宫旁解剖与早期宫颈癌的宫旁组织处理

Parametrial Anatomy and Parametrium Management for Early Stage Cervical Cancer

目前认为,宫旁组织是指起于子宫、宫颈、阴道旁,终于盆腔侧壁的额状三维组织平面。Querleu-Morrow手术分型(简称Q-M手术分型)依据该解剖学基础及相对应的宫旁转移模式,以具体解剖结构作为宫旁组织切除的标志,提出宫颈癌最新手术分型,获得了标准化和个体化的宫旁组织处理,目前在临床广泛应用,其中宫旁淋巴结的单独切除、保留盆腔自主神经等理念具有重要意义。多项研究着眼于探讨宫旁转移低危的早期宫颈癌患者行较小切除范围的手术术式及其安全性和可行性,其结果尚待进一步明确。宫旁淋巴结(PLN)的检出、引流模式以及前哨淋巴结活检的应用也是目前及未来长期的研究热点。

Parametrium is now widely accepted as a three-dimensional anatomic plane locating between uterine, cervix, vagina and the pelvic lateral wall. Based on anatomical theory and the corresponding model of parametrial metastasis, the latest surgery classification of cervical cancer was proposed by the Querleu-Morrow classification ( Q-M classification) and has been widely accepted in clinical practice. In the Q-M classification, specific anatomical structures are taken as the landmarks for parametrium resection. A standardized and individualized parametrium management have been recommended consequently. It is also of great significance to highlight the concepts of parametrial lymph node ( PLN) resection and pelvic autonomic nerve preservation. A number of studies have been conducted to investigate the safety and feasibility of less radical surgery in low-risk paramatrial metastasis candidates. PLN detection, its drainage patterns and the application of sentinel lymph node biopsy are also hot spots presently and in the long run.