经阴道广泛性子宫切除术中输尿管损伤的应用解剖研究  

Anatomy study of ureter injury in vaginal radical hysterectomy

作　　者：赵杉珊[1] 钟梅[1] 陈春林[1] 郭遂群[1] 刘萍[1] 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515

出　　处：《中国实用妇科与产科杂志》2008年第4期289-291,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：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 provide the anatomic basis for vaginal radical hysterectomy by studying the anatomic characters of ureter near the cervix. Methods Thirteen cases of fresh uterus were collected by the operation of vaginal radical hysterectomy and ureters were observed on the basis of positions marked in the operation. Results （ 1 ） Ureter was near the cervix in the vesieo-cervical-vaginal ligament;（2） VCVL were classified into two types： Ⅰ , cervical type（ 38% ）, Ⅱ , cervical-vaginal type （62%） ;（ 3 ）The distance of point X to line A, in type Ⅰ ,left was（ 2.16 ± 1.00 ）cm, right was（ 2.68 ± 0.79 ） cm ; in type Ⅱ ,left was （ 2.37 ± 0.93 ） cm, right was （ 1.69 ± 0.95 ） cm ; （4） The distance of point X to line B/C, in type Ⅰ ,left was （ 1.12 ± 0.83 ） cm, right was （0.96 ± 0.55 ） cm ;in type Ⅱ,left was （ 0.67 ± 0.60 ） cm, right was （ 0.43 ± 0.31 ） cm ; （5） The distance of point X to point Y, in type Ⅰ , left was （ 2.24 ± 0.63 ） cm, right was （ 1.68 ± 0.44 ） cm ; in type Ⅱ ,left was （ 3.21 ± 0.75 ） cm, right was（2.89 ± 0.76 ） cm. Conclusion To search the ureter tunnel and the point X, separate and resect ureter near the cervix accurately on the basis of anatomic basis can reduce the incidence of the ureter injury in the vaginal radical hysterectomy.

关 键 词：经阴道广泛性子宫切除术 膀胱宫颈阴道韧带 输尿管膝部 

分 类 号：R71[医药卫生—妇产科学]