Departments of Obstetrics and Gynecology, Neurology and Neurotherapeutics, and Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
Obstet Gynecol. 2019 May;133(5):896-904. doi: 10.1097/AOG.0000000000003221.
To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal ureter.
In this observational cadaveric study, 35 female cadavers were examined, 30 by gross dissections and five microscopically. Ureter length and segments of pelvic ureter were measured. Closest distances between the ureter and clinically relevant points were recorded. The distal pelvic ureter and surrounding parametrium were evaluated microscopically. Nerve density was analyzed using automated quantification of peripheral nerve immunostaining. Average measurements of nerve density in the anterior and posterior quadrants surrounding the ureter were statistically compared using a two-tailed t test. Descriptive statistics were used for analyses with distances reported as mean±SD (range).
Gross dissections revealed ureter length of 26.3±1.4 (range 24-29) cm (right), 27.6±1.6 (25-30.5) cm (left). Lengths of ureter from pelvic brim to uterine artery crossover were 8.2±1.9 (4.4-11.5) cm (right), 8.5±1.5 (4.5-11.5) cm (left) and from crossover to bladder wall 3.3±0.7 (2.4-5.8) cm (right), 3.2±0.4 (2.6-4.1) cm (left). Intramural ureter length was 1.5±0.3 (1-2.2) cm (right) and 1.7±1.2 (0.8-2.5) cm (left). Distances from the ureter to uterine isthmus: median 1.7 (range 1-3.0) cm (right) and 1.7 (1.0-2.9) cm (left); lateral anterior vaginal fornix 1.5 (1.0-3.1) cm (right) and 1.7 (0.8-3.2) cm (left); lateral vaginal apex 1.3 (1.0-2.6) cm (right) and 1.2 (1.1-2.2) cm (left) were recorded. Microscopy demonstrated denser fibrovascularity posteromedial to the ureter. Peripheral nerve immunostaining revealed greater nerve density posterior to the distal ureter.
Proximity of the ureter to the uterine isthmus and lateral anterior vagina mandates careful surgical technique and identification. The intricacy of tissue surrounding the distal ureter within the parametrium and the increased nerve density along the posterior distal ureter emphasizes the importance of avoiding extensive ureterolysis in this region.
进一步评估盆腔输尿管与临床相关结构的关系，并描述输尿管远端的解剖结构、组织学和神经密度。
在这项观察性尸体研究中，对 35 具女性尸体进行了检查，其中 30 具进行了大体解剖，5 具进行了显微镜检查。测量输尿管的长度和盆腔输尿管的节段。记录输尿管与临床相关点的最近距离。显微镜下评估远端盆腔输尿管和周围的子宫旁组织。使用外周神经免疫染色的自动量化分析神经密度。使用双侧 t 检验对输尿管周围前、后象限的神经密度进行统计学比较。距离的平均值采用均数±标准差（范围）表示，用于分析的描述性统计数据。
大体解剖显示右侧输尿管长度为 26.3±1.4cm（范围 24-29cm），左侧输尿管长度为 27.6±1.6cm（范围 25-30.5cm）。从骨盆边缘到子宫动脉交叉处的输尿管长度为 8.2±1.9cm（右侧）、8.5±1.5cm（左侧），从交叉处到膀胱壁的长度为 3.3±0.7cm（右侧）、3.2±0.4cm（左侧）。壁内输尿管长度为 1.5±0.3cm（右侧）和 1.7±1.2cm（左侧）。输尿管至子宫峡部的距离：中位数 1.7cm（范围 1-3.0cm）（右侧）和 1.7cm（范围 1.0-2.9cm）（左侧）；外侧前阴道穹窿 1.5cm（右侧 1.0-3.1cm）和 1.7cm（左侧 0.8-3.2cm）；外侧阴道顶点 1.3cm（右侧 1.0-2.6cm）和 1.2cm（左侧 1.1-2.2cm）。显微镜下显示输尿管后壁有更密集的纤维血管性组织。外周神经免疫染色显示远端输尿管后段神经密度增加。
输尿管与子宫峡部和外侧前阴道的接近需要谨慎的手术技术和识别。子宫旁组织内远端输尿管周围组织的复杂性以及沿远端输尿管后段神经密度的增加，强调了避免在该区域广泛输尿管松解的重要性。
