早期宫颈癌根治性子宫切除术.ppt

ART After completely separating the parametria, ligating the uterine vessels at their origins and completing the ureterolysis, an anterior colotomy is performed facilitated by a vaginal cylinder. 完全分离宫旁,断扎子宫血管及输尿管松解术后,经阴道的结肠前部切开就易于进行 ART A Wertheim clamp can be used to determine the vaginal resection margin. Wertheim钳用于确定阴道切开的边缘 ART Clamps are placed at the level of the internal os. 钳子置于宫颈内口 Using a knife, the radical trachelectomy is completed by separating the fundus from the isthmus or upper endocervix at approximately 5?mm below the level of the internal os.在宫颈内口下方5mm处分离并切除宫颈 ART Endometrial and upper endocervical curettage as well as a shave margin on the remaining tissue is sent for frozen-section. 内膜和颈管内刮宫及残余部分边缘快速病理 Frozen section is obtained on the endocervical margin. 取颈管内边缘部分做冰冻 Frozen section is obtained circumferentially on the vaginal cuff.阴道周缘部分做冰冻 ART A permanent cerclage with #0 Ethibond is placed and the knot tied posteriorly.  0号线环扎后部 ART Reconstruction of the uterine corpus to upper vagina after the cerclage is placed. 环扎后将阴道顶端重建于宫颈 ART The uterine fundus is reattached to the vaginal apex with 6 to 8 interrupted #2-0 absorbable sutures. 子宫体与阴道顶重新间断缝合 ART The reconstructed fundus with remaining blood supply from the intact utero-ovarian ligaments—uterine serosa without evidence of fundal ischemia. 在没有基底部局部缺血的证据时，重建宫体和卵巢固有韧带与子宫浆膜的血供 Robotic Radical Trachelectomy (RRT)机器人根治性子宫颈切除术 Chuang L et al, Fertility-sparing Robotic-assisted Radical Trachelectomy and Bilateral Pelvic Lymphadenectomy in Early-stage Cervical Cancer Journal of Minimally Invasive Gynecology, Vol 15, Issue 6, 2008, Pages 767-770 . Burnett A, Robotic radical trachelectomy and pelvic lymphadenectomy in early cervical cancer, Gynecol. Oncol. 112 (2009), p. S8. Six cases reported Intraoperative Margin Assessment术中切缘的评估 The peripheral soft tissue including the parametria is inked green while the LUS/EC margins are inked blue. 周边疏松组织及宫旁染成绿色而LUS/EC 边缘染成蓝色 In some cas