Falcone Tommaso, Walters Mark D
Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Obstet Gynecol. 2008 Mar;111(3):753-67. doi: 10.1097/AOG.0b013e318165f18c.
Hysterectomy is the second most commonly performed surgical procedure in the United States. The indications for hysterectomy have changed little over the last decade. In spite of a large number of potential alternatives to hysterectomy for the management of benign disease, hysterectomy rates have remained relatively stable. The informed consent process for hysterectomy requires discussion of several important considerations, such as the risks and benefits of prophylactic oophorectomy and the need for removal of the cervix. The preponderance of studies on hysterectomy outcomes has shown improvement of pelvic symptoms and quality of life. Attention to perioperative details such as prophylactic antibiotics and prevention of venous thromboembolic events are important to assure a safe outcome. Laparotomy is still the most common route for hysterectomy. Large prospective controlled trials and a Cochrane review have clearly shown that vaginal hysterectomy is the surgical route of choice for hysterectomy. In our experience, previous cesarean delivery, large uterus, or request for removing the ovaries are not valid reasons for excluding vaginal hysterectomy as an approach.
子宫切除术是美国第二常见的外科手术。在过去十年中，子宫切除术的适应症变化不大。尽管对于良性疾病的治疗有大量子宫切除术的潜在替代方法，但子宫切除术的比率一直相对稳定。子宫切除术的知情同意过程需要讨论几个重要的考虑因素，例如预防性卵巢切除术的风险和益处以及切除宫颈的必要性。关于子宫切除术结果的大量研究表明盆腔症状和生活质量有所改善。关注围手术期细节，如预防性使用抗生素和预防静脉血栓栓塞事件，对于确保安全的手术结果很重要。剖腹手术仍然是子宫切除术最常见的途径。大型前瞻性对照试验和Cochrane综述清楚地表明，阴道子宫切除术是子宫切除术的首选手术途径。根据我们的经验，既往剖宫产史、子宫较大或要求切除卵巢并不是排除阴道子宫切除术作为一种手术方法的有效理由。
