阴式全子宫切除术的相关解剖学研究进展

Anatomic Research Progress of Transvaginal Hysterectomy

阴式全子宫切除术(transvaginal hysterectomy,TVH)具有创伤小、出血少、腹部无瘢痕、术后恢复快、住院时间短、并发症少、手术费用低等优点。"在同等条件下,若能实施阴式手术,尽量以实施阴式手术为宜"这是国内外妇科专家达成的共识。尽管有确凿的证据支持经阴道途径,但对于国内外大多数医院而言,腹式全子宫切除仍占较大比例。影响TVH广泛开展的主要原因是手术医生的经验及阴式手术水平,其中最大的障碍是对解剖平面不熟悉,基于对出血和膀胱损伤的担忧,结合TVH的手术视野小、操作技术要求高,更阻碍了阴式手术的发展。综述TVH中涉及的解剖学知识,旨在为经阴式手术提供应用解剖学基础,为更好地推广阴式手术提供有用的资料。

Transvaginal hysterectomy（TVH） has the advantages of small trauma, little bleeding, no scar on the abdomen,quicker recovery, shorter hospitalization time, fewer complications and lower costs. ＂Under the same conditions, transvaginal route should be the first option for hysterectomy＂ is a consensus reached by gynecological experts all over the world. Although there is solid evidence to support vaginal access, abdominal total hysterectomy still accounts for a large proportion of domestic and foreign hospitals. The main reasons for the widespread development of TVH are the experience of the surgeon and the level of the vaginal operation. The biggest obstacle is the unfamiliarity of the anatomical plane. The concern of bleeding and urinary bladder damage, combined with the operation of TVH vision and high technical requirements of operation, hindered the development of vaginal surgery. Therefore, this article reviews the anatomical knowledge involved in TVH, which aims to provide the application of anatomical basis for transvaginal operation, and to provide useful data for better vaginal surgery.