Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Daegu, Korea.
Clin Anat. 2010 Mar;23(2):186-91. doi: 10.1002/ca.20915.
Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament.
许多关于保留神经的根治性子宫切除术的报告已经发表。然而，大多数报告都是基于剖腹手术或尸体解剖的系统描述。本工作旨在通过腹腔镜描述保留神经的根治性子宫切除术的盆腔解剖结构，重点关注下腹下丛。本研究基于 1999 年以来 125 例 FIGO 分期为 IB 期宫颈癌患者的腹腔镜保留神经根治性子宫切除术。通过腹腔镜显示下腹下丛，由骶神经根（S2、S3 和 S4）、骶交感神经节和腹下神经的传入纤维以及形成其膀胱、子宫阴道和直肠分支的传出纤维组成。在分离膀胱子宫韧带后叶时，识别出各种膀胱静脉。如果将下膀胱静脉的切缘向内牵拉并向上牵引，则暴露下腹下丛的膀胱分支，并将其分为内侧和外侧分支。腹腔镜的放大视图使得在分离子宫骶骨韧带、子宫直肠韧带和膀胱子宫韧带后叶的深部时，可以仔细解剖神经和血管，并确保清晰的切除边缘。
