手術前推測子宮肌瘤之病人是否可接受子宮絞碎術之臨床建議

10.6666/ClinMed.201905_83(5).0048

施胤竹；陳怡仁；王鵬惠

絞碎術（morcellation） ； 高速碎瘤機（power morcellators） ； 子宮惡性肉瘤（uterine sarcoma） ； 惡性子宮平滑肌肉瘤（leiomyosarcoma）

臨床醫學月刊

83卷5期（2019 / 05 / 31）

287 - 293

繁體中文

絞碎術（morcellation）是將子宮或子宮肌瘤切成小塊組織使能穿過較小的傷口取出之手術方法，多應用於腹腔鏡手術。近期使用高速碎瘤機（power morcellators）切除子宮或子宮肌瘤的手術開始受到注意，若病人為未預期之子宮惡性疾病個案，手術中未將組織置於封閉環境中進行絞碎，組織的碎片有可能散佈造成疾病擴散，因此在病人預計接受子宮手術並於開放環境中進行組織絞碎之前需評估是否有子宮惡性疾病，但是其中子宮惡性肉瘤目前並沒有非常有效的術前評估方法，因此接受絞碎術之病人會有未預期子宮惡性肉瘤組織散佈風險而有較差之預後。以開腹子宮或子宮肌瘤切除手術取代腹腔鏡手術併絞碎術雖然可避免散佈惡性組織，但卻較常發生手術相關併發症，最終是否要接受絞碎術需要醫師與病人共同參與決策，完整的術前風險告知是必要的。

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