METHOD FOR COMBINED TREATMENT OF LOCALLY ADVANCED CERVICAL CANCER Russian patent published in 2025 - IPC A61B17/42 

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to oncology and gynaecology. That is followed by two courses of intra-arterial superselective chemotherapy and a nerve-sparing radical hysterectomy of D-type. Staged nerve-sparing radical hysterectomy of D-type is performed 3 weeks after the superselective chemotherapy. Parabladder and pararectal spaces are selected with sequential determination of projections of cardinal, sacro-uterine, vesicouterine ligaments having hypogastric nerves and branches of the inferior hypogastric plexus, followed by a double-sided iliac-obturative lymphadenectomy, with separation of the obturator nerve, the sacral plexus and the sciatic nerve. Vessels of internal iliac vessels system are localized and resected. Internal iliac artery, the superior vesical artery, the obturative artery, the internal iliac vein and its tributaries are clipped twice, further, ligation and stitching of the internal iliac vein is performed until the upper gluteal vein flows into it, the ligatured vessels are removed in the medial direction to the level of the mesourethral plate, ligation is followed by inspecting dorsal tissues of lateral parametrium, including: pelvic fascia, iliopsoas and piriform muscles. Ureters are dissected in a single anatomical structure, the mesourethral plate, while preserving the ureter and hypogastric nerves, the mesoureter is preserved throughout from the sacral promontory to the intersection with the uterine vessels, then the uterosacral ligament is removed, wherein the tributaries of the internal iliac vein basin, which at this stage are retracted medially to the paravaginal tissues and are in the lateral parametrium block, are visualized. Pelvic plexus is separated and preserved: the pelvic plexus is visualized by working with a swab in the medial direction and traction for the hypogastric nerve, the resected tissues of the lateral parametrium with vessels are taken to the uterus, wherein above ureter leaving tissue with uterine artery, superior vesical artery, then through an opening in the mesoureter, under the ureter, tissues with veins of the internal iliac vein basin are taken to the uterus, uterine nerves of the pelvic plexus are transected. At the final stage, the vegetative pelvic plexuses are preserved; a vesicoureteral Yabuki space is localized; and vesical nerves of the pelvic plexus are separated from a posterior portion of the vesicouterine ligament with using a swab in the lateral-medial direction and traction of the pelvic plexus. Upper and lower vesical veins ligated at the third stage are resected with an anterior parametrium free of vesical nerves at the level of urinary bladder. Ureter with mesoureter is taken up and medially so that angle in relation to vagina makes 90 degrees. Mesoureter with a hypogastric nerve, a pelvic plexus and vesical nerves are traced; thereafter, paravaginal tissues are clamped at the level of a middle one-third of the vagina, and the vagina is cut off at the level of the middle one-third.

EFFECT: method enables preserving the function of the lower urinary tract and the adequate urination.

1 cl, 3 dwg, 1 ex