子宫内膜癌及癌前病变的生育力保护和保存OA

In recent years,the incidence of endometrial cancer and its precancerous lesions has shown a trend of younger onset,placing more women with childbearing desires in a difficult dilemma between cancer treatment and fertility preservation.Although fertility-sparing treatments provide these patients with the possibility of pregnancy,the potential damage to endometrial and ovarian function caused by the disease itself and its treatment cannot be overlooked.Regarding the uterus,prolonged fertility-sparing therapy may lead to endometrial atrophy,fibrosis,and even intrauterine adhesions,significantly impairing embryo implantation.For the ovaries,primary dysfunction,metabolic abnormalities(such as metabolic syndrome and obesity),and the impact of therapeutic drugs may result in reduced ovarian reserve and ovulation disorders,ultimately compromising fertility.Therefore,fertility protection should be performed throughout the entire fertility-sparing treatment process:on one hand,treatment regimens should be optimized to shorten duration and minimize endometrial damage,and emerging technologies such as stem cell,platelet-rich plasma(PRP),and low-intensity focused ultrasound(LIFU)should be appropriately employed to repair the endometrial microenvironment after complete remission;on the other hand,pay attention to ovarian function assessment and intervention,offer fertility preservation options in a timely manner to the high-risk patients,including embryo,oocyte,or ovarian tissue cryopreservation,and improve overall reproductive outcomes through lifestyle modifications and metabolic management.Notably,the exploration of precision diagnosis and treatment based on molecular subtyping and immunotherapy is paving new pathways to expanding the indications for fertility-sparing therapy and enhancing efficacy and safety.Looking ahead,only through an integrated,multidisciplinary approach involving gynecologic oncology,reproductive medicine,endocrinology and genetics and by implementing individualized,life-course comprehensive management can we truly fulfill patients' fertility aspirations while ensuring their life safety.