Ercoli A, Delmas V, Gadonneix P, Fanfani F, Villet R, Paparella P, Mancuso S, Scambia G
Department of Gynecology, Catholic University, Rome, Italy.
Surg Radiol Anat. 2003 Jul-Aug;25(3-4):200-6. doi: 10.1007/s00276-003-0137-7. Epub 2003 Aug 9.
Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.
根治性子宫切除术是国际妇产科联盟（FIGO）IA2-IIA期宫颈癌的首选治疗方法。它会引发多种严重并发症，比如因自主神经系统手术创伤导致的泌尿和肛门直肠功能障碍。为了确定在经典根治性子宫切除术和保留神经的根治性子宫切除术中涉及神经损伤风险的手术步骤，我们在大量经过防腐处理的新鲜女性尸体中研究了盆筋膜、血管和神经结构之间的关系。我们发现，经典根治性子宫切除术后潜在去神经支配的范围与手术的根治程度直接相关。具有高神经损伤风险的手术步骤是切除子宫骶韧带、膀胱子宫韧带和子宫颈旁组织。如果能仔细识别并遵循特定的切除界限，如子宫深静脉，那么保留神经的宫颈癌根治性子宫切除术方法是可行的。然而，保留神经的手术努力应与切除疾病及其所有潜在局部扩散途径的肿瘤学优先事项相平衡。
