Niikura Hitoshi, Katahira Atsuko, Utsunomiya Hiroki, Takano Tadao, Ito Kiyoshi, Nagase Satoru, Yoshinaga Kohsuke, Tokunaga Hideki, Toyoshima Masafumi, Kinugasa Yusuke, Uchiyama Eiichi, Murakami Gen, Yabuki Yoshihiko, Yaegashi Nobuo
Department of Gynecology and Obstetrics, Tohoku University School of Medicine, Sendai, Japan.
Tohoku J Exp Med. 2007 Aug;212(4):403-13. doi: 10.1620/tjem.212.403.
Radical hysterectomy has been performed for invasive cervical cancer, and autonomic nerve-sparing procedures have been developed to preserve bladder function. To perform and improve the nerve-sparing radical hysterectomy, it is important to understand anatomy of the intra pelvic fasciae, specially vesico-uterine ligament (VUL), because most of injuries to the nerves occurred during incision of the VUL in radical hysterectomy procedures. The objectives of the present study were to provide histological understanding of major structures found in nerve-sparing radical hysterectomy. Serial macroscopic slices (15-20 mm thick) from five female pelves were trimmed and prepared for paraffin-embedded histology. We noted an anatomical entity as "the visceroparietal fascial bridge", which corresponds with the macroscopically identified arcus tendineus fasciae pelvis. A histologically identifiable neurovascular pedicle to the bladder neck corresponded with the deep portion of VUL. These findings could help better preservation of autonomic nerves during radical hysterectomy and improve patient's quality of life after the operation. Translation of surgical anatomy into anatomic terminology enables us to have fruitful discussions with persuasive power by excluding any bias from individual surgeons.
根治性子宫切除术已用于浸润性宫颈癌的治疗,并且已经开发出保留自主神经的手术方法以保留膀胱功能。为了实施并改进保留神经的根治性子宫切除术,了解盆腔筋膜的解剖结构,特别是膀胱子宫韧带(VUL)非常重要,因为在根治性子宫切除术中,大多数神经损伤发生在切开膀胱子宫韧带的过程中。本研究的目的是对保留神经的根治性子宫切除术中发现的主要结构进行组织学研究。从五个女性骨盆中获取连续的宏观切片(15 - 20毫米厚),修整后制成石蜡包埋的组织学切片。我们发现了一个解剖学实体,称为“脏壁筋膜桥”,它与宏观上确定的盆筋膜弓状腱相对应。膀胱颈的一个组织学上可识别的神经血管蒂与膀胱子宫韧带的深部相对应。这些发现有助于在根治性子宫切除术中更好地保留自主神经,并改善患者术后的生活质量。将手术解剖学转化为解剖学术语,使我们能够通过排除个别外科医生的任何偏见,进行有说服力的富有成效的讨论。