Tinelli Andrea, Malvasi Antonio, Hurst Brad S, Tsin Daniel A, Davila Fausto, Dominguez Guillermo, Dell'edera Domenico, Cavallotti Carlo, Negro Roberto, Gustapane Sarah, Teigland Chris M, Mettler Liselotte
Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy.
JSLS. 2012 Jan-Mar;16(1):119-29. doi: 10.4293/108680812X13291597716302.
The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate. The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids, including pain, infertility, and reproductive outcomes.
子宫肌瘤假包膜是围绕平滑肌瘤的纤维神经血管结构，将其与正常外周肌层分隔开。子宫肌瘤假包膜由富含神经纤维的神经血管网络组成，类似于围绕前列腺的神经血管束。保留神经的根治性前列腺切除术与子宫肌瘤切除术有几个有趣的相似之处。它既可以作为现代子宫肌瘤手术切除的有用模型，也可以加速我们对纤维血管束和神经递质在包膜内子宫肌瘤切除术后生殖潜能的愈合和恢复中所起作用的理解。手术创新，如应用于包膜内技术的腹腔镜或机器人子宫肌瘤切除术，通过放大围绕平滑肌瘤的子宫肌瘤假包膜，起源于根治性前列腺切除术方法，该方法强调仔细解剖神经血管束以在前列腺切除术后保留性功能。轻柔地将子宫平滑肌瘤与假包膜神经血管束分离，减少了子宫出血和子宫肌肉组织损伤，同时保留了假包膜神经肽纤维。该技术对生殖功能产生了有利影响，并改善了生育结果。进一步的研究应确定肌瘤假包膜神经血管束在肌瘤的形成、生长和病理生理后果（包括疼痛、不孕和生殖结局）中的作用。
