背景:根治性子宫切除术的解剖学描述和范围通常在世界各地的文献和手术报告中有所不同。相同的术语通常用于描述不同的程序,和不同的术语经常被用来描述相同的程序,尽管有指南和分类系统。这使得很难解释回顾性手术报告,分析外科数据库,了解技术描述,并解释外科研究的结果。
目的:与国际妇科肿瘤专家合作,本研究的目的是在定义和解释2017年更新的Querleu-Morrow根治性子宫切除术分类法方面达成共识.
方法:A型解剖模板,B,和C根治性子宫切除术由尸体解剖时拍摄的一组13张图像记录。与根治性子宫切除术命名和相关程序的定义/描述相关的在线调查在国际根治性子宫切除术专家中分发。采用三步改进的德尔菲法建立共识。根据专家的回应对图像图例进行了修改,然后作为第二轮调查的一部分进行了重新分配。对有关特定图像的问题的“是”答复表明了共识。欢迎任何回答“否”问题的人发表评论并提供理由。建立了最后一组图像和图例,以在解剖学上说明和定义/描述侧面,腹侧,和宫颈周围组织的背侧切除。
结果:总共有13个问题需要审查。29名专家完成了整个过程。除一个问题外,所有问题的最终共识均超过90%(86%)。共识率相对较低的问题涉及A型和B2型根治性子宫切除术的定义,这是2017年更新版本2008Querleu-Morrow分类的主要创新。共识率最高的问题涉及B1和C类型的定义,这是最常进行的根治性子宫切除术。
结论:2017年版本的Querleu-Morrow分类被证明是定义和描述根治性子宫切除术范围的可靠工具,在国际妇科肿瘤专家中具有高度共识。在临床实践和临床研究中,必须了解和实施子宫切除术的确切定义。
The anatomic descriptions and extents of radical hysterectomy often vary across the literature and operative reports worldwide. The same nomenclature is often used to describe varying procedures, and different nomenclature is often used to describe the same procedure despite the availability of
guideline and classification systems. This makes it difficult to interpret retrospective surgical reports, analyze surgical databases, understand technique descriptions, and interpret the findings of surgical studies.
In collaboration with international experts in gynecologic oncology, the purpose of this study was to establish a consensus in defining and interpreting the 2017 updated Querleu-Morrow classification of radical hysterectomies.
The anatomic templates of type A, B, and C radical hysterectomy were documented through a set of 13 images taken at the time of cadaver dissection. An online survey related to radical hysterectomy nomenclature and definitions or descriptions of the associated procedures was circulated among international experts in radical hysterectomy. A 3-step modified Delphi method was used to establish
consensus. Image legends were amended according to the experts\' responses and then redistributed as part of a second round of the survey.
Consensus was defined by a yes response to a question concerning a specific image. Anyone who responded no to a question was welcome to comment and provide justification. A final set of images and legends were compiled to anatomically illustrate and define or describe a lateral, ventral, and dorsal excision of the tissues surrounding the cervix.
In total, there were 13 questions to review, and 29 experts completed the whole process. Final
consensus exceeded 90% for all questions except 1 (86%). Questions with relatively lower consensus rates concerned the definitions of types A and B2 radical hysterectomy, which were the main innovations of the 2017 updated version of the 2008 Querleu-Morrow classification. Questions with the highest
consensus rates concerned the definitions of types B1 and C, which are the most frequently performed radical hysterectomies.
The 2017 version of the Querleu-Morrow classification proved to be a robust tool for defining and describing the extent of radical hysterectomies with a high level of consensus among international experts in gynecologic oncology. Knowledge and implementation of the exact definitions of hysterectomy radicality are imperative in clinical practice and clinical research.