Intraoperative anatomy of laparoscopic high uterosacral ligament suspension

LI Wen-jing; ZOU Guo-fang; LIU Wen-hui; PAN Xiu-yuan

doi:10.11659/jjssx.01E025010

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Intraoperative anatomy of laparoscopic high uterosacral ligament suspension

Clinical Research | 更新时间：2026-01-19

- Intraoperative anatomy of laparoscopic high uterosacral ligament suspension
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 35, Issue 1, Pages: 66-70(2026)
- 作者机构：
  
  1.粤北人民医院妇科，广东韶关 512026
  2.粤北人民医院人事科，广东韶关 512026
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.01E025010
  CLC： R711.23
- Received：03 January 2025，
  
  Published：25 January 2026
- 稿件说明：
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李文静,邹果芳,刘文慧等.腹腔镜高位宫骶韧带悬吊术的术中解剖探讨[J].局解手术学杂志,2026,35(01):66-70.

LI Wen-jing,ZOU Guo-fang,LIU Wen-hui,et al.Intraoperative anatomy of laparoscopic high uterosacral ligament suspension[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(01):66-70.
李文静,邹果芳,刘文慧等.腹腔镜高位宫骶韧带悬吊术的术中解剖探讨[J].局解手术学杂志,2026,35(01):66-70. DOI： 10.11659/jjssx.01E025010.

LI Wen-jing,ZOU Guo-fang,LIU Wen-hui,et al.Intraoperative anatomy of laparoscopic high uterosacral ligament suspension[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(01):66-70. DOI： 10.11659/jjssx.01E025010.

摘要

目的

探讨女性盆底Ⅰ水平右侧宫骶韧带的支撑结构特征，为腹腔镜下高位宫骶韧带悬吊术（HUS）的精准盆底修复提供解剖学依据。

方法

选取2022年1月至2023年12月就诊于粤北人民医院的妇科手术患者。将40例按盆腔器官脱垂定量分期法评为Ⅱ~Ⅲ度的中盆腔脱垂行腹腔镜下全子宫切除联合HUS的患者设为病例组；另选取40例因早期宫颈癌（ⅠA2~ⅠB2期，无盆腔器官脱垂）行腹腔镜下C型子宫切除术的患者设为对照组。术中应用腹腔镜宫颈癌手术间隙解剖理念，系统分离并辨识右侧宫骶韧带、主韧带、输尿管、直肠及子宫动脉等结构。重点观察右侧宫骶韧带的形态学特征，测量其长度及厚度，分析其与毗邻结构的解剖关系；设立宫骶韧带起点、分支点、坐骨棘点及终点，分析其与输尿管、直肠、子宫动脉距离；并通过牵拉评估其受力方向及强度，以明确悬吊手术的最佳锚定点。

结果

右侧宫骶韧带起始于骶骨前外侧骨面；自骶骨骨面发出的韧带纤维在起点远端2~3 cm处汇集成束状结构为分支点；子宫最大前倾位下显露的宫骶韧带上端为分支点；于坐骨棘水平面显露的宫骶韧带位置标记为坐骨棘点;终点位于宫颈周围环5点钟与7点钟位。病例组患者的宫骶韧带明显长于对照组，薄于对照组，差异均有统计学意义（

0.05）。2组患者右侧宫骶韧带分支点至终点距离比较，差异有统计学意义（

0.05）。2组患者坐骨棘点至终点距离比较，差异无统计学意义（

˃0.05）。2组患者右侧宫骶韧带的分支点、坐骨棘点、终点与直肠距离比较，差异均无统计学意义（

˃0.05）；右侧宫骶韧带的分支点、坐骨棘点、终点与输尿管的距离则越向下则越近。2组患者宫骶韧带终点与子宫动脉距离均稍小于1 cm，组间比较无统计学差异（

0.05）。选择坐骨棘点作为锚定点时，其定位位置更低且牵拉力方向向后，符合正常解剖状态。

结论

推荐坐骨棘点作为HUS的关键锚定点，悬吊缝合长度建议为5.5 cm，厚度约0.8 cm，缝合终点应抵达包含骶主韧带复合体的宫颈周围环，以增强悬吊力学强度。为避免术后泌尿系统并发症，建议从坐骨棘水平上方1 cm处沿宫骶韧带外侧缘精细解剖，钝性分离并推移输尿管至显露宫颈周围环。主韧带因力学支撑效能有限，无需进行解剖。

