Höckel M, Konerding M A, Heussel C P
Department of Obstetrics and Gynecology, University of Mainz, Germany.
Am J Obstet Gynecol. 1998 May;178(5):971-6. doi: 10.1016/s0002-9378(98)70533-2.
Our purpose was to improve the therapeutic index of radical hysterectomy by extending the resection of parametrial tissue without further impairing pelvic autonomic nerve functions.
We studied the topographic anatomy of the parametrial tissue with high-resolution magnetic resonance imaging and by dissection of fresh human cadavers. We then performed a clinical feasibility study of the liposuction-assisted nerve-sparing extended radical hysterectomy.
Magnetic resonance imaging demonstrated that the perispinous adipose tissue is retained after type III radical hysterectomy and is a frequent site of tumor recurrence. The perispinous adipose tissue contains the pelvic plexus, the pelvic splanchnic nerves, small blood vessels, and lymphatic tissue. We developed the liposuction-assisted nerve-sparing extended radical hysterectomy and applied it to seven consecutive patients with cervical or vaginal cancer. No intraoperative or postoperative complications occurred. Postoperative magnetic resonance imaging assured us that perispinous adipose tissue was cleared in all cases. A metastatic lymph node was found in the perispinous adipose tissue removed by liposuction from one patient. Suprapubic cystostomies could be removed after a median period of 12 days.
The nerve-sparing removal of perispinous adipose tissue by liposuction is a feasible addition to wide en bloc parametrectomy in anatomically defined planes.
我们的目的是通过扩大宫旁组织切除术来提高根治性子宫切除术的治疗指数，同时不进一步损害盆腔自主神经功能。
我们通过高分辨率磁共振成像和新鲜人体尸体解剖研究了宫旁组织的局部解剖结构。然后我们进行了一项吸脂辅助保留神经扩大根治性子宫切除术的临床可行性研究。
磁共振成像显示，III型根治性子宫切除术后棘周脂肪组织得以保留，且是肿瘤复发的常见部位。棘周脂肪组织包含盆腔丛、盆内脏神经、小血管和淋巴组织。我们开发了吸脂辅助保留神经扩大根治性子宫切除术，并将其应用于7例连续的宫颈癌或阴道癌患者。未发生术中或术后并发症。术后磁共振成像证实所有病例的棘周脂肪组织均被清除。从1例患者吸脂切除的棘周脂肪组织中发现了一个转移淋巴结。耻骨上膀胱造瘘管在中位时间12天后可以拔除。
通过吸脂保留神经切除棘周脂肪组织，在解剖学定义的平面上是广泛整块子宫旁切除术的一种可行补充。
