腹腔镜子宫深静脉入路宫颈癌根治术  

A novel direct approach to the deep uterine vein in laparoscopic radical hysterectomy

作　　者：张婷[1] 秦珊珊[1] 郁胜胜 于鹃鹏[1] 宋禹辰 高迎春[1] Zhang Ting;Qin Shanshan;Yu Shengsheng;Yu Juanpeng;Song Yuchen;Gao Yingchun(The Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University, Huaian 223300, China)

机构地区：[1]南京医科大学附属淮安市第一人民医院妇科,淮安223300

出　　处：《中华腔镜外科杂志（电子版）》2021年第6期363-364,共2页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：患者取膀胱截石位,全身麻醉,建立二氧化碳人工气腹,采用常规腹腔镜宫颈癌根治术的穿刺点置入Trocar。进入腹腔后首先定位阔韧带后叶的输尿管位置,打开其表面腹膜,分离输尿管周围筋膜,向外上牵拉输尿管,逐步向盆底方向分离,可以显露子宫深静脉。继续向膀胱方向分离,可以显露膀胱上静脉,血管夹双重夹闭,在子宫深静脉回流入髂内静脉部位血管夹双重夹闭。在输尿管的外上方分离子宫动脉,在近髂内动脉处血管夹双重夹闭,如果需切除附件,则在子宫动脉夹闭后,分离卵巢动(静)脉,然后夹闭。所有夹闭血管暂时均不切断,作为后面手术的解剖标志。其余手术步骤同常规宫颈癌根治术。The patient took the bladder lithotomy position and underwent general anesthesia.Then carbon dioxide artificial pneumoperitoneum was established.Trocar was placed at the puncture point of conventional laparoscopic radical cervical cancer.After entering the abdominal cavity,we identified the ureter on the posterior peritoneum,and the peritoneum was dissected just above the ureter.By continuously exploring the pelvic cavity along the ureter,especially through the opening of the space below the ureter in a cranial to caudal direction,we could easily identify.Continue to dissect the deep uterine vein towards the bladder,we exposed the deep bladder vein.Then we clamped the blood vessel at the part where the deep uterine vein flows back into the internal iliac vein.Next,we separated the uterine artery at the outer upper part of the ureter,and clamped the vessel.If you need to cut off the accessories,separate the ovarian arteriovenous after the uterine artery clamped,and then clamp it.All clamped vessels were not cut off temporarily and used as anatomical markers for subsequent surgery.The next steps were the same as routine radical hysterectomy for cervical cancer.

关 键 词：子宫深静脉 宫颈癌 广泛子宫切除术 腹腔镜 

分 类 号：R73[医药卫生—肿瘤]