宫颈癌手术变迁与关键技巧(郑州会议).pptVIP

* * * * * * * * * * Cibula et al. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecologic Oncology 2011; 122: 264-268. Cibula et al. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecologic Oncology 2011; 122: 264-268. Cibula et al. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecologic Oncology 2011; 122: 264-268. 水平一 水平二 水平三 水平四 III型手术导致的后果 III型手术损伤自主神经 膀胱功能障碍 性功能障碍 结肠直肠功能障碍 NERVE SPARING RADICAL HYSTERECTOMY 宫颈癌手术的进展 保留神经的根治性子宫切除术（Nerve sparing radical hysterectomy，NSRH） 根治性宫颈切除术（Radical Trachelectomy，RH） 宫颈癌手术的难点 Wertheim手术已经历100多年，Wertheim - Meigs手术（1945 - 2014）也有近70年，但对于精细的血管解剖和神经解剖不够清楚。 手术的难点在于主韧带的处理与膀胱宫颈韧带的处理。 — 主韧带的血管神经解剖？？？ — 膀胱宫颈韧带的血管神经解剖？？？ 腹腔镜下根治性子宫切除术的几个关键步骤： — 1.盆腔淋巴结切除：右侧盆腔淋巴结切除.mp4 — 2.直肠宫颈间隙（Douglas窝）的处理：分离直肠宫颈间隙（douglas窝）.mp4 — 3.分离两个侧窝：分离右侧膀胱侧窝和直肠侧窝、起始部切断和游离右侧子宫动脉.mp4 — 4.右侧膀胱宫颈韧带的处理：分离切断右侧膀胱宫颈韧带前后叶.mp4 研究与探索NSRH 更加清晰认识： 主韧带、膀胱宫颈韧带血管精细解剖 盆腔自主神经的精细解剖 Fig. 1. Development of the pararectal space and paravesical space S. Fujii / Gynecologic Oncology 111 (2008) S33–S41 Fig. 2. Isolation of the deep uterine vein. Fig. 3. Division of the deep uterine vein reveals the pelvic splanchnic nerve. Fig. 4. Isolation and division of the hypogastric nerve. Fig. 5. The anterior leaf of the vesicouterine ligament. Fig. 6. The posterior leaf of the vesicouterine ligament. Fig. 7. Blood vessels in the posterior leaf of the vesicouterine ligament. Fig. 8. Division of the middle vesical vein. Fig. 9. Division of the inferior vesical vein reveals the bladder branch from the inferior hypogastric plexus. Fig. 10. Cross-shaped inferior hypogastric plexus and isolation of the uterine branch from the plexus. Fig. 11. Division of the uterine branch creates T-shaped nerve plane of the inferior hypogastric