Observation Of The Histological Anatomy Around The Cervix For Nerve Sparing Radical Hysterectomy

Objective: Nerve-sparing radical hysterectomy(NSRH) was considered to be an effective method to improve the postoperative complications of cervical cancer. But it needed gynecologic oncologists to know well the anatomical knowledge of precise pelvic, especially the position of the pelvic autonomic nerve systerm, how it ran and what the relationship was with the surrounding tissues. This article was aimed at describing the distribution relationship between the blood vessels and the nerves, determining which type of the nerve was and providing further histological evidences for NSRH.Methods: This study used cadaveric specimens to make serial paraffin sections in different cross-sectional levels. Then, it researched the morphology of the parametrium, the distribution and the relationship between the blood vessels and nerves, the different types of the nerves, the composition of connective tissues in the ligaments of the uterus, by using HE staining, immunohistochemical staining and Masson trichromatic special staining respectively.Results:1 The superficial layer of the cardinal ligament contained a large number of blood vessels, such as superficial uterine vein, uterine artery, uterine deep vein, inferior rectal artery, etc. The nerval part of the cadinal ligament namely inferior hypogastric plexus, located in the dorsal side of the uterine deep vein, containing a large number of nerve fibers and ganglion cells. These nerve tissues, forming as neural plates, ran in an almost straight line direction from the dorsal to the ventral side, in the lateral side of the cervix. Moreover, it also set out small branchs to the cervix and bladder. There were loose adipot connective tissues between the vascular and nerve part of the cardinal ligament.2 The uterosacral ligament ran in the lateral side of the cervix in a wavy shape. The ventral edge of the uterosacral ligament continued to the posterior fascial of the cardinal ligament. Hypogastric nerves went through the dorsolateral side of the uterosacral ligament. At the ureteral opening level, the uterosacral ligament continued to the Denonvilliers fascia.3 The superficial layer(anterior leaf) of the vesicocervical ligament only had two small blood vessels which were known as cervicovesical vessels, while, the deep layer(posterior leaf) had a large number of vesical vessels and nerves. The sections of the vesical nerves were mainly located in the dorsomedial side of the vesical vessels and the ventrolateral side of the vagina.4 Hypogastric nerves which went through the dorsolateral side of the uterosacral ligament were sympathetic nerves.5 The inferior hypogastric plexus were mixed with sympathetic nerves and parasympathetic nerves. At the cervical isthmus level, parasympathetic nerves mainly were located in the superficial dorsal side of the deep uterine vein. The content of sympathetic nerves increased in the dorsolateral side of cervix and the deep dorsal side of the deep uterine vein. At the level of posterior vaginal fornix section, parasympathetic nerves were mainly located in the dorsal side of inferior rectal artery. However, sympathetic nerves were scarce and mainly located in the lateral side of cervix and uterosacral ligament. At the level of ureterovesical orifice section, the nerves mainly were distributed in the dorsolateral side of the Denonvilliers fascia. The content of parasympathetics nerves was slightly more than the sympathetic nerves, The vagina and rectum branchs of inferior hypogastric plexus were mainly parasympathetic nerves.6 The vesical nerves were mixed with sympathetic nerves and parasympathetic nerves. At the cervical isthmus level, The content of parasympathetics nerves was more than the sympathetic nerves. At the level of posterior vaginal fornix section, sympathetic nerves were rare. At the level of ureterovesical orifice section, the vesical nerves which distributed to the dorsolateral side of ureterovesical orifice, the dorsomedial side of the vesical veins were mainly sympathetic nerves, while, those along the vaginal wall were mainly parasympathetic nerves. At the upper one third of vagina section, the content of sympathetics nerves was more than the parasympathetic nerves.7 Peripheral afferent nerves were mixed with peripheral motor nerves. Isolated sensory ganglia or sensory nerve fibers were not present.8 The vesicocervical ligament had loose adipose tissues and fine collagen fibers.The vascular part of the cadinal ligament contained adipose tissues and small number of collagen fibers, while, the nerval part of the cadinal ligament had further increased collagen fibers which were irregular arrangement. In addition to a large number of collagen fibers, the uterosacral ligament also had red spindle smooth muscle fibres. These collagen fibers and smooth muscle fibers were arranged in layered.Conclusions:1 The deep uterine vein was suitable as an anatomical landmark to preserve the nerves of the cadinal ligament.2 Vesical veins can be landmarks to reduce the injury of vesical nerves which were located in the dorsomedial side of the veins, when cutting off the deep layer of the vesicocervical ligament.3 Denonvilliers fascia can be landmarks to retaine the inferior hypogastric plexus which was distributed in the ventrolateral side of it.4 The inferior hypogastric plexus and its bladder nerves in which the sympathetic nerves were located in the ventral side, were mixed with sympathetic nerves and parasympathetic nerves.5 NSRH retained most of parasympathetic nerves and a small part of sympathetic nerves.6 Peripheral afferent nerves were mixed with peripheral motor nerves.