腹腔镜高位宫骶韧带悬吊术的术中解剖探讨

李文静; 邹果芳; 刘文慧; 潘修远

doi:10.11659/jjssx.01E025010

您当前的位置：

首页 >

文章列表页 >

腹腔镜高位宫骶韧带悬吊术的术中解剖探讨

临床研究 | 更新时间：2026-01-19

- 腹腔镜高位宫骶韧带悬吊术的术中解剖探讨
- Intraoperative anatomy of laparoscopic high uterosacral ligament suspension
- 局解手术学杂志 2026年35卷第1期页码：66-70
- 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：
  
  李文静，E-mail：ccyd61@163.com
- 基金信息：
  
  2021年度韶关市科技计划项目（粤北人民医院高水平医院建设）立项项目(210927074532408)
- DOI：10.11659/jjssx.01E025010
  中图分类号： R711.23
- 收稿：2025-01-03，
  
  纸质出版：2026-01-25
- 稿件说明：
移动端阅览
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

Sima YZ ， Chen YS . MSC-based therapy in female pelvic floor disorders ［J］. Cell Biosci ， 2020 ， 10 （ 1 ）： 1 - 21 . doi： 10.1186/s13578-020-00466-4 http://dx.doi.org/10.1186/s13578-020-00466-4 .

中华医学会妇产科学分会妇科盆底学组 . 盆腔器官脱垂的中国诊治指南（2020年版）［J］. 中华妇产科杂志， 2020 ， 55 （ 5 ）： 300 - 306 . doi： 10.3760/cma.j.cn112141-20200106-00016 http://dx.doi.org/10.3760/cma.j.cn112141-20200106-00016 .

赵林业，王丽，吴倩，等 . 阴部神经相关选穴对针灸治疗压力性尿失禁疗效影响的Meta分析［J］. 浙江中西医结合杂志， 2023 ， 33 （ 6 ）： 563 - 569 . doi： 10.3969/j.issn.1005-4561.2023.06.022 http://dx.doi.org/10.3969/j.issn.1005-4561.2023.06.022 .

徐婉婉，赵小峰 . 治疗中盆腔缺陷的盆底修复手术方式研究进展［J］. 浙江医学， 2021 ， 43 （ 6 ）： 687 - 690 . doi： 10.12056/j.issn.1006-2785.2021.43.6.2019-1236 http://dx.doi.org/10.12056/j.issn.1006-2785.2021.43.6.2019-1236 .

Glazener CM ， Breeman S ， Elders A ， et al . Mesh，graft，or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery：two parallel-group，multicentre，randomised，controlled trials （PROSPECT）［J］. Lancet ， 2017 ， 389 （ 10067 ）： 381 - 392 . doi： 10.1016/S0140-6736（16）31596-3 http://dx.doi.org/10.1016/S0140-6736（16）31596-3 .

Nager CW ， Visco AG ， Richter HE ， et al . National institute of child health and human development pelvic floor disorders network. Effect of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse： 5-year results of a randomized clinical trial ［J］. Am J Obstet Gynecol ， 2021 ， 225 （ 2 ）： 153.e1 - 153.e31 . doi： 10.1016/j.ajog.2021.03.012 http://dx.doi.org/10.1016/j.ajog.2021.03.012 .

艾贵海，成佳景，李怀芳，等 . 女性前盆底重建术的临床解剖研究［J］. 局解手术学杂志， 2019 ， 28 （ 6 ）： 425 - 428 . doi： 10.11659/jjssx.12E018091 http://dx.doi.org/10.11659/jjssx.12E018091 .

Sutkin G ， Zyczynski HM ， Sridhar A ， et al . Association between adjuvant posterior repair and success of native tissue apical suspension ［J］. Am J Obstet Gynecol ， 2020 ， 222 （ 2 ）： 161.e1 - 161.e8 . doi： 10.1016/j.ajog.2019.08.024 http://dx.doi.org/10.1016/j.ajog.2019.08.024 .

DeLancey JO ， Sørensen HC ， Lewicky-Gaupp C ， et al . Comparison of the puborectal muscle on MRI in women with POP and levator ani defects with those with normal support and no defect ［J］. Int Urogynecol J ， 2012 ， 23 （ 1 ）： 73 - 77 . doi： 10.1007/s00192-011-1527-8 http://dx.doi.org/10.1007/s00192-011-1527-8 .

