广泛性子宫颈切除术后子宫载荷对子宫韧带和阴道影响的有限元仿真

目的 应用有限元法分析广泛性子宫颈切除术后不同子宫载荷(腹压和子宫重量)时子宫阔、圆韧带和阴道的应力分布和变形情况，获得子宫韧带和阴道对子宫载荷变化的敏感度。方法 建立后位子宫、韧带和阴道三维几何模型并导入ABAQUS软件，然后设置约束、施加载荷，计算各部位的应力和变形。结果 广泛性子宫颈切除术后阔、圆韧带的应力和位移均有不同程度增大；阔、圆韧带和阴道的应力和变形均随子宫载荷的增大而增大，阔韧带的变形和应力主要分布于中下部(腹压变化)或中上部(子宫重量变化),圆韧带的应力与变形主要分布于中下部，阴道的应力与变形主要分布于中上部；腹压与子宫重量单独变化或同时变化时，阴道所受应力及对载荷变化的敏感度最大，阔韧带变形及对载荷变化的敏感度最大，总的应力和变形排序因载荷情况不同而略有差异，并且子宫重量比腹压对韧带和阴道的影响程度显著。结论 研究结果与临床资料相符，可为临床手术方案优化和发病机制探索提供指导。

Influences of Uterine Load on Uterine Ligament and Vagina after Radical Trachelectomy: A Finite Element Simulation

Objective To analyze the stress distribution and deformation of vaginas, broad ligament (BL), round ligament (RL) under different uterine loads (abdominal pressure and uterine weight) after radical trachelectomy (RT) by finite element method, and obtain the sensitivity of BL, RL and vaginas to changes in uterine loads. Methods The three-dimensional ( 3D) geometric models of the posterior uterus, BL, RL and vagina were established and imported into ABAQUS software. After the constraints were set and the loads were applied, the stress and deformation of each part were calculated. Results The stress and displacement of BL and RL increased in different degrees after the RT operation. The stress and deformation of BL, RL and vagina increased with the increase of uterine load. The deformation and stress of BL were mainly distributed in the middle and lower part (with abdominal pressure changing) or the middle and upper part (with uterine weight changing). The stress and deformation of RL were mainly distributed in the middle and lower part, and the stress and deformation of vagina were mainly distributed in the middle and upper part. When abdominal pressure and uterine weight changed alone or together, the vaginal stress and its sensitivity to load changes were the greatest, and the displacement of BL and its sensitivity to load change were the greatest. The order of the total stress and deformation was slightly different due to different load conditions, and the influence of uterine weight on ligaments and vagina was more significant than that of abdominal pressure. Conclusions The results are consistent with clinical data, and can provide guidance for clinical surgical plan optimization and pathogenesis exploration.