Liposuction-assisted nerve-sparing extended radical hysterectomy:: Oncologic rationale, surgical anatomy, and feasibility study
Liposuction-assisted nerve-sparing extended radical hysterectomy:: Oncologic rationale, surgical anatomy, and feasibility study
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DOI：
10.1016/s0002-9378(98)70533-2
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发表时间：
1998-05-01
影响因子：
9.8
通讯作者：
Heussel, CP
中科院分区：
文献类型：
--
作者：
Höckel, M;Konerding, MA;Heussel, CP
目的：我们的目的是提高根治性子宫切除术的治疗指数，扩大切除宫旁组织，而不进一步损害盆腔自主神经functions.Study设计：我们研究了高分辨率磁共振成像和解剖新鲜的人类尸体的宫旁组织的局部解剖。结果：磁共振成像显示，III型根治性子宫切除术后，棘突周围脂肪组织残留，是肿瘤复发的常见部位。盆周脂肪组织包括盆丛、盆内脏神经、小血管和淋巴组织。我们开发了脂肪抽吸辅助神经保留广泛子宫切除术，并将其应用于7例宫颈癌或阴道癌患者。无术中或术后并发症发生。术后磁共振成像证实所有病例的棘突周围脂肪组织均被清除。1例患者在抽脂术切除的棘突周围脂肪组织中发现转移性淋巴结。耻骨上膀胱造口可以删除后，中位数为12 days.CONCLUSION：神经保留切除的脂肪抽吸术是一个可行的除了广泛的整块子宫旁切除术在解剖学定义的平面。
OBJECTIVE: Our purpose was to improve the therapeutic index of radical hysterectomy by extending the resection of parametrial tissue without further impairing pelvic autonomic nerve functions.STUDY DESIGN: We studied the topographic anatomy of the parametrial tissue with high-resolution magnetic resonance imaging and by dissection of fresh human cadavers. We then performed a clinical feasibility study of the liposuction-assisted nerve-sparing extended radical hysterectomyRESULTS: Magnetic resonance imaging demonstrated thai the perispinous adipose tissue is retained after type III radical hysterectomy and is a frequent site of tumor recurrence. The perispinous adipose tissue contains the pelvic plexus, the pelvic splanchnic nerves, small blood vessels, and lymphatic tissue. We developed the liposuction-assisted nerve-sparing extended radical hysterectomy and applied it to seven consecutive patients with cervical or vaginal cancer. No intraoperative or postoperative complications occurred. Postoperative magnetic resonance imaging assured us that perispinous adipose tissue was cleared in all cases. A metastatic lymph node was found in the perispinous adipose tissue removed by liposuction from one patient. Suprapubic cystostomies could be removed after a median period of 12 days.CONCLUSION: The nerve-sparing removal of perispinous adipose tissue by liposuction is a feasible addition to wide en bloc parametrectomy in anatomically defined planes.