The Assessment Of Uterine Blood Supply After Abdominal Radical Trachelectomy With Three-Dimensional Computed Tomographic Angiography

Objective:Abdominal radical trachelectomy (ART) is a type C radical resection with the bilateral uterine vessels ligated at their origin from the hypogastric. Which artery supply the remaining uterus after ART? How does this kind of blood-supplying-mode influence on the function of the remaining uterus? This study aimed to determine the changes of pelvic arterial network after ART and to evaluate the relationship between the anatomy alteration and uterine function after ART.Methods:Between April of2004and March of2013, ART were performed in140patients with cervical malignancies at our institution.27patients met the inclusion creteria and1patients was excluded because of poor imaging quality. We utilized computed tomography angiography (CTA) to illustrate the vascular pattern of the remaining uterus. Patients were devided into2groups by the uterine artery contribute to the blood supply or not. Measure the diameter of the supplying vessels. When the vessels originated from different arteries, define the one with greater diameter the dominated supplying vessel. Analyze the relationship between the blood-supplying-mode and presevation of the uterine arteries; and the relationship between the blood-supplying-mode and the uterine function after ART.Results:The mean age of the27patients were29years old(ranging from15to41). The FIGO stage of the24cervical cancer patients were IB1for17, IA2for4and IA1with lymphovescular invasion for3. The median follow-up time was18months (ranging from2to77months). There were3fertility outcomes,3complaining disturbance of menstruation and no one recurred. The dealt with the uterine arteries during the procedure were16preserved and10ligated. The CTA reconstructed results showed that the uterus was supplied by bilateral uterine arteries preoperatively. Post-operatively, the uterus was mainly supplied (1)by only OA65%(17/26);(2)by OA and offside UA44%(7/26);(3)by only UA8%(2/26). Patients who ligated bilateral uterine arteries showed no UA contributed to the blood supply of the remaining uterus. Patients who preserved UA showed56%(9/16) UA contributed to the blood supply, only25%(4/16) still showed a UA dominated blood-supplying-mode. In the only OA supplying mode, the mean diameter of the left OA was (1.547±0.1077)mm(95%CI:1.319～1.775); the mean diameter of the left OA was (1.694±0.0770)mm(95%CI:1.531～1.857). In the OA and offside UA supplying mode, the mean diameter of the supplying UA was1.47±0.22mm; the mean diameter of the supplying OA was1.47±0.15. In the only UA supplying mode, the diameter of the left UA were1.6mm and3mm, the diameter of the right UA were1.7mm and1.1mm.There were2fertility outcomes from UA uncontributed group11.8%(2/17);1from UA contributed group11.1%(1/9).P=1, no significant statistics difference was observed. There were1menstruation disturbance from UA uncontributed group5.9%(1/17);2from UA contributed group22.2%(2/9).P=0.268, no significant statistics difference was observed. The mean diameter of the supplying UA of the fertility outcomes were2.0mm. The mean diameter of the supplying OA was1.9mm on the left and1.63mm on the right. All over the average standard of the same supplying mode. The mean diameter of supplying UA from the menstruation disturbance group was1.1mm. The mean diameter of the supplying OA was0.83mm on the left and1.1mm on the right. All below the average standard of the same supplying mode.Conclusions:Although we tried hard to preserve the uterine arteries in surgery with the intention to have the uterus a better blood supply, the anatomic success to preserve uterine arteries during ART does not always come through functional after the procedure. There were no sigificant differences in the uterine function between the UA contributed group and UA uncontributed group. Otherwise, the uterine function may be related to the diameter of the supplying vessels.