Kato Tomoyasu, Murakami Gen, Yabuki Yoshihiko
Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
Jpn J Clin Oncol. 2003 Nov;33(11):589-91. doi: 10.1093/jjco/hyg107.
Nerve-sparing radical hysterectomy was established by Japanese gynecologists. They identified two parts of the cardinal ligament, namely the vascular part and the neural part, and postulated that the neural part contained the pelvic splanchnic nerves. However, our fresh cadaver studies demonstrated that these nerves ran dorsomedially in contrast to the classical concept. The aim of this study is to further validate this finding in clinical cases.
We examined the intraoperative biopsy specimens collected from the neural part of the cardinal ligament in four patients with cervical carcinoma who underwent nerve-sparing radical hysterectomy with dissection of the neural part.
Careful dissections demonstrated that the pelvic splanchnic nerves arise from the dorsomedial side of the neural part at the bottom of the pararectal space. The neural part was composed of a connective tissue with focal positive staining by S-100 protein.
We propose that complete dissection of the cardinal ligament should be performed during nerve-sparing hysterectomy to increase its radicality.
保留神经的根治性子宫切除术由日本妇科医生创立。他们确定了主韧带的两个部分，即血管部分和神经部分，并推测神经部分包含盆内脏神经。然而，我们的新鲜尸体研究表明，与传统概念相反，这些神经向背内侧走行。本研究的目的是在临床病例中进一步验证这一发现。
我们检查了4例宫颈癌患者在接受保留神经的根治性子宫切除术并对神经部分进行解剖时从主韧带神经部分采集的术中活检标本。
仔细解剖显示，盆内脏神经起源于直肠旁间隙底部神经部分的背内侧。神经部分由一种经S-100蛋白局灶性阳性染色的结缔组织组成。
我们建议在保留神经的子宫切除术中应完整解剖主韧带，以提高其根治性。
