UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

子宫次全切除术后的子宫颈切除术

Authors
Rosanne M Kho, MD
Javier F Magrina, MD
Section Editor
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
王新宇, 主任医师

引言

在子宫次全切除术后行子宫颈切除术以切除残留宫颈，通常用于治疗子宫次全切除术后发生的子宫颈症状或疾病。在一项纳入70例接受了子宫次全切除术的连续女性患者的病例系列研究中，17例(24%)患者随后报告了如周期性阴道出血、盆腔痛和性交痛等症状[1]。术后周期性阴道出血通常是残留的子宫内膜所致，在数项比较子宫次全切除术与子宫全切除术的试验中，子宫次全切除术组有5%-20%的患者报告有术后周期性阴道出血[2-4]。疼痛和性交痛可能由粘连、宫颈纤维瘤或者子宫体分碎术所致，子宫体分碎术可导致疼痛性子宫肌层种植和/或子宫内膜异位症[5]。

本专题将总结子宫次全切除术后子宫颈切除手术的指征、操作技术和可能的并发症。早期宫颈癌女性保留生育力的根治性子宫颈切除术将单独讨论。 (参见“保留生育力的宫颈癌手术”)

指征

子宫颈切除术通常在子宫次全切除术后进行，以治疗残留宫颈所致的疾病或症状。它也可与其他盆腔手术(如卵巢切除术、肠切除术)联合进行。来自单个医疗机构的最大型子宫颈切除术病例系列研究中(n=310，1974-2003年间的病例)，最常见的指征有[6]：

●脱垂(52%)

●盆腔肿块(25%)

       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2015-08-19.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Okaro EO, Jones KD, Sutton C. Long term outcome following laparoscopic supracervical hysterectomy. BJOG 2001; 108:1017.
  2. Thakar R, Ayers S, Clarkson P, et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 2002; 347:1318.
  3. Gimbel H, Zobbe V, Andersen BM, et al. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG 2003; 110:1088.
  4. Learman LA, Summitt RL Jr, Varner RE, et al. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol 2003; 102:453.
  5. Hilger WS, Magrina JF. Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy. Obstet Gynecol 2006; 108:772.
  6. Hilger WS, Pizarro AR, Magrina JF. Removal of the retained cervical stump. Am J Obstet Gynecol 2005; 193:2117.
  7. Peruzzi WT, Candido KD. Respiratory care. In: Trauma: Critical Care, Wilson WC, Grande CM, Hoyt DB. (Eds), Informa Health Care USA Inc, New York 2007. Vol 2, p.492.
  8. Perrin M, Fletcher A. Laparoscopic abdominal surgery. Contin Educ Anaesth Crit Care Pain 2004; 4:107.
  9. Sheth SS. Vaginal excision of cervical stump. J Obstet Gynaecol 2000; 20:523.
  10. Margulies RU, Rogers MA, Morgan DM. Outcomes of transvaginal uterosacral ligament suspension: systematic review and metaanalysis. Am J Obstet Gynecol 2010; 202:124.
  11. Klauschie J, Wechter ME, Jacob K, et al. Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 2010; 17:504.
  12. Kho RM, Akl MN, Cornella JL, et al. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures. Obstet Gynecol 2009; 114:231.
  13. El-Zohairy MA. Trachelectomy: a review of 15 cases. J Egypt Natl Canc Inst 2010; 22:185.
  14. Parkar RB, Hassan MA, Otieno D, Baraza R. Laparoscopic Trachelectomy for Cervical Stump 'Carcinoma in situ'. J Gynecol Endosc Surg 2011; 2:58.
  15. Nezhat CH, Rogers JD. Robot-assisted laparoscopic trachelectomy after supracervical hysterectomy. Fertil Steril 2008; 90:850.e1.
  16. Nezhat CH, Nezhat F, Roemisch M, et al. Laparoscopic trachelectomy for persistent pelvic pain and endometriosis after supracervical hysterectomy. Fertil Steril 1996; 66:925.
  17. Pasley WW. Trachelectomy: a review of fifty-five cases. Am J Obstet Gynecol 1988; 159:728.