Nakamura Masaru, Tanaka Kyoko, Hayashi Shigenori, Morisada Tohru, Iwata Takashi, Imanishi Nobuaki, Aoki Daisuke
Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan.
Department of Obstetrics and Gynecology, Toho University School of Medicine, Japan.
Eur J Obstet Gynecol Reprod Biol. 2019 Apr;235:66-70. doi: 10.1016/j.ejogrb.2019.02.002. Epub 2019 Feb 16.
Radical hysterectomy is performed for invasive cervical cancer. In this surgery, separation of the anterior leaf and posterior leaves of the vesicouterine ligament (VUL) is important. We studied the local anatomy of the anterior leaf of the VUL, especially the branches of the umbilical artery from the view point of surgery and cadaver dissection.
We observed the cervicovesical blood vessels and the connective tissue layer continued from umbilical artery and searched for the origin of the cervicovesical blood vessels in radical hysterectomy. We also dissected a formalin-fixed female cadaver, and observed the same points.
After separation of the connective tissue of urinary bladder from the cervical fascia, we could discern the outline of the distal ureter near the ureterovesical junction. We separate the connective tissue of the so-called anterior leaf of the VUL enwrapping the ureter gently, and then the ureter with the connective tissue is completely rolled out laterally. We identified a cervicovesical vessel crossing over the ureter. We looked for the central side of the cervicovesical vessel and found that cervicovesical vessel was a branch of the superior vesical artery. And, during cadaver dissection, we found that the connective tissue and the branches of the superior vesical artery were similarly observed.
We found the precise anatomy of the connective tissue layer from umbilical artery to urinary bladder and the superior vesical artery. Our procedure based on the precise anatomy obtained in this study is reasonable anatomically as a method for separation of the vesicouterine ligament during radical hysterectomy.
根治性子宫切除术用于治疗浸润性宫颈癌。在该手术中，膀胱子宫韧带（VUL）前后叶的分离很重要。我们从手术和尸体解剖的角度研究了VUL前叶的局部解剖结构，尤其是脐动脉的分支。
我们观察了宫颈膀胱血管以及从脐动脉延续而来的结缔组织层，并在根治性子宫切除术中寻找宫颈膀胱血管的起源。我们还解剖了一具用福尔马林固定的女性尸体，并观察了相同的部位。
在将膀胱的结缔组织与宫颈筋膜分离后，我们可以在输尿管膀胱连接处附近辨别出远端输尿管的轮廓。我们轻轻地分离包裹输尿管的所谓VUL前叶的结缔组织，然后将输尿管连同结缔组织一起完全向外侧翻开。我们发现一条宫颈膀胱血管跨过输尿管。我们寻找宫颈膀胱血管的中央侧，发现宫颈膀胱血管是膀胱上动脉的一个分支。并且，在尸体解剖过程中，我们发现结缔组织和膀胱上动脉的分支情况与之相似。
我们发现了从脐动脉到膀胱以及膀胱上动脉的结缔组织层的确切解剖结构。我们基于本研究中获得的精确解剖结构所采用的手术方法，在解剖学上作为根治性子宫切除术中分离膀胱子宫韧带的一种方法是合理的。
