Kho Rosanne M, Abrão Mauricio S
*Women's Health Institute, Cleveland Clinic, Cleveland, Ohio †Department of Obstetrics and Gynecology, University of Sao Paulo, Sao Paulo, Brazil.
Clin Obstet Gynecol. 2017 Jun;60(2):286-295. doi: 10.1097/GRF.0000000000000285.
Review of literature is conducted to determine the best minimally invasive hysterectomy (MIH) route for large uterus, identify preoperative considerations and describe alternative techniques to power morcellation. Studies after 2010 revealed multiple MIH approaches. Vaginal hysterectomy is preferred over laparoscopic and laparoscopic assistance with less operative time and hospital cost. In morbidly obese patients with large uteri, total laparoscopic hysterectomy is superior to vaginal hysterectomy with lesser odds of blood transfusion and lower length of hospital stay. Although MIH for the large uterus is feasible, many questions remain unanswered. Well-designed multicenter prospective trial incorporating clinical pathways to compare outcomes is needed.
进行文献综述以确定治疗大子宫的最佳微创子宫切除术（MIH）途径，确定术前注意事项，并描述电动粉碎术的替代技术。2010年后的研究揭示了多种MIH方法。阴道子宫切除术比腹腔镜和腹腔镜辅助手术更受青睐，手术时间和住院费用更低。在患有大子宫的病态肥胖患者中，全腹腔镜子宫切除术优于阴道子宫切除术，输血几率更低，住院时间更短。尽管大子宫的MIH是可行的，但许多问题仍未得到解答。需要设计良好的多中心前瞻性试验，并纳入临床路径以比较结果。
