中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2011年
2期
109-112
,共4页
李雅钗%黄向华%张琳%朱志洁%王振海
李雅釵%黃嚮華%張琳%硃誌潔%王振海
리아차%황향화%장림%주지길%왕진해
结肠,乙状%移植%阴道%黏膜%泛素硫酯酶%血管活性肠肽%神经肽Y%免疫组织化学
結腸,乙狀%移植%陰道%黏膜%汎素硫酯酶%血管活性腸肽%神經肽Y%免疫組織化學
결장,을상%이식%음도%점막%범소류지매%혈관활성장태%신경태Y%면역조직화학
Colon,sigmoid%Transplantation%Vagina%Mucous membrane%Ubiquitin thiolesterase%Vasoactive intestinal peptide%Neuropeptide Y%Immunohistochemistry
目的 探讨乙状结肠代阴道成形术后阴道黏膜神经再分布的变化.方法 2002年1月至2010年12月,取在河北医科大学第二医院接受乙状结肠代阴道成形术的20例先天性无阴道患者的人工阴道黏膜组织,采用免疫组化方法检测局部组织中蛋白基因产物9.5(PGP 9.5)的表达及血管活性肠肽(VIP)能神经和神经肽Y(NPY)能神经的分布,取材时间在术后1～3年,并与原位乙状结肠黏膜进行比较.结果 (1)神经纤维密度:人工阴道黏膜组织的黏膜层、黏膜下层和肌层均可见丰富的PGP9.5阳性表达的神经纤维,VIP和NPY阳性表达的神经纤维主要分布在血管周围和肌层;人工阴道黏膜组织中PGP 9.5阳性表达的神经纤维密度为17±6,高于VIP(2.9±1.0)和NPY(2.5±0.8)阳性表达的神经纤维密度,差异有统计学意义(P＜0.05).(2)人工阴道黏膜PGP 9.5的表达:术后1年,人工阴道黏膜PGP 9.5的表达水平为14±4,低于原位乙状结肠黏膜的28±7,差异有统计学意义(P＜0.05);术后2～3年,PGP 9.5的表达水平逐步升高,术后第3年,PGP 9.5的表达水平达22±7,且这种变化以黏膜下层最为明显.(3)人工阴道黏膜VIP和NPY的表达:术后1年,阴道黏膜VIP和NPY的表达水平分别为2.3±0.7、2.5±1.1,低于原位乙状结肠黏膜的5.3±1.4、5.5±1.1,差异均有统计学意义(P＜0.05);术后2～3年,VIP表达水平逐渐回升,术后3年为3.7±0.7,明显高于术后1年的2.3±0.7,差异有统计学意义(P＜0.05),NPY表达水平在术后3年内回升不明显.结论 乙状结肠代阴道成形术后,阴道黏膜的神经分布特征与原位乙状结肠相似.在术后1～3年内,人工阴道黏膜神经纤维密度降低后又有逐步回升趋势.
目的 探討乙狀結腸代陰道成形術後陰道黏膜神經再分佈的變化.方法 2002年1月至2010年12月,取在河北醫科大學第二醫院接受乙狀結腸代陰道成形術的20例先天性無陰道患者的人工陰道黏膜組織,採用免疫組化方法檢測跼部組織中蛋白基因產物9.5(PGP 9.5)的錶達及血管活性腸肽(VIP)能神經和神經肽Y(NPY)能神經的分佈,取材時間在術後1～3年,併與原位乙狀結腸黏膜進行比較.結果 (1)神經纖維密度:人工陰道黏膜組織的黏膜層、黏膜下層和肌層均可見豐富的PGP9.5暘性錶達的神經纖維,VIP和NPY暘性錶達的神經纖維主要分佈在血管週圍和肌層;人工陰道黏膜組織中PGP 9.5暘性錶達的神經纖維密度為17±6,高于VIP(2.9±1.0)和NPY(2.5±0.8)暘性錶達的神經纖維密度,差異有統計學意義(P＜0.05).(2)人工陰道黏膜PGP 9.5的錶達:術後1年,人工陰道黏膜PGP 9.5的錶達水平為14±4,低于原位乙狀結腸黏膜的28±7,差異有統計學意義(P＜0.05);術後2～3年,PGP 9.5的錶達水平逐步升高,術後第3年,PGP 9.5的錶達水平達22±7,且這種變化以黏膜下層最為明顯.(3)人工陰道黏膜VIP和NPY的錶達:術後1年,陰道黏膜VIP和NPY的錶達水平分彆為2.3±0.7、2.5±1.1,低于原位乙狀結腸黏膜的5.3±1.4、5.5±1.1,差異均有統計學意義(P＜0.05);術後2～3年,VIP錶達水平逐漸迴升,術後3年為3.7±0.7,明顯高于術後1年的2.3±0.7,差異有統計學意義(P＜0.05),NPY錶達水平在術後3年內迴升不明顯.結論 乙狀結腸代陰道成形術後,陰道黏膜的神經分佈特徵與原位乙狀結腸相似.在術後1～3年內,人工陰道黏膜神經纖維密度降低後又有逐步迴升趨勢.
