臨床婦人科産科74巻7号

2020年07月発行

今月の臨床 若年女性診療の「こんなとき」どうする？―多彩でデリケートな健康課題への処方箋 若年婦人科腫瘍へのアプローチ

若年女性の悪性腫瘍（CINも含めて）にはどのように対処すべきか

著者： 田中良道¹

所属機関： ¹大阪医科大学産婦人科

ページ範囲：P.728 - P.732

●【子宮頸部腫瘍】CIN3（高度異形成〜上皮内がん）に対しては子宮頸部円錐切除で妊孕能温存可能である．AIS（上皮内腺癌）あるいはⅠA期子宮頸がんでは子宮温存も選択できるが，断端所見や間質浸潤の深さ，脈管侵襲の有無に注意し術式を検討する．ⅠB1期，ⅡA1期で妊孕能温存を考慮する場合は広汎子宮頸部摘出術を検討する．

●【子宮体部腫瘍】子宮内膜異型増殖症あるいは子宮体がん（類内膜がんG1）かつMRI検査で明らかな筋層浸潤がみられない症例に対して，高用量MPA療法が選択肢となる．

●【卵巣腫瘍】卵巣上皮性悪性腫瘍では，ⅠA期およびⅠC期の非明細胞癌G1〜2とⅠA期明細胞癌では妊孕能温存術が考慮される．胚細胞腫瘍では進行期や組織学的分類にかかわらず妊孕能温存療法が考慮できる．

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