Gauthier T, Huet S, Marcelli M, Lamblin G, Chêne G
Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Larrey, 87000 Limoges, France.
Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Larrey, 87000 Limoges, France.
J Gynecol Obstet Biol Reprod (Paris). 2015 Dec;44(10):1168-82. doi: 10.1016/j.jgyn.2015.09.032. Epub 2015 Oct 31.
To provide clinical practice guidelines from the French college of obstetrics and gynaecology (CNGOF), based on the best evidence available, concerning the surgical approach, the vaginal suture method, the surgeon's experience and morcellation to avoid complications with hysterectomy for benign gynaecological disease.
English and French review of literature about complications with hysterectomy for benign gynaecological disease, excluding cancer.
For benign gynaecological disease, vaginal (VH) or laparoscopic (LH) hysterectomy are recommended (grade B). In case of big uterus, VH or LH are recommended (grade C). VH is not contraindicated in nulliparous (Grade C). VH is not contraindicated in case of previous caesarean (grade C). In obese women, VH and LH are recommended (grade C). It should be recommended to perform at least 30 hysterectomies during learning curve (grade C). Hysterectomy should be performed by surgeon doing at least 10 hysterectomies each year (grade C). No vaginal suture method is recommended (grade C). It is recommended to assess cancer risk before (histological sample and/or imagery) when morcellation is planned (expert opinion).
基于现有最佳证据，提供法国妇产科学会（CNGOF）关于手术方式、阴道缝合方法、外科医生经验以及碎切术的临床实践指南，以避免良性妇科疾病子宫切除术的并发症。
对关于良性妇科疾病（不包括癌症）子宫切除术并发症的英文和法文文献进行综述。
对于良性妇科疾病，推荐经阴道子宫切除术（VH）或腹腔镜子宫切除术（LH）（B级）。子宫较大时，推荐VH或LH（C级）。未生育女性行VH无禁忌证（C级）。既往有剖宫产史行VH无禁忌证（C级）。肥胖女性推荐VH和LH（C级）。在学习曲线阶段，建议至少完成30例子宫切除术（C级）。子宫切除术应由每年至少进行10例子宫切除术的外科医生实施（C级）。不推荐特定的阴道缝合方法（C级）。计划进行碎切术时，建议术前评估癌症风险（组织学样本和/或影像学检查）（专家意见）。
