DeLancey J O
Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor.
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1717-24; discussion 1724-8. doi: 10.1016/0002-9378(92)91562-o.
Our aim was to understand how vaginal eversion after hysterectomy differs from other forms of prolapse.
The role of individual structures involved in vaginal support was studied by pelvic dissection of 61 cadavers. Serial cross sections from 13 additional cadavers were examined.
The upper third of the vagina (level I) is suspended from the pelvic walls by vertical fibers of the paracolpium, which is a continuation of the cardinal ligament. In the middle third of the vagina (level II) the paracolpium attaches the vagina laterally to the arcus tendineus and fascia of the levator ani muscles. The vagina's lower third fuses with the perineal membrane, levator ani muscles, and perineal body (level III). Dissection reveals that the paracolpium's vertical fibers in level I prevented prolapse of the vaginal apex and vaginal eversion.
The paracolpium in level I forms the critical factor that differentiates vaginal eversion from posthysterectomy cystocele-rectocele or enterocele in which the vaginal apex remains well suspended.
我们的目的是了解子宫切除术后阴道外翻与其他形式脱垂的不同之处。
通过对61具尸体进行盆腔解剖，研究参与阴道支撑的各个结构的作用。检查了另外13具尸体的连续横断面。
阴道上三分之一（I级）通过阴道旁组织的垂直纤维悬吊于盆腔壁，阴道旁组织是主韧带的延续。在阴道中三分之一（II级），阴道旁组织将阴道外侧附着于肛提肌的腱弓和筋膜。阴道下三分之一与会阴膜、肛提肌和会阴体融合（III级）。解剖显示，I级阴道旁组织的垂直纤维可防止阴道顶端脱垂和阴道外翻。
I级阴道旁组织是区分阴道外翻与子宫切除术后膀胱膨出-直肠膨出或肠膨出的关键因素，在膀胱膨出-直肠膨出或肠膨出中，阴道顶端仍悬吊良好。
