，用于保留生育功能治疗弥漫性子宫内膜G2级子宫内膜样腺癌。
通过带旁白的视频片段逐步演示弥漫性子宫内膜G2级子宫内膜样腺癌保留生育功能管理的技术，结合使用15 Fr双极微型切除镜和“三步”切除技术（德国图特林根的卡尔·史托斯公司）以及组织切除装置（TRD）（美敦力公司的Truclear Elite Mini）。
宫腔镜评估阴性以及术后3个月和6个月的子宫内膜活检阴性。
子宫内膜腔正常且活检阴性。
对于弥漫性子宫内膜G2级子宫内膜样腺癌，采用联合宫腔镜技术，随后进行双孕激素治疗（左炔诺孕酮宫内节育器+醋酸甲地孕酮160 mg/日），可能会有更高的完全缓解率；使用TRD在输卵管开口附近完成切除可降低术后宫腔粘连风险并改善生殖结局。
新内容是什么？：一种用于弥漫性子宫内膜G2级子宫内膜样腺癌的新型保留生育功能的手术方法。
