Sieunarine K, Moxey P, Boyle D C M, Ungar L, Lindsay I, Del Priore G, Smith J R
Department of Gynaecology, Chelsea and Westminster Hospital at Imperial College School of Medicine, London, United Kingdom.
Int J Gynecol Cancer. 2005 Sep-Oct;15(5):967-73. doi: 10.1111/j.1525-1438.2005.00161.x.
While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.
在研发用于保守性宫颈癌治疗的腹式根治性宫颈切除术技术时，对子宫的血管供应进行了全面检查。子宫需要多少血管来维持其存活这一问题随之而来。在对1B期宫颈癌进行腹式根治性宫颈切除术后，仅通过两条漏斗骨盆血管就能成功维持子宫体的血液供应（n = 34）。采用该技术后已成功实现妊娠（n = 2）。在腹式根治性宫颈切除术中已采用选择性结扎盆腔血管。本研究的目的是研究漏斗骨盆韧带和阔韧带的血管系统，评估卵巢血管和子宫血管对子宫整体灌注的贡献，并探讨选择性盆腔血管结扎的临床应用。对10例良性全腹子宫切除术及双侧输卵管卵巢切除术标本的漏斗骨盆血管和阔韧带进行了新鲜解剖。在10例常规良性腹式子宫切除术中，在子宫角处按特定间隔使用改良探头测量灌注指数（PI）和氧饱和度（O₂Sat），以评估卵巢血管和子宫血管对子宫整体灌注的贡献，并且所研究的概念已应用于某些妇科手术中。卵巢/漏斗骨盆血管经阔韧带向内侧走行至子宫角，并始终在其外侧缘向卵巢发出一个分支。此外，还注意到有更多血管从子宫角沿卵巢韧带向外侧走行至卵巢内侧。PI和O₂Sat测量结果表明，子宫血管和卵巢血管对子宫灌注的贡献几乎相等。选择性结扎盆腔血管的临床应用已用于某些常易发生危及生命的大出血的妇科手术中。选择性临时结扎子宫血管和卵巢血管已被证明在化疗耐药性妊娠滋养细胞疾病的手术治疗、施特拉斯曼手术、输卵管间质部妊娠破裂时的保留生育功能手术以及难治性产后出血中是有用的。子宫的六条供血血管（卵巢血管、子宫血管和阴道血管）中，仅两条（卵巢血管或子宫血管或两者组合）就足以维持子宫存活。
