Hoffman Mitchel S, Williams Vonetta, Salihu Hamisu M, Gunasekaran Sivaselvi, Sayer Robyn A, Hakam Ardeshir, Roberts William S
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of South Florida College of Medicine, Tampa, FL, USA.
Am J Obstet Gynecol. 2008 Aug;199(2):191.e1-7; discussion 191.e7. doi: 10.1016/j.ajog.2008.04.030. Epub 2008 Jun 13.
The objective of the study was to analyze the histopathologic content of the vascular portion of the cardinal ligament in patients undergoing radical hysterectomy for cervical cancer.
The vascular portion of the cardinal ligament was completely removed during radical hysterectomy. The maximum cervical diameter and length of the vascular ligament were measured on the fresh specimen. After inking, the pathologist separated and embedded the entire vascular segment from each side. Microscopic examination followed.
Eighty-four patients were available for analysis. The mean cervical diameter was 3.9 cm (2-8), whereas the mean vascular segment length on the right and left sides were 4 cm (1-10) and 3.8 cm (1-7), respectively. Mean number of vascular segment lymph nodes were as follows: medial right = 0.7 (0-4), medial left = 0.6 (0-5), lateral right = 0.4 (0-3), and lateral left = 0.6 (0-6). Mean diameter of medial and lateral lymph nodes were 2 mm (0.25-8) and 3.3 mm (0.25-16), respectively. The length of the vascular segment correlated inversely with maximum cervical diameter. Thirty-one percent (26 of 84) had positive pelvic side wall lymph nodes. Fourteen patients had positive vascular segment lymph nodes (1 positive = 7, more than 1 positive = 7). Three of 7 patients had bilateral positive vascular segment lymph nodes; all 7 had microscopic disease in the paravaginal soft tissue, and all 7 had positive pelvic side wall lymph nodes (6 of 7 bilateral). Including the 14 patients, a total of 19 had nodal or nonnodal microscopic disease in the vascular segment. Of these, 7 had disease in the lateral half of the vascular ligament. Histologic sectioning revealed nerve twigs and/or scattered ganglia in the vascular segment but no large nerve trunks.
Among a population of women with high-risk, early-stage cervical cancer, the lateral vascular segment of the cardinal ligament contained metastatic disease in a substantial number of patients. This segment contains no major nerve trunks. When radical hysterectomy is chosen as primary treatment for such patients, the vascular segment of the cardinal ligament should be completely excised.
本研究的目的是分析接受宫颈癌根治性子宫切除术患者主韧带血管部分的组织病理学内容。
在根治性子宫切除术中完全切除主韧带的血管部分。在新鲜标本上测量宫颈最大直径和血管韧带长度。染色后，病理学家从每一侧分离并包埋整个血管段。随后进行显微镜检查。
84例患者可供分析。宫颈平均直径为3.9厘米（2 - 8厘米），而右侧和左侧血管段的平均长度分别为4厘米（1 - 10厘米）和3.8厘米（1 - 7厘米）。血管段淋巴结的平均数量如下：右侧内侧 = 0.7（0 - 4），左侧内侧 = 0.6（0 - 5），右侧外侧 = 0.4（0 - 3），左侧外侧 = 0.6（0 - 6）。内侧和外侧淋巴结的平均直径分别为2毫米（0.25 - 8毫米）和3.3毫米（0.25 - 16毫米）。血管段长度与宫颈最大直径呈负相关。31%（84例中的26例）盆腔侧壁淋巴结阳性。14例患者血管段淋巴结阳性（1个阳性 = 7例，1个以上阳性 = 7例）。7例患者中有3例双侧血管段淋巴结阳性；所有7例阴道旁软组织均有微观病变，所有7例盆腔侧壁淋巴结均阳性（7例中有6例双侧阳性）。包括这14例患者，共有19例在血管段有淋巴结或非淋巴结微观病变。其中，7例在血管韧带外侧半有病变。组织切片显示血管段有神经小支和/或散在的神经节，但无大的神经干。
在高危早期宫颈癌女性人群中，相当数量患者的主韧带外侧血管段存在转移性疾病。该段不含主要神经干。当选择根治性子宫切除术作为此类患者的主要治疗方法时，应完整切除主韧带的血管段。
