Two important factors determine the success of a TVH for a woman with an enlarged uterus. One factor is vaginal relaxation and uterine mobility, which is important in performing a TVH in a patient with an enlarged uterus without descensus (12). Womnen who have had many vaginal deliveries have a more relaxed vagina,whereas the vaginal vault can be restricted with difficult access to the uterine vessel in a nullipara. Another factor determining the success of TVH is the surgeon's ability to perform uterine morcellation (9). Uterine morcellation was needed and performed in all patients who underwent TVH and LAVH in this study. Vaginal morcellation of an enlarged uterus. although time consuming, is safe and effective. We preferred the technique of applying traction with a tenacula on the cutting end of the uterus followed by a series of wedge resections (9)and vaginal myomectomies (9) in a patient with uterine fibroids. Other techniques such as bisection (9).coring (13),the Pryor technique (14)and the Lash procedure (15) are also effective. The surgeon has to be familiar with all techniques because a combination increases the success of surgery. 

                                                                          [Acta obster Gynecol Scand .2002;(81):1132-1138]

對(duì)于一個(gè)子宮增大的女性來(lái)說(shuō)，陰式子宮切除術(shù)(TVH)取決于兩個(gè)因素。一個(gè)因素是陰道松緊度和子宮活動(dòng)度，這對(duì)于一個(gè)子宮增大而無(wú)下垂的女性在施行TVH時(shí)非常重要。多次陰道分娩的女性，陰道更加松弛，而未產(chǎn)婦的陰道穹隆很緊，不易處理子宮血管。決定TVH成功與否的另一個(gè)因索是手術(shù)醫(yī)師實(shí)施子宮分碎術(shù)的技能。本研究中所有進(jìn)行TVH和腹腔鏡輔助下的陰式子宮切除術(shù)(LAVH)的病人都需要施行子宮分碎術(shù)。一個(gè)增大子宮的陰道分碎術(shù)雖然耗時(shí)，但是安全有效。對(duì)于子宮肌瘤患者，我們更傾向于使用牽引術(shù)，將拉鉤放在子宮切口末端，之后進(jìn)行一系列楔形切除術(shù)和陰式子宮肌瘤剝除術(shù)。其他諸如對(duì)切術(shù)，挖除術(shù)，Pryor技術(shù)，以及Lash過(guò)程也很有效。外科醫(yī)師必須熟練操作所有技術(shù)，因?yàn)榫C合利用這些技術(shù)能增加手術(shù)成功率。

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