中国实用妇科与产科杂志2013，Vol.29Issue(6)：473-479,7.
广泛子宫切除术中主韧带应用解剖研究
The study on surgical anatomy of the cardinal ligament in radical hysterectomy
摘要
Abstract
Objective The purpose of this study was to understand further into the composition of cardinal ligament and its relationship with pelvic extra-peritoneal spaces from the surgical anatomy point of view and to provide a new precise skeletal dissection model for radical hysterectomy (RH).Methods 10 fixed Chinese female cadavers from Education and Research Office of Anatomy in Cangzhou Medical Specialized School were involved in this study.The ligamentous structure of cardinal ligament and pelvic spaces were examined and recorded carefully.The anatomic landmarks of cardinal ligament associated with Piver classification of RH was analyzed.Results (1) The cardinal ligament was a double-layered fascia surrounding mesentery-like structure between the paravesical space and the pararectal space.In the sheath,the core was composed of the blood vessels from internal iliac artery and vein and pelvic splanchnic nerve from S3.The deep uterine vein was the borderline vessel between the blood part and the nerve part.(2)The mean width of left cardinal ligament weas (5.31 ± 0.74) cm and the right was (5.48 ± 0.68) cm.The means of caudal depth of cardinal ligament were (5.76 ± 0.55) cm (left) and (5.51 ± 0.39) cm (right) respectively.The means of cranial depth of cardinal ligament were (4.93 ± 0.41)cm (left) and (4.81 ± 0.48)cm (right) respectively.The pararectal space was shallower than the paravesical space and with much more blood vessels in its bottom.(3)The blood vessels in the cardinal ligament varied largely and the basic vessels were superior vesical artery,middle vesical artery,uterine artery,superficial uterine vein,deep uterine vein,middle rectal vessel and vaginal vein was the most important vessel for surgery.(4)The anatomic landmarks for Piver classification in the cardinal ligament were uterine artery different points (medial to ureter,originating point from internal iliac artery),superior vesical artery and lateral umbilical artery.Conclusion The cardinal ligament is mesentery-like structure with abundant blood vessels and nerve in it located in pelvic extra-peritoneal space.A new understanding about cardinal ligament in radical hysterectomy would lead to a new model of RH--from en bloc resection to precise skeletal dissection.关键词
广泛子宫切除术/主韧带/尸体解剖/临床解剖Key words
radical hysterectomy/ cardinal ligament / cadaver dissection / surgical anatomy分类
医药卫生引用本文复制引用
吴小华,刘世凯,杨波,郭亮,隋月林,孙杨,刘晓旭,梁军,周楠..广泛子宫切除术中主韧带应用解剖研究[J].中国实用妇科与产科杂志,2013,29(6):473-479,7.基金项目
河北省杰出青年科学基金(C2010002011) （C2010002011）
