Precise anatomy of the vesico-uterine ligament for radical hysterectomy
Precise anatomy of the vesico-uterine ligament for radical hysterectomy
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DOI：
10.1016/j.ygyno.2006.07.041
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发表时间：
2007-01-01
影响因子：
4.7
通讯作者：
Baba, Tsukasa
中科院分区：
文献类型：
--
作者：
Fujii, Shingo;Takakura, Kenji;Baba, Tsukasa
目标.为了阐明膀胱子宫韧带（VUL）的解剖结构，我们在Okabayashi根治性子宫切除术中在放大倍数（x2.5）下仔细分离VUL。59例患者（TNM命名：pTIb：39例，pT 2a：5例，pT 2b：7例，宫颈癌经动脉抗癌药物输注治疗后：8例）接受了这项细致的手术。在两个不同的时间点记录失血量：VUL分离期间和子宫切除后。在完全分离子宫动脉和子宫浅静脉与输尿管后，我们可以识别VUL前叶的真正结缔组织，在其中我们分离并分离出一束独特的血管：从膀胱到宫颈跨越输尿管的宫颈膀胱血管。前叶的其余组织仅为无血管结缔组织。VUL的后叶是位于输尿管下方的组织，连接膀胱后壁和侧宫颈/上侧阴道。在结缔组织中，我们发现了与子宫深静脉相连的膀胱中、下静脉。这些静脉的分离可使膀胱及输尿管与侧宫颈及阴道上段完全分离。VUL分离期间的平均失血量为20 ± 10 g（N=59），根治性子宫切除术后的平均失血量为189 ± 91.6 g（N=59）。VUL中的血管的精确网络被识别。对该解剖结构的了解对施行根治性子宫切除术是很重要的。(c)2006年爱思唯尔公司All rights reserved.
Objectives. To clarify the anatomy of the vesico-uterine ligament (VUL), we meticulously separated the VUL under magnification (x2.5) during Okabayashi's radical hysterectomy,Methods. Fifty-nine patients (TNM nomenclature: pTIb: 39, pT2a: 5, pT2b: 7, after trans-arterial anticancer-drug infusion treatment for the cervical cancer: 8) underwent this meticulous operation. Blood loss was recorded at two separate time points: during the separation of the VUL and after removal of the uterus.Results. After complete separation of the uterine artery and superficial uterine vein from the ureter, we could identify the genuine connective tissue of the anterior leaf of the VUL in which we isolate and divide a distinct bundle of blood vessels: the cervicovesical vessels that cross over the ureter from the bladder to the cervix. The remaining tissues in the anterior leaf is only avascular connective tissue. The posterior leaf of the VUL is the tissue residing under the ureter connecting the posterior wall of the bladder and the lateral cervix/upper lateral vagina. In the connective tissues, we identified the middle and inferior vesical veins connecting with the deep uterine vein. The division of these veins could separate the urinary bladder with ureters completely from the lateral cervix and upper vagina. The mean blood loss during the separation of the VUL was 20 +/- 10 g (N=59) and after radical hysterectomy was 189 +/- 91.6 g (N=59).Conclusion. A precise network of blood vessels in the VUL is identified. The knowledge of this anatomy is important to perform radical hysterectomy. (c) 2006 Elsevier Inc. All rights reserved.