Lichtenegger W, Anderhuber F, Ralph G
Baillieres Clin Obstet Gynaecol. 1988 Dec;2(4):841-56. doi: 10.1016/s0950-3552(98)80012-6.
Wertheim's radical operation aimed, by removing the parametrial tissue far from the tumour, to achieve margins free of disease. The paratissues contain the lymphatic channels draining the cervix. They run to the pelvic wall and are interspersed by lymph nodes scattered throughout the parametrium. If lymphadenectomy is to be curative then the entire parametrium must be removed. To this end the resection of the cardinal ligament was pushed to its limit by dissection directly at the pelvic wall. The surgical technique is guided by the anatomy of the pelvic fascia. The gaine hypogastrique lies just beneath the peritoneum and facilitates the opening of the paravesical space. The following are discussed: the condensations of the pelvic fascia; the composition of the cardinal ligament; the division into a venous, an arterial, and a neurovegetative root; and the anatomy of the connective tissue planes. The order in which the surgical steps are carried out is important. The paraspaces are opened first. The ureter is identified, and lymphadenectomy is performed. The rectum is dissected off the vagina, and the uterosacral ligaments are identified and removed. Only then is the vesico-uterine fold opened. The bladder is dissected off the vagina, and the anterior parametrium is clamped and divided. Now the cardinal ligament is completely exposed. The bladder, rectum and ureter have been mobilized so that the parametrium can be divided sharply directly at the pelvic wall, clipping the vessels step-by-step. The paracolpium is clamped and divided according to the proposed vaginal cuff. Thus, the entire lymphatic drainage can be removed. The value of this extension of radical abdominal hysterectomy lies especially in the treatment of large, voluminous tumours.
韦特海姆根治性手术旨在通过切除远离肿瘤的子宫旁组织，实现切缘无病灶。子宫旁组织包含引流子宫颈的淋巴管。它们通向盆腔壁，并散布着分布于整个子宫旁组织的淋巴结。如果淋巴结清扫术要达到治愈目的，那么必须切除整个子宫旁组织。为此，通过直接在盆腔壁进行解剖，将主韧带的切除推到极限。手术技术以盆筋膜的解剖结构为指导。下腹膜下筋膜位于腹膜下方，便于打开膀胱旁间隙。以下将讨论：盆筋膜的致密化；主韧带的组成；分为静脉、动脉和神经植物性根部；以及结缔组织平面的解剖结构。手术步骤的执行顺序很重要。首先打开侧间隙。识别输尿管并进行淋巴结清扫术。将直肠从阴道分离，识别并切除子宫骶韧带。只有到那时才打开膀胱子宫褶。将膀胱从阴道分离，钳夹并切断前子宫旁组织。现在主韧带完全暴露。膀胱、直肠和输尿管已游离，以便可以在盆腔壁直接锐性切断子宫旁组织，逐步钳夹血管。根据拟定的阴道袖口钳夹并切断阴道旁组织。这样，整个淋巴引流就可以被切除。这种扩大根治性腹式子宫切除术的价值尤其体现在治疗巨大肿瘤方面。
