Obstet Gynecol. 2019 Mar;133(3):604-605. doi: 10.1097/AOG.0000000000003127.
Morcellation is a surgical technique used to reduce the size of the uterus or myomas by creating smaller pieces to allow the tissue to be removed through small incisions or with laparoscopic instruments. Open (uncontained) morcellation of the uterus and myomas has been scrutinized because of the possible spread of an unsuspected leiomyosarcoma while using a power morcellator during a hysterectomy or myomectomy for presumed symptomatic uterine leiomyomas. Before considering open morcellation of the uterus, a woman should be evaluated to determine if she is at increased risk of malignancy of the uterine corpus. Morcellation of a malignancy is contraindicated, and women should be evaluated preoperatively to identify malignancy. However, leiomyosarcoma cannot be reliably diagnosed preoperatively; thus, there is a risk that a woman with a presumed leiomyoma may have a malignancy that may be spread through morcellation, leading to a potentially worsened prognosis. Although an abdominal hysterectomy or myomectomy may reduce the chance of spreading cancer cells in women with undiagnosed leiomyosarcoma, it is associated with increased morbidity when compared with minimally invasive approaches. The obstetrician-gynecologist and patient should engage in shared decision making, including informed consent explaining the risks and benefits of each approach to surgery for presumed leiomyomas, the risks and benefits of morcellation, and alternatives to morcellation.
子宫旋切术是一种通过将子宫或肌瘤切成小块来缩小其体积的手术技术，以便通过小切口或腹腔镜器械将组织切除。由于在子宫切除术或子宫肌瘤剔除术中使用电动旋切器时可能会无意中传播未被发现的平滑肌肉瘤，因此对开放性（非封闭性）子宫旋切术和子宫肌瘤旋切术进行了仔细审查。在考虑进行开放性子宫旋切术之前，应评估女性是否存在子宫体恶性肿瘤的风险增加。不建议对恶性肿瘤进行旋切术，并且应在术前对女性进行评估以确定是否存在恶性肿瘤。然而，平滑肌肉瘤不能可靠地在术前诊断；因此，患有疑似平滑肌瘤的女性可能患有恶性肿瘤，这些肿瘤可能通过旋切术传播，从而导致预后恶化。尽管腹部子宫切除术或子宫肌瘤剔除术可能会降低未确诊的平滑肌肉瘤患者癌细胞扩散的机会，但与微创手术方法相比，它会增加发病率。妇产科医生和患者应共同做出决策，包括知情同意书，解释每种手术方法治疗疑似平滑肌瘤的风险和益处、旋切术的风险和益处，以及旋切术的替代方法。