刘西鹏，丁明德，张辉，等 . 腹腔镜下自体筋膜修复术治疗DeLancey Ⅰ和Ⅱ水平盆腔脏器脱垂的近期效果［J］. 河北医药， 2024 ， 46 （ 16 ）： 2491 - 2494 . doi： 10.3969/j.issn.1002-7386.2024.16.021 http://dx.doi.org/10.3969/j.issn.1002-7386.2024.16.021 .

Kieserman-Shmokler C ， Swenson CW ， Chen L ， et al . From molecular to macro： the key role of the apical ligaments in uterovaginal support ［J］. Am J Obstet Gynecol ， 2020 ， 222 （ 5 ）： 427 - 436 . doi： 10.1016/j.ajog.2019.10.006 http://dx.doi.org/10.1016/j.ajog.2019.10.006 .

赵小峰，陈功立，雷玲，等 . 腹腔镜下间隙解剖观察阴道三水平理论的关键解剖结构［J］. 浙江大学学报（医学版）， 2018 ， 47 （ 4 ）： 329 - 337 . doi： 10.3785/j.issn.1008-9292.2018.08.01 http://dx.doi.org/10.3785/j.issn.1008-9292.2018.08.01 .

欧阳银鸾，王瑞，徐婉婉，等 . 子宫骶韧带内侧膜解剖间隙：从探索到临床应用［J］. 手术电子杂志， 2023 ， 10 （ 4 ）： 5 - 9 . doi： 10.3969/j.issn.2095-8331.2023.04.002 http://dx.doi.org/10.3969/j.issn.2095-8331.2023.04.002 .

夏志军，宋悦 . 女性泌尿盆底疾病临床诊治［M］. 北京：人民卫生出版社， 2016 ： 80 - 108 .

商晓，朱兰，郎景和，等 . 宫骶韧带悬吊术的中国女性在体生物力学研究［J］. 中华妇产科杂志， 2018 ， 53 （ 10 ）： 700 - 704 . doi： 10.3760/cma.j.issn.0529-567x.2018.10.009 http://dx.doi.org/10.3760/cma.j.issn.0529-567x.2018.10.009 .

Jones KA ， Feola A ， Meyn L ， et al . Tensile properties of commonly used prolapse meshes ［J］. Int Urogynecol J Pelvic Floor Dysfunct ， 2009 ， 20 （ 7 ）： 847 - 853 . doi： 10.1007/s00192-008-0781-x http://dx.doi.org/10.1007/s00192-008-0781-x .

刘玮 . 腹腔镜下骶韧带高位悬吊术治疗中盆腔缺陷的临床效果［J］. 中国当代医药， 2021 ， 28 （ 24 ）： 152 - 154 . doi： 10.3969/j.issn.1674-4721.2021.24.043 http://dx.doi.org/10.3969/j.issn.1674-4721.2021.24.043 .

王倩，夏志军 . 高位宫骶韧带悬吊术治疗中盆腔缺陷的研究进展［J］. 国际妇产科学杂志， 2021 ， 48 （ 2 ）： 213 - 218 . doi： 10.12280/gjfckx.20200493 http://dx.doi.org/10.12280/gjfckx.20200493 .

田梦，王雅莉 . POP合并CPP腹腔镜下高位骶韧带悬吊术后疗效分析［D］. 郑州：郑州大学， 2023 .

Houlihan S ， Kim-Fine S ， Birch C ， et al . Uterosacral vault suspension （USLS） at the time of hysterectomy： laparoscopic versus vaginal approach ［J］. Int Urogynecol J ， 2019 ， 30 （ 4 ）： 611 - 621 . doi： 10.1007/s00192-018-3801-5 http://dx.doi.org/10.1007/s00192-018-3801-5 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

生物反馈电刺激对腹腔镜下子宫悬吊术后盆腔器官脱垂的临床疗效

经阴道自然腔道内镜手术在盆腔器官脱垂中的应用

术前口服碳水化合物对超重或肥胖患者Trendelenburg体位行腹腔镜子宫切除的影响

改良腹腔镜子宫骶骨固定术治疗盆腔器官脱垂的临床疗效