Ceccaroni Marcello, Clarizia Roberto, Roviglione Giovanni, Ruffo Giacomo
Gynecologic Oncology and Minimally-Invasive Pelvic Surgery Unit, International School of Surgical Anatomy, Sacred Heart Hospital, Ospedale Sacro Cuore-Don Calabria, Via Don A. Sempreboni No. 5, 37024, Negrar, Verona, Italy,
Surg Endosc. 2013 Nov;27(11):4386-94. doi: 10.1007/s00464-013-3043-z. Epub 2013 Jun 20.
Efforts to improve approaches to the so called "parametrium" with minimally invasive and less dangerous techniques have led to a better study of the anatomic location and composition of that region. Nevertheless, many misconceptions and confusions about the anatomy of the posterior parametrium and its structures still remain. This study aimed to review anatomic and surgical data and to identify several clear landmarks and surgical steps for a nerve-sparing approach to posterior parametrectomy in the course of radical pelvic surgery with or without rectal resection.
The literature and anatomic dissections of fresh, embalmed, and formalin-fixed female pelvis cadavers were reviewed. The authors' laparotomic and laparoscopic case series also was reviewed for deep-infiltrating endometriosis as well as uterine, ovarian, and rectal cancer.
The anatomic entity commonly termed the "posterior parametrium" can be identified as the conjunction of three important anatomic structures (ligaments): the cranial structure (uterosacral ligaments), the caudad structure (rectovaginal ligaments), and the laterocaudad structure (lateral rectal ligaments). Identification of these structures (containing autonomic innervations for pelvic viscera) may allow an accurate nerve-sparing surgical approach in many radical pelvic operations.
The incidences of urinary, rectal, and sexual morbidity after radical pelvic surgical procedures for oncologic diseases (rectal/ovarian cancer, advanced endometrial/cervical cancer, posterior pelvic recurrences) and deep severe endometriosis can be reduced by better knowing and dissecting the right embryo-anatomic planes of the so-called "posterior parametrium."
人们致力于采用微创且危险性较低的技术来改进对所谓“子宫旁组织”的处理方法，这使得对该区域的解剖位置和组成有了更好的研究。然而，关于子宫后旁组织及其结构的解剖学仍存在许多误解和困惑。本研究旨在回顾解剖学和手术数据，并确定在进行或不进行直肠切除的根治性盆腔手术过程中，保留神经的子宫后旁组织切除术的几个明确标志和手术步骤。
回顾了新鲜、防腐处理及福尔马林固定的女性骨盆尸体的文献及解剖学研究。还回顾了作者的开腹手术和腹腔镜手术病例系列，涉及深部浸润性子宫内膜异位症以及子宫、卵巢和直肠癌。
通常被称为“子宫后旁组织”的解剖实体可被确定为三个重要解剖结构（韧带）的结合：头侧结构（子宫骶韧带）、尾侧结构（直肠阴道韧带）和外侧尾侧结构（直肠侧韧带）。识别这些结构（包含盆腔脏器的自主神经支配）可能有助于在许多根治性盆腔手术中采用精确的保留神经手术方法。
通过更好地了解和解剖所谓“子宫后旁组织”的正确胚胎解剖平面，可以降低针对肿瘤性疾病（直肠癌/卵巢癌、晚期子宫内膜癌/宫颈癌、盆腔后部复发）和深部严重子宫内膜异位症进行根治性盆腔手术后泌尿、直肠和性功能障碍的发生率。
