目前子宫内膜癌(EC)发病率逐年上升，并且呈现年轻化趋势，保留生育功能治疗(FST)成为国际妇产科联盟(FIGO)分期为ⅠA期(肿瘤局限于子宫内膜)，病理特征为子宫内膜样腺癌、G1级分化、无肌层浸润者的重要选择。本研究将这类患者定义为年轻早期EC(EEC)患者(年龄<40岁)。目前对年轻EEC患者的治疗核心，在于采取FST策略的孕激素疗法、左炔诺孕酮宫内节育系统(LNG-IUS)、宫腔镜下EC病灶切除术等，实现对这类患者达到完全缓解(CR)，并达到维持其生育潜力的目的。EEC患者的FST孕激素治疗，如醋酸甲羟孕酮或甲地孕酮仍是主流方案，但是LNG-IUS因其具有局部高浓度孕激素释放和较低的全身不良反应，显示出可使年轻EEC患者达到更高的CR率和更优的耐受性优势。宫腔镜下EC病灶切除术联合孕激素的FST治疗，可进一步提高EEC患者的CR率和妊娠成功率，成为部分年轻EEC患者的首选治疗方案。年轻EEC患者的FST辅助治疗，如二甲双胍、促性腺激素释放激素激动剂(GnRHa)及芳香化酶抑制剂联合使用，可为肥胖(人体质量指数≥30 kg/m²)者或孕激素耐药年轻EEC患者提供替代选择。关于年轻EEC患者FST策略的最佳药物治疗方案、剂量、给药途径和治疗持续时间，迄今仍存在不确定性，使年轻EEC患者采取FST措施仍然面临诸多挑战。笔者拟就年轻EEC患者的FST最新策略，包括年轻EEC患者选择、诊断评估、治疗方案及长期管理的最新研究进展进行阐述，并探讨年轻EEC患者的分子分型在FST个体化治疗中的潜在价值，旨在对采取FST策略的年轻EEC患者提供更为系统、个体化的治疗策略与长期管理方案，改善年轻EEC患者的生育结局与长期生存质量。

The incidence of endometrial cancer (EC) has been increasing annually, with a trend toward younger onset age, making fertility-sparing treatment (FST) a critical option for patients with International Federation of Gynecology and Obstetrics (FIGO) stage ⅠA (tumor confined to the endometrium) and pathological features of endometrioid adenocarcinoma, G1 grade differentiation, and no myometrial invasion, who are defined as young early-stage EC (EEC) patients (<40 years old) in this study. The current FST approach focuses on achieving complete regression (CR) and preserving fertility potential through progesterone therapy, the levonorgestrel-releasing intrauterine system (LNG-IUS), and hysteroscopic resection of EC lesions. Progestin therapy (medroxyprogesterone acetate or megestrol acetate) remains the primary FST, but LNG-IUS demonstrates higher CR rates and better tolerability due to its localized high-dose progesterone release and reduced systemic side effects. Combining hysteroscopic EC lesion resection with progestin therapy further improves CR rates and pregnancy success, making it the preferred option for some young patients with EEC. Additionally, FST adjuvant therapies such as metformin, gonadotrophin releasing hormone activator (GnRHa), and aromatase inhibitors provide alternative options for obese with body mass index ≥30 kg/m² or progestin-resistant EEC patients. However, uncertainties remain regarding the optimal drug regimen, dosage, administration route, and treatment duration, posing ongoing challenges in FST of young patients with EEC. This article systematically reviews the latest FST strategies for young patients with EEC, including patient selection, diagnostic evaluation, therapeutic approaches, and long-term management, and exploring the potential role of molecular classification in personalized therapy, to provide more systematic and individualized treatment strategies and long-term management plans for young EEC patients who adopt the FST strategy, so as to improve the reproductive outcomes and long-term quality of life of young EEC patients.