Chrysostomou Andreas, Djokovic Dusan, Edridge William, van Herendael Bruno J
Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
Department of Obstetrics and Gynecology, Nova Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital S. Francisco Xavier - CHLO, Lisbon, Portugal.
Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:262-267. doi: 10.1016/j.ejogrb.2018.10.058. Epub 2018 Nov 1.
This project was established by the International Society for Gynecologic Endoscopy (ISGE) to provide evidence-based recommendations on the selection of women in whom vaginal hysterectomy can be safely performed.
The ISGE Task Force for vaginal hysterectomy for non-prolapsed uterus defined key clinical questions that led the literature search and formulation of recommendations. The search included Medline/PubMed and Cochrane Database. English language articles were reviewed from January 2003 to January 2018, in conjunction with reviews published by the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL). The bibliographies of selected works were also checked to acquire additional data where relevant. The available information was graded by the level of evidence using the approach developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. For each clinical question, the ISGE recommendations were defined in accordance with the evidence quality.
Six recommendations on patient selection for vaginal hysterectomy, including two grade 1B and four grade 2B recommendations were established.
Vaginal hysterectomy for non-prolapsed uterus is the treatment of choice for many gynaecological patients in whom hysterectomy is indicated. It may be safely executed, and thus, should be offered to a large group of appropriately selected women, who today are operated in the main by the abdominal or laparoscopic approach. All efforts should be directed towards teaching the technique of vaginal hysterectomy during residency.
本项目由国际妇科内镜学会（ISGE）设立，旨在为可安全实施阴道子宫切除术的女性选择提供循证建议。
ISGE非脱垂子宫阴道子宫切除术特别工作组确定了关键临床问题，这些问题引导了文献检索及建议的制定。检索包括Medline/PubMed和Cochrane数据库。对2003年1月至2018年1月期间的英文文章进行了综述，并结合美国妇产科医师学会（ACOG）和美国妇科腹腔镜医师协会（AAGL）发表的综述。还检查了所选著作的参考文献，以在相关情况下获取更多数据。使用推荐分级、评估、制定与评价（GRADE）工作组制定的方法，根据证据水平对现有信息进行分级。针对每个临床问题，ISGE根据证据质量确定了建议。
制定了六项关于阴道子宫切除术患者选择的建议，包括两项1B级建议和四项2B级建议。
对于许多有子宫切除术指征的妇科患者，非脱垂子宫阴道子宫切除术是首选治疗方法。它可以安全地实施，因此应提供给一大批经过适当选择的女性，目前这些女性主要通过腹部或腹腔镜手术进行治疗。在住院医师培训期间，应全力致力于教授阴道子宫切除术技术。
