Nervenschonende radikale Hysterektomie I. Anatomische Grundlagen und Operationstechnik

Zusammenfassung

Fragestellung

Fragestellung: Kann der therapeutische Index bei der operativen Behandlung des Zervixkarzinoms verbessert werden?

Methodik

Methodik: Liposuction-assistierte Untersuchungen der topographischen Neuroanatomie im Becken weiblicher Körperspender bildeten die Grundlage für die Entwicklung der nervenschonenden radikalen Hysterektomie [11].

Ergebnisse

Ergebnisse: Die nervenschonende radikale Hysterektomietechnik unterscheidet sich von der traditionellen Wertheim-Meigs-Operation durch: 1. Resektion von zusätzlichem Risikogewebe, insbesondere im inferioren posterioren Parametrium sowie lateral und dorsal der großen Beckengefäße; 2. Reduktion des Gewebetraumas durch Präparation in durch die Embryonalentwicklung vorgegebenen Ebenen; 3. Darstellen und Schonen wesentlicher Anteile des autonomen Beckennervensystems.

Schlussfolgerung

Schlussfolgerung: Die Umsetzung neuer anatomischer und tumorbiologischer Erkenntnisse in die Technik der nervenschonenden radikalen Hysterektomie eröffnet eine Möglichkeit, die operative Behandlung des Zervixkarzinoms zu verbessern.

Abstract

Objective

Objective: To improve the therapeutic index of the surgical treatment of cervical cancer.

Methods

Methods: The technique of nerve-sparing radical hysterectomy was developed based on liposuction-assisted neuroanatomical studies of the female pelvis.

Results

Results: Compared with conventional radical hysterectomy, the nerve-sparing procedure permitted the resection of more parametrial tissue, particularly in the inferior and posterior parametrium as well as lateral to and behind the major vessels. Tissue trauma was reduced by dissection along embryologically preformed planes. Major portions of the autonomic pelvic nerve supply were dissected out and preserved.

Conclusions

Conclusions: The application of new anatomical and tumor biological findings in nerve-sparing radical hysterectomy may improve the surgical treatment of cervical cancer.

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