Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
Am J Obstet Gynecol. 2023 Aug;229(2):178-180. doi: 10.1016/j.ajog.2023.03.033. Epub 2023 Mar 25.
Dense adhesions because of severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterate the cul-de-sac and distort normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries and voiding dysfunction. Surgeons should recognize the importance of not only avoiding ureteral and rectal injuries but also focusing on the preservation of the hypogastric nerves. Herein, we reported the anatomic highlights and surgical steps of laparoscopic hysterectomy for posterior cul-de-sac obliteration with the nerve-sparing technique.
由于严重的子宫内膜异位症导致的后颈腹膜与前乙状结肠或直肠之间的致密粘连，使后穹窿封闭并使正常解剖标志变形。子宫内膜异位症手术与严重并发症相关，包括输尿管和直肠损伤以及排尿功能障碍。外科医生不仅应该认识到避免输尿管和直肠损伤的重要性，还应该关注下腹神经的保护。在此，我们报告了腹腔镜子宫切除术治疗后穹窿封闭的解剖要点和神经保护技术的手术步骤。
