[Studies on preservation of the vesical branch of the cardinal ligament in total hysterectomy for malignant uterine tumors].

A clinical study was conducted on the topographical anatomy of the cardinal ligament. It resulted in the discovery of findings given below, which were used as the basis for a new cardinal ligament procedure. This operative procedure was applied for the treatment of stage I endometrial carcinoma, for which a general consensus has never been reached as to the procedure of choice, and for the treatment of stage I b to III cervical carcinoma in older patients and those with various complications, type which in the past have received radiotherapy only. Conclusions reached as a result of this series of procedures are also presented. 1) The cardinal ligament bifurcates in Y-shape at about the mid point between the pelvic wall and the uterine cervix into the chordal tissues composed of nerve fibers and the veins returning from the post-lateral wall of the bladder (provisionally called vesical branch of the cardinal ligament), and into other chordal tissues composed of nerve fibers and the veins returning from the uterine cervix (provisionally called cervical branch of the cardinal ligament). Together with these two branches, the posterior part of the vesicouterine ligament forms a triangle, and the interior of which is filled with loose connective tissues. 2) The cervical branch of the cardinal ligament is severed at its base of bifurcation. In addition, the cardinal ligament between the bifurcation and the pelvic wall was cleaned by suction to preserve the profound uterine veins and pelvic nerves. In spite of this procedure, however, there was no postoperative trace of the radio-opaque medium that was dispersed preoperatively within the cardinal ligament. 3) The procedure was performed concurrently with pelvic lymphadenectomy during the period from October 1980 to June 1988 in 117 patient types as previous described. For the patients with stage I b to III of cervical carcinoma, radiotherapy with 40 Gy of whole pelvis was generally used concurrently. Loss of blood and time required for the described operation were significantly less (p less than 0.01) than those seen in radical hysterectomy. In addition, the number of days required to reduce the residual urine down to an acceptable level was significantly shorter (p less than 0.05) with this procedure. Although the number of days needed to resume spontaneous urination was shorter, it was not statistically significant.(ABSTRACT TRUNCATED AT 400 WORDS)