文章：

根治性子宫切除术与全子宫系膜切除术——两种治疗宫颈癌的解剖学概念

Radical Hysterectomy or Total Mesometrial Resection—Two Anatomical Concepts for Surgical Treatment of Cancer of the Uterine Cervix

原文发布日期：5 November 2023

DOI: 10.3390/cancers15215295

类型: Article

开放获取: 是

英文摘要：

A radical hysterectomy is the standard method of surgical treatment for patients with early-stage cancer of the uterine cervix. It was first introduced more than 100 years ago. Since then, various and many different radical procedures, which diverge in terms of radicality, have been described. Inconsistencies are clearly seen in practical anatomy, which were defined as surgically created artifacts. Moreover, the disparity of the procedure is most notable regarding the terminology of pelvic connective tissues and spaces. Despite these controversies, the procedure is widely performed and implemented in the majority of guidelines for the surgical treatment of cancer of the uterine cervix. However, a different and unique concept of surgical treatment of cervical cancer has been reported. It is based on ontogenetic anatomy and maps any tissue in the mature organism according to its embryologic development. The clinical implementation of this theory in the context of early cervical cancer is total mesometrial resection. The present article aims to describe and compare the anatomical and surgical basics of a radical hysterectomy (type C1/C2) and total mesometrial resection. Discrepancies regarding the terminology, resection lines, and surgical planes of both procedures are highlighted in detail. The surgical anatomy of the pelvic autonomic nerves and its surgical dissection is also delineated. This is the first article that compares the discrepancy of classic anatomy and ontogenic anatomy regarding surgical treatment of cancer of the uterine cervix. Clinical data, oncological outcome, and neoadjuvant and adjuvant treatment regarding both procedures are not the topic of the present article.

摘要翻译： 

根治性子宫切除术是早期宫颈癌患者手术治疗的标准方法，该术式于百余年前首次提出。此后，学界陆续描述了多种不同根治程度的术式变体。实践中可见明显的不一致性，这些差异被定义为手术人为因素造成的技术变异。尤其在盆腔结缔组织及间隙的术语命名方面，不同术式间存在显著差异。尽管存在这些争议，该术式仍在绝大多数宫颈癌手术治疗指南中得到广泛采用。 然而，近年来出现了一种基于个体发育解剖学的独特宫颈癌手术治疗理念。该理论依据胚胎发育规律对成熟机体的组织进行系统定位，其在早期宫颈癌治疗中的临床应用体现为全系膜子宫切除术。本文旨在系统阐述并比较根治性子宫切除术（C1/C2型）与全系膜子宫切除术的解剖学基础与手术原理，重点剖析两种术式在术语体系、切除范围及手术层面等方面的差异，同时详细描述盆腔自主神经的外科解剖及手术分离技术。本文首次系统比较了经典解剖学与个体发育解剖学在宫颈癌手术治疗中的理论差异，但关于两种术式的临床数据、肿瘤学结局及新辅助/辅助治疗等内容不在本文讨论范围内。

原文链接：

Radical Hysterectomy or Total Mesometrial Resection—Two Anatomical Concepts for Surgical Treatment of Cancer of the Uterine Cervix