子宫肉瘤患者保留生育功能治疗研究进展
Advancements in Fertility-Sparing Treatments for Patients Diagnosed with Uterine Sarcoma
摘要: 子宫肉瘤(Uterine Sarcomas, US)是一组罕见且异质性极强的子宫恶性肿瘤，虽多发于围绝经期，但仍有相当比例的育龄期女性受累。随着生育年龄的推迟及辅助生殖技术的进步，年轻患者对保留生育功能治疗(FST)的需求日益凸显。本文综述了对子宫肉瘤患者实施FST的最新研究进展，分析了低级别子宫内膜间质肉瘤(LG-ESS)、子宫腺肉瘤(UA)及子宫平滑肌肉瘤(uLMS)等不同亚型的保育治疗可行性、肿瘤学安全性及妊娠结局。现有证据表明，早期LG-ESS和无肉瘤样过度生长的UA患者行FST后妊娠结局相对较好，但复发风险仍需高度警惕；而uLMS及高级别子宫内膜间质肉瘤(HG-ESS)因侵袭性强、预后不良，保育治疗需极度慎重。此外，本文还阐述了保育手术、激素治疗及辅助生殖技术在子宫肉瘤FST综合诊疗中的应用策略。
Abstract: Uterine Sarcomas (US) constitute a rare and highly heterogeneous group of malignant tumors affecting the uterus. While these tumors predominantly manifest during the perimenopausal period, a significant number of cases occur in women of reproductive age. The trend of delayed childbearing has led to an increased demand for fertility-sparing treatment (FST). This review critically examines the feasibility and safety of FST for various subtypes, including endometrial stromal sarcoma (ESS), uterine adenosarcoma (UA), and uterine leiomyosarcoma (uLMS). Current evidence indicates that early-stage low-grade ESS and UA without sarcomatous overgrowth are associated with favorable pregnancy outcomes, albeit with a risk of recurrence. In contrast, FST should be approached with extreme caution in cases of aggressive uLMS and high-grade ESS due to their poor prognosis. The review concludes by discussing comprehensive strategies that integrate surgical intervention, hormonal therapy, and assisted reproductive technologies.
文章引用：杨梓琦, 姜洁. 子宫肉瘤患者保留生育功能治疗研究进展[J]. 临床医学进展, 2026, 16(4): 668-674. https://doi.org/10.12677/acm.2026.1641293

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