Kerbage Y, Azaïs H, Estevez J P, Merlot B, Collinet P
Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
Gynecol Obstet Fertil. 2016 Jul-Aug;44(7-8):417-23. doi: 10.1016/j.gyobfe.2016.05.006. Epub 2016 Jun 27.
Modern surgery tends to the improvement of minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy in many directions. Regarding the extraction of large uterus, morcellation is currently the only way to externalize surgical specimens (myomas, uterine), without increasing the skin opening while allowing to reduce postoperative complications compared to laparotomy. However, in 2014, the Food and Drug Administration (FDA) discourages the use of uterine morcellation because of oncological risk. This recommendation has been challenged by a part of the profession. Our review has sought to identify the evidence for and against the use of morcellation. We also tried to quantify surgical risk and the current means of prevention. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available could not enable any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnosis modalities (imaging, preoperative biopsy) are to continue to minimize the oncological risk.
现代外科手术倾向于改进微创策略。腹腔镜手术经过多年实践,在许多方面取代了开腹手术。对于巨大子宫的切除,粉碎术目前是将手术标本(肌瘤、子宫)取出体外的唯一方法,在不增加皮肤切口的同时,与开腹手术相比还能减少术后并发症。然而,2014年,美国食品药品监督管理局(FDA)因肿瘤风险不鼓励使用子宫粉碎术。这一建议受到了部分业内人士的质疑。我们的综述旨在找出支持和反对使用粉碎术的证据。我们还试图量化手术风险及当前的预防手段。子宫肉瘤的发病率仍难以确切确定,术前诊断手段仍然不足。目前现有的少量回顾性研究无法给出任何建议。对粉碎术器械的评估以及术前诊断方式(影像学、术前活检)的改进仍需继续,以尽量降低肿瘤风险。