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目的探讨输尿管宫颈段的局部解剖学特征,为经阴道广泛性子宫切除术(VRH)术中避免输尿管损伤提供解剖学依据。方法收集2006年9月至2007年6月南方医科大学南方医院妇产科13份VRH术后新鲜离体子宫标本,术中标记与输尿管位置相关的位点,术后测量相关数据,分析输尿管宫颈段的局部解剖学特征。结果(1)输尿管宫颈段走行于膀胱宫颈阴道韧带(VCVL)内,输尿管膝部位于宫颈外口水平线(A线)之上,宫颈外侧壁垂直线(B或C线)的外侧。(2)根据其附着点的不同将VCVL分为宫颈型(Ⅰ型,5份)和宫颈阴道型(Ⅱ型,8份)。(3)输尿管膝部最低点(X点)到宫颈外口水平线的垂直距离:Ⅰ型中左、右两侧分别为(2.16±1.00)cm、(2.68±0.79)cm,Ⅱ型中左、右两侧分别为(2.37±0.93)cm、(1.69±0.95)cm。(4)X点到过阴道侧穹隆顶点的B或C线的水平距离:Ⅰ型中左、右两侧分别为(1.12±0.83)cm、(0.96±0.55)cm,Ⅱ型中左、右两侧分别为(0.67±0.60)cm、(0.43±0.31)cm。(5)X点到VCVL下部附着点(Y点)的距离:Ⅰ型中左、右两侧分别为(2.24±0.63)cm、(1.68±0.44)cm,Ⅱ型中左、右两侧分别为(3.21±0.75)cm、(2.89±0.76)cm。结论在VRH中,根据VCVL的分型及其下部附着点的位置,准确逆行找到输尿管膝部,并分离输尿管宫颈段是预防输尿管损伤、确保手术安全性的关键。
Objective To investigate the anatomic features of ureteric cervical segment and to provide anatomic evidence for preventing ureteral injury during radical vaginal hysterectomy (VRH). Methods From September 2006 to June 2007, 13 freshly isolated uterus specimens collected from gynecology and obstetrics department of Nanfang Hospital, Southern Medical University from September 2006 to June 2007 were collected. The sites related to the location of the ureter were marked during operation. Relevant data were measured after operation and the ureteric cervix Local anatomy of the segment. Results (1) The ureter cervical segment runs in the vesical cervix vaginal ligament (VCVL), and the ureter knee is located above the horizontal line of the external cervical orifice (line A) and outside of the vertical line of the external cervical wall (line B or C). (2) VCVL was divided into cervical type (typeⅠ, type5) and cervical vaginal type (typeⅡ, type8) according to their attachment points. (3) The vertical distance from the lowest point of ureter (X point) to the level of cervical external orifice: (2.16 ± 1.00) cm and (2.68 ± 0.79) cm in left and right sides of type Ⅰ, The right sides were (2.37 ± 0.93) cm and (1.69 ± 0.95) cm, respectively. (4) The horizontal distance from point X to the vertex of the vaginal vault B or C: The left and right sides of type Ⅰ were (1.12 ± 0.83) cm and (0.96 ± 0.55) cm respectively. The left and right of type Ⅱ The two sides were (0.67 ± 0.60) cm and (0.43 ± 0.31) cm, respectively. (5) The distance from point X to the lower point of VCVL (point Y): The left and right sides of type Ⅰ were (2.24 ± 0.63) cm and (1.68 ± 0.44) cm respectively, the left and right sides of type Ⅱ (3.21 ± 0.75) cm, (2.89 ± 0.76) cm. Conclusion In VRH, according to the classification of VCVL and the location of its lower attachment point, accurate retrograde finding of ureter laparotomy and separation of ureteric cervix can prevent ureteral injury and ensure the safety of surgery.