Читать книгу Ambulatory Urology and Urogynaecology - Группа авторов - Страница 46

The cervix and upper vagina are suspended by the endopelvic fascia (parametria) and condensations of the connective tissue, the uterosacral and cardinal ligaments. The uterosacral ligaments pass from the posterior aspect of the cervix and upper vagina, form the lateral boundaries of the pouch of Douglas, and attach to the anterior surface of the sacrum at the level of the sacrococcygeal joint up to the level of S3. The uterosacral ligaments are each 12–14 cm long and subdivided into distal (2–3 cm), intermediate (5 cm), and proximal (5–6 cm). The distal portion is commonly used to anchor the vaginal apex in McCall's culdoplasty. The proximal portion is diffuse in attachment and generally thinner. The intermediate portion is thick, well defined, and at least 2.5 cm away from the ureter and hence suitable for suspension procedures. The cardinal ligaments (transverse cervical) attach to the posterolateral pelvic walls from the cervix and lateral vaginal fornix. These attachments are referred to as the level I or suspensory support. Together, they support the lower uterus, cervix, and upper vagina. They also maintain vaginal length and a nearly horizontal vaginal axis supported by the levator plate. Failure of the level I support leads to uterine or vaginal vault prolapse (apical prolapse).