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]

对于一个子宫增大的女性来说，阴式子宫切除术(TVH)取决于两个因素。一个因素是阴道松紧度和子宫活动度，这对于一个子宫增大而无下垂的女性在施行TVH时非常重要。多次阴道分娩的女性，阴道更加松弛，而未产妇的阴道穹隆很紧，不易处理子宫血管。决定TVH成功与否的另一个因索是手术医师实施子宫分碎术的技能。本研究中所有进行TVH和腹腔镜辅助下的阴式子宫切除术(LAVH)的病人都需要施行子宫分碎术。一个增大子宫的阴道分碎术虽然耗时，但是安全有效。对于子宫肌瘤患者，我们更倾向于使用牵引术，将拉钩放在子宫切口末端，之后进行一系列楔形切除术和阴式子宫肌瘤剥除术。其他诸如对切术，挖除术，Pryor技术，以及Lash过程也很有效。外科医师必须熟练操作所有技术，因为综合利用这些技术能增加手术成功率。

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