Abstract

Objective

To explore the supporting structure of right uterosacral ligament at the level Ⅰ in female pelvic floor，thereby providing an anatomical basis for precise repair of pelvic floor in laparoscopic high uterosacral ligament suspension（HUS）.

Methods

Patients who underwent gynecological surgery at Yuebei People's Hospital from January 2022 to December 2023 were selected. Among them， 40 cases with middle pelvic organ prolapse and graded Ⅱ to Ⅲ according to the pelvic organ prolapse quantification system， who underwent laparoscopic total hysterectomy combined with HUS were designated as the case group； 40 patients with early cervical cancer （ⅠA2 to ⅠB2 stage， without pelvic organ prolapse） who underwent laparoscopic C-type hysterectomy were selected as the control group. Based on the anatomical concept of laparoscopic cervical cancer surgical space， the structures such as the right uterosacral ligament，cardinal ligament，ureter， rectum，and uterine artery were dissected and recognized. The morphology of the right uterosacral ligament was carefully observed， its length and thickness were measured，and its relationship with the surrounding structures was analyzed. The starting point， branching point， ischial spine point， and ending point of the uterosacral ligament were established， and their distances to the ureter， rectum， and uterine artery were analyzed. The load-bearing direction and strength were assessed through traction to determine the optimal anchor points for suspension surgery.

Results

The right uterosacral ligament originated from the anterior-lateral bony surface of the sacrum； the ligament fibers converging from the sacral surface formed a distinct bundle， approximately 2 to 3 cm distal to the starting point was the branching point； the upper end of the exposed uterosacral ligament in the maximally anteverted position of the uterus was the branching point； the uterosacral ligament exposed at the ischial spine level was the ischial spine point； the endpoint was located on the three-dimensiona

l ring around the cervix between the 5 o'clock and 7 o'clock positions. The uterosacral ligaments of patients in the case group were significantly longer but thinner than those in the control group， with statistically significant differences （

0.05）. There was a statistically significant difference on the distances from the branching point to the ending point of the right uterosacral ligament between the two groups （

0.05）. The distances from the ischial spine point to the ending point between the two groups showed no statistically significant differences （

˃0.05）. The distances from the branching point， ischial spine point， and ending point of the uterosacral ligament to rectum between the two groups showed no statistically significant differences （

˃0.05）. The distances from the ureter to the branching point， ischial spine point， and ending point of the right uterosacral ligament decreased progressively in the downward direction. The distances from the ending point of uterosacral ligament to uterine artery of patients in the two groups were slightly less than 1 cm， without statistically significant difference between the groups （

0.05）. When choosing the ischial spine as anchor point， its positioning was lower and the direction of the pulling force was backwards， which was consistent with the normal anatomical conditions.

Conclusion

The ischial spine point is recommended as the key anchor point of HUS. The suggested suspension suture length is about 5.5 cm， with a thickness of approximately 0.8 cm， and the suture ending point should reach the three-dimensional ring around the cervix containing uterosacral-cardinal ligament complex to enhance the suspension force. To avoid postoperative urinary complications，it is recommended to conduct fine anatomy 1 cm above ischial spine along the outer side of uterosacral ligament， perform blunt separation and push ureter until exposing the three-dimensional ring around the cervix. The cardinal ligament does not require dissection due to its limited mechanical support efficiency.

关键词

Keywords

references

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