保留生育功能的治疗策略在早期子宫内膜癌（EC）和子宫内膜非典型增生（AEH）患者中已展现出显著的临床疗效，然而，部分复发患者仍存在强烈的生育需求要求再次保守治疗，这为临床治疗提出了新的挑战。该文回顾了复发患者再治疗的最新研究进展，并结合既往研究结果，得出以下结论。首先在制定再治疗方案前，需全面评估患者的肿瘤特征、生育意愿及全身状况等关键因素，这些因素共同决定了再治疗的可行性和个体化策略。其次，AEH/EC的再治疗方案多种多样，仍以大剂量口服孕激素为主，联合二甲双胍、促性腺激素释放激素激动剂和宫腔镜切除术等能改善治疗结局，应对不同患者具体情况制定个体化治疗方案。基于文献分析，再治疗的完全缓解（CR）率可达81.1% ~ 88.6%，妊娠率为26.5% ~ 50.0%，活产率为14.3% ~ 29.0%，但复发率仍维持在24.5% ~ 45.5%的较高水平，显著高于初次治疗。这表明，再治疗在控制疾病和实现生育目标方面取得了一定成效，但复发风险仍需高度重视。再治疗过程中需建立严格的监测和随访体系。此外，研究发现年龄> 35岁，超重或肥胖、合并多囊卵巢综合征、代谢综合征、病理级别高、临床分期晚等因素与更高的复发风险相关。而CR后妊娠、减重和维持治疗是预防复发的保护性因素，因此建议在患者在治疗过程中积极减重，并且获得CR后尽早启动辅助生殖技术，以优化妊娠结局并降低复发风险。未来研究应着重探索分子分型指导下的精准治疗策略，并深入挖掘具有预测价值的生物标志物，从而为患者制定更加个体化、精准化的治疗方案。

Although fertility-preserving treatment strategies have demonstrated significant clinical efficacy in patients with early-stage endometrial cancer （EC） and atypical endometrial hyperplasia （AEH）， some patients who experience recurrence still express a strong desire for fertility and request conservative retreatment. This poses new challenges for clinical management. This article reviews the latest research advances in retreatment for recurrent patients and synthesizes findings from previous studies to draw the following conclusions. First， before formulating a retreatment plan， it is crucial to comprehensively evaluate key factors such as tumor characteristics， fertility intentions， and overall health status of the patient. These factors collectively determine the feasibility and appropriateness of an individualized retreatment strategy. Second， studies have shown that retreatment options for AEH/EC are diverse， with high-dose oral progestin remaining the primary approach. Combining progestin with metformin， GnRH-a， and hysteroscopic resection can enhance treatment outcomes. Individualized treatment plans should be tailored to the specific conditions of each patient. Based on literature analysis， the complete remission （CR） rate of retreatment ranges from 81.1% to 88.6%， with a pregnancy rate of 26.5% ? 50.0% and a live birth rate of 14.3% ? 29.0%. However， the recurrence rate remains high at 24.5% ? 45.5%， significantly higher than that of initial treatment. This indicates that while retreatment has achieved some success in disease control and fertility preservation， the risk of recurrence still requires significant attention. Therefore， a strict monitoring and follow-up system must be established during retreatment. Additionally， studies have identified factors associated with a higher risk of recurrence， including age over 35， overweight or obesity， polycystic ovarian syndrome， metabolic syndrome， high pathological grade， and advanced clinical stage. On the other hand， pregnancy following CR， weight loss， and maintenance therapy serve as protective factors against disease recurrence. Patients are encouraged to actively engage in weight management during treatment and consider initiating assisted reproductive technology promptly after achieving CR to optimize pregnancy outcomes while minimizing the risk of recurrence. Future research should prioritize investigating precision treatment strategies informed by molecular classification and identifying predictive biomarkers， thereby enabling the development of more personalized and precise treatment plans tailored to individual patients.