腹腔镜子宫颈癌根治术中子宫血管与输尿管走行关系的研究

The role of concomitant relationship between uterine blood vessel and ureter in the laparoscopic radical resection of cervical cancer

目的研究子宫血管与输尿管的走行关系,指导在子宫动脉阻断术中对子宫血管和输尿管的准确游离。方法对18例宫颈癌患者实施腹腔镜下根治性子宫切除术,术中游离子宫血管和输尿管,观察不同部位子宫血管和输尿管的走行关系、变异并测量两管腔的间距。结果子宫动脉起始点至与输尿管交叉处长度为2.5～4.0 cm。此段子宫动脉与输尿管的关系为子宫动脉起始点位于输尿管外下方,两者的距离为1.0～1.5 cm,自起始点子宫动脉前上、前内走行,延伸为略低或平行于输尿管,至交叉处跨越至输尿管上方。子宫动脉与输尿管交叉点至子宫峡部的血管长度为1.2～1.8 cm,子宫动脉干终点与输尿管入膀胱处距离为1.0 cm。结论子宫动脉阻断术中,前路阻断电凝子宫动脉注意防止输尿管热损伤;后路阻断在子宫动脉输尿管交叉点头侧应在输尿管外侧平行输尿管或略低于输尿管处找寻子宫动脉;侧路阻断在输尿管外下方1.0～1.5 cm处可找到子宫动脉起始点。

Objective This study was aimed to determine the concomitant relationship of uterine blood vessel and ureter in the laparoscopic radical resection of cervical cancer. Methods A total of 18 cervical cancer patients were recruited in this study. During the lapa- roscopic radical hysterectomy process, the uterine artery and ureter were dissected carefully. Their concomitant relationship, variation and the distance of these two lumina in different parts were measured. Results The length between the origin of uterine artery and its point across ureter was 2.5 - 4.0 cm. Uterine artery is lower than ureter at starting point about 1.0 - 1.5 cm, then inclining slightly anteriorly and superiorly until it reach the cross point. The length between cross point of uterine artery and its end point is 1.2 - 1.8 cm. The distance between vessel end point and ureter end point is 1.0 cm. Conclusions Our data indicated the anatomical location of uterine artery and ureter which may help to reduce the complication during the surgery.