Schneider A, Possover M, Kamprath S, Endisch U, Krause N, Nöschel H
Department of Gynecology, Friedrich Schiller University, Jena, Germany.
Obstet Gynecol. 1996 Dec;88(6):1057-60. doi: 10.1016/S0029-7844(96)00307-9.
In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.
在腹腔镜辅助下根治性阴道子宫切除术中，腹腔镜用于分离膀胱旁间隙和直肠旁间隙。在对主韧带进行双极电凝至子宫深静脉水平后，将其分离并切断。经阴道途径，在输尿管进入膀胱柱之前予以识别。将子宫血管向下牵拉，直至在腹腔镜下可见其电凝端。切开膀胱宫颈反折后，抓住并游离子宫底（德德莱因手法）。通过将子宫颈和子宫底拉向对侧，暴露低位主韧带和子宫骶韧带。解剖并结扎主韧带和子宫骶韧带，然后切除标本。我们对33例宫颈癌患者实施了腹腔镜淋巴结清扫术联合根治性阴道子宫切除术。阴道手术阶段的平均手术时间为80分钟，腹腔镜手术阶段为215分钟，包括腹主动脉旁和盆腔淋巴结清扫以及主韧带的处理。4例患者需要输血。3例患者膀胱受损，1例患者左侧输尿管受损，另1例患者左侧髂内静脉受损。所有术中并发症均在一期手术时完成修复。未观察到瘘管形成。患者平均28天后完全康复。腹腔镜辅助下的绍塔 - 施托克方法可能被证明是传统根治性腹部子宫切除术的一种安全替代方法。
