腹腔鏡絞碎術取出惡性子宮平滑肌肉瘤的風險

Risk of Occult Uterine Leiomyosarcoma after Morcellation

絞碎術乃腹腔鏡手術中有效取出大病灶的方法，目的是不必擴大傷口即可取出大病灶，最多用在子宮肌瘤。但是，子宮惡性平滑肌肉瘤在手術前難以與良性肌瘤作區別。理論上，用絞碎術取出樣本，會有腫瘤細胞留在腹腔中，如屬惡性，會增加復發率和降低生存率，但至今仍未有足夠的證據加以證實。因此，術前必須與接受絞碎術的患者明確說明利弊得失與取代方法。

Morcellation is an effective method of specimen removal that can reduce the need for laparotomy in both benign and malignant lesions in laparoscopic operation. However, uterine leiomyosarcoma is difficult to differentiate from benign fibroids, and a reliable method of preoperative diagnosis is not available. Several authors demonstrate that dissemination of tumor cells in morcellation, resulting in increased rate of recurrence and poor survival is uncertain. Therefore patients should be adequately counseled to make an informed decision regarding undergoing a morcellation procedure.