保留神经的根治性子宫切除术:小林氏法。

IF 0.8 Q4 SURGERY
Surgery Journal Pub Date : 2021-09-30 eCollection Date: 2021-12-01 DOI:10.1055/s-0041-1728751
Hiroyuki Yoshikawa
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引用次数: 0

摘要

1921年,冈林教授引进了冈林手术后,几位外科医生在日本引进了许多改进措施。其中之一是所谓的东京方法,由尾野九作博士(1950年)、东京大学小林隆教授(1961年、1970年)和东京大学坂本昭一教授(1981年)改进和修订。保留神经的根治性子宫切除术于1961年被引入,并于1970年由小林教授改进。2自主神经通路包括胃下神经(交感神经)、盆腔植神经(副交感神经)和盆腔神经丛作为两神经的连接,以及神经丛通往膀胱的分支(膀胱神经分支),除晚期病例外,均得以保留。他将保神经手术过程分为四个步骤,将自主神经通路与相邻组织分离,沿该通路由枢机韧带、骶髂韧带、直肠肌/阴道韧带和膀胱外韧带组成。第一步是将主韧带(子宫深血管)与盆腔植神经分离。第二步是将被切断的主韧带内侧与盆腔神经丛分离。第一步和第二步是在自主神经系统的外侧进行的。第三步是从腹下神经和盆腔神经丛分离骶髂肌和直肠子宫肌/阴道韧带。第三步是实现高度根治性的必要步骤,即在不损伤盆腔神经丛的情况下切断直肠附近的骶髂韧带和直肠肌/阴道韧带。第四步是将阴道旁组织和膀胱外韧带的后(深)层与神经丛的膀胱神经分支分离。第三步和第四步在自主神经系统的内侧进行。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Nerve-Sparing Radical Hysterectomy: Kobayashi's Method.

Nerve-Sparing Radical Hysterectomy: Kobayashi's Method.

Nerve-Sparing Radical Hysterectomy: Kobayashi's Method.

Nerve-Sparing Radical Hysterectomy: Kobayashi's Method.

After Prof. S. Okabayashi introduced Okabayashi Operation in 1921, several surgeons introduced numerous improvements in Japan. One of them is so-called the Tokyo Method which was improved and revised by Dr. Kyusaku Ogino (1950), Prof. Takashi Kobayashi, University of Tokyo (1961, 1970), and Prof. Shoichi Sakamoto, University of Tokyo (1981). The nerve-sparing radical hysterectomy without sacrificing radicality was introduced in 1961 1 and improved in 1970 by Prof. Kobayashi. 2 The autonomic nerve pathway including hypogastric nerve (sympathetic nerve), pelvic splanchnic nerve (parasympathetic nerve), and pelvic nerve plexus as a junction of the two nerves and the branch of the plexus to the bladder (vesical nerve branch) are preserved except in advanced cases. He divided the process of nerve-sparing surgery into four steps for separating the autonomic nerve pathway from adjacent tissues along the pathway consisting of cardinal, sacrouterine, rectouterine/vaginal, and vesicouterine ligaments. The first step is separation of the cardinal ligament (deep uterine vessels) from the pelvic splanchnic nerve. The second step is separation of the medial side of severed cardinal ligament from the pelvic nerve plexus. The first and second steps are performed in the lateral side of the autonomic nerve system. The third step is separation of sacrouterine and rectouterine/vaginal ligaments from hypogastric nerve and pelvic nerve plexus. The third step is necessary for achieving high radicality, namely, for severing the sacrouterine and rectouterine/vaginal ligaments near the rectum without damage to the pelvic nerve plexus. The fourth step is separation of paravaginal tissues and posterior (deep) layer of the vesicouterine ligament from the vesical nerve branches of the plexus. The third and fourth steps are performed in the medial side of the autonomic nerve system.

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Surgery Journal
Surgery Journal SURGERY-
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