Rousseau M, Morel A, Dechoux S, Bouet P E, Catala L, Lefebvre Lacoeuille C, Descamps Ph, Legendre G
Service de Gynécologie - Obstétrique, Saint-François d'Assise, Centre Hospitalier Universitaire de Québec, 10 rue de l'Espinay, G1L 3L5 Québec, Canada; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, 49033 Angers Cedex, France.
Department of Radiology, GH Diaconesses-Croix Saint Simon, 125 Rue d' Avron, 75020 Paris, France; Department of Radiology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris (APHP), 4 rue de la Chine, 75020 Paris, France.
J Gynecol Obstet Hum Reprod. 2018 Oct;47(8):341-349. doi: 10.1016/j.jogoh.2018.05.015. Epub 2018 Jun 4.
The objective of this literature review is to reiterate the epidemiology, clinical signs, and radiological signs that should be consistent with a uterine sarcoma as well as the precautionary pre- and postoperative principles that help prevent morcellation of uterine sarcomas when treating patients with uterine fibroids.
We conducted this literature review by consulting the Pubmed, Medline, and Cochrane Systematic Review databases up to 28/02/2017 using the following keywords: fibroid, myoma, leiomyoma, sarcoma, leiosarcoma, uterine cancer, myomectomy, hysterectomy, morcellation, and uterine morcellation. We also used the reference lists of the selected articles to find more data on the websites of North-American and European learned societies that specialise in obstetrics and gynaecology.
In the case of morcellation of uterine fibroids, the risk of an undiagnosed uterine sarcoma is estimated to be between 1 in 278 to 1 in 1960 women. Preoperative examination, free informed consent following discussion about the risks and complications associated with morcellation, as well as research on the contraindications to the use of morcellation are the crucial points addressed by learned societies. The main solution recommended at present is morcellation confined to a laparoscopic bag.
There is a risk of morcellating an occult sarcoma when performing a myomectomyor hysterectomy for fibroids. Implementing the use of morcellation containment bags should be the norm. The use of minimally invasive surgery (laparoscopic orvaginal) and the associated benefit-risk ratio compared to a laparotomy should also be discussed with the patient before the operation.
本综述旨在重申子宫肉瘤应具备的流行病学特征、临床体征和放射学征象，以及在治疗子宫肌瘤患者时有助于预防子宫肉瘤粉碎术的术前和术后预防原则。
我们通过检索截至2017年2月28日的PubMed、Medline和Cochrane系统评价数据库进行本综述，使用以下关键词：肌瘤、平滑肌瘤、肉瘤、平滑肌肉瘤、子宫癌、子宫肌瘤切除术、子宫切除术、粉碎术和子宫粉碎术。我们还利用所选文章的参考文献列表，在北美和欧洲专门从事妇产科的学术团体网站上查找更多数据。
在子宫肌瘤粉碎术的情况下，未诊断出子宫肉瘤的风险估计为每278至1960名女性中有1例。术前检查、在讨论粉碎术相关风险和并发症后获得自由的知情同意，以及研究粉碎术的禁忌证是学术团体关注的关键点。目前推荐的主要解决办法是将粉碎术限制在腹腔镜袋内进行。
在对肌瘤进行子宫肌瘤切除术或子宫切除术时，存在粉碎隐匿性肉瘤的风险。应常规使用粉碎术 containment 袋。术前还应与患者讨论使用微创手术（腹腔镜或阴道手术）以及与开腹手术相比的相关利弊。
