Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Gynecology and Obstetrics, Academical Medical Center, Amsterdam, The Netherlands.
Gynecol Oncol. 2014 Jan;132(1):107-13. doi: 10.1016/j.ygyno.2013.10.030. Epub 2013 Nov 4.
Radical hysterectomy with pelvic lymphadenectomy is the treatment of choice for early-stage cervical cancer. Wertheim's original technique has been often modified, mainly in the extent of parametrectomy. Okabayashi's technique is considered as the most radical variant regarding removal of the ventral parametrium and paracolpal tissues. Surgical outcome concerning recurrence and survival is good, but morbidity is high due to autonomic nerve damage. While the autonomic network has been studied extensively, the lymphatic system is less understood. This study describes the lymphatic drainage pathways of the cervix uteri and specifically the presence of lymphatics in the vesico-uterine ligament (VUL).
A developmental series of 10 human female fetal pelves was studied. Paraffin embedded blocks were sliced in transverse sections of 8 or 10 μm. Analysis was performed by staining with antibodies against LYVE-1 (lymphatic endothelium), S100 (Schwann cells), alpha-Smooth Muscle Actin (smooth muscle cells) and CD68 (macrophages). The results were three-dimensionally represented.
Two major pathways drained the cervix uteri: a supra-ureteral pathway, running in the cardinal ligament superior to the ureter, and a dorsal pathway, running in the utero-sacral ligament towards the rectal pillars. No lymph vessels draining the cervix uteri were detected in the VUL. In the paracolpal parametrium lymph vessels draining the upper vagina fused with those from the bladder.
The VUL does not contain lymphatics from the cervix uteri. Hence, the favorable survival outcomes of the Okabayashi technique cannot be explained by radical removal of lymphatic pathways in the ventrocaudal parametrium.
根治性子宫切除术加盆腔淋巴结清扫术是早期宫颈癌的首选治疗方法。Wertheim 的原始技术经常被修改，主要是在附件切除术的范围上。Okabayashi 的技术被认为是在切除腹侧附件和旁膜组织方面最激进的变体。手术结果在复发和生存方面良好，但由于自主神经损伤，发病率较高。虽然自主神经系统已经得到了广泛的研究，但淋巴系统的了解较少。本研究描述了子宫颈的淋巴引流途径，特别是在膀胱子宫韧带 (VUL) 中存在淋巴管。
研究了 10 个人类女性胎儿骨盆的发育系列。石蜡包埋块被切成 8 或 10 μm 的横切片。通过染色抗 LYVE-1（淋巴管内皮细胞）、S100（施万细胞）、α-平滑肌肌动蛋白（平滑肌细胞）和 CD68（巨噬细胞）来进行分析。结果以三维形式表示。
两条主要途径引流子宫颈：输尿管上方的超输尿管途径和朝向直肠柱的子宫骶骨韧带的背侧途径。在 VUL 中未检测到引流子宫颈的淋巴管。旁膜附件中的上阴道淋巴管与膀胱的淋巴管融合。
VUL 不包含来自子宫颈的淋巴管。因此，Okabayashi 技术的良好生存结果不能用腹侧后附件中淋巴途径的根治性切除来解释。