목적 탐토을상결장대음도성형술후음도점막신경재분포적변화.방법 2002년1월지2010년12월,취재하북의과대학제이의원접수을상결장대음도성형술적20례선천성무음도환자적인공음도점막조직,채용면역조화방법검측국부조직중단백기인산물9.5(PGP 9.5)적표체급혈관활성장태(VIP)능신경화신경태Y(NPY)능신경적분포,취재시간재술후1～3년,병여원위을상결장점막진행비교.결과 (1)신경섬유밀도:인공음도점막조직적점막층、점막하층화기층균가견봉부적PGP9.5양성표체적신경섬유,VIP화NPY양성표체적신경섬유주요분포재혈관주위화기층;인공음도점막조직중PGP 9.5양성표체적신경섬유밀도위17±6,고우VIP(2.9±1.0)화NPY(2.5±0.8)양성표체적신경섬유밀도,차이유통계학의의(P＜0.05).(2)인공음도점막PGP 9.5적표체:술후1년,인공음도점막PGP 9.5적표체수평위14±4,저우원위을상결장점막적28±7,차이유통계학의의(P＜0.05);술후2～3년,PGP 9.5적표체수평축보승고,술후제3년,PGP 9.5적표체수평체22±7,차저충변화이점막하층최위명현.(3)인공음도점막VIP화NPY적표체:술후1년,음도점막VIP화NPY적표체수평분별위2.3±0.7、2.5±1.1,저우원위을상결장점막적5.3±1.4、5.5±1.1,차이균유통계학의의(P＜0.05);술후2～3년,VIP표체수평축점회승,술후3년위3.7±0.7,명현고우술후1년적2.3±0.7,차이유통계학의의(P＜0.05),NPY표체수평재술후3년내회승불명현.결론 을상결장대음도성형술후,음도점막적신경분포특정여원위을상결장상사.재술후1～3년내,인공음도점막신경섬유밀도강저후우유축보회승추세.
Objective To investigate re-innervation in the neovaginal mucosa of patients underwent sigmoid colon vaginoplasty in treatment of Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS).Methods Biopsies in the upper third of the posterior neovagina were taken in 20 patients treated by sigmoid colon vaginoplasty at 1, 2 and 3 years after surgery, respectively. Protein gene product 9. 5 ( PGP 9. 5 ),vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) were detected by immunohistochemical method and compared with those in intact sigmoid colon mucosa. Results ( 1 ) Density of nerve fiber:abundant distribution of PGP 9. 5 nerve fibers were observed in the mucosal muscle layer, submucosa, and smooth muscle layer of the neovagina. The nerve fibers of VIP and NPY immunoreactivity were mainly distributed around blood vessels and in the smooth muscles. In the neovagina, the density of nerve fibers of PGP 9. 5 of 17 ± 6 were much more than VIP of 2. 9 ± 1.0 and NPY of 2. 5 ± 0. 8 significantly ( P ＜ 0. 05 ).( 2 ) Expression of PGP 9. 5 in neovagina: at 1 year after surgery, PGP 9. 5 positive expression of 14 ± 4 was significantly lower in the neovagina than 28 ± 7 in the intact sigmoid colon( P ＜ 0. 05 ). However, after 2 to 3 years, its expression displayed an upgrade tendency in the neovagina and was significantly higher at the 3 year postoperatively than that at the 1 years postoperatively ( 22 ± 7 vs. 14 ± 4, P ＜ 0. 05 ). The changes were much more obvious in submucosa. (3) The expression of VIP and NPY in neovagina: at 1 year after surgery, VIP and NPY positive nerve fibers were also decreased in the neovagina when compared with those in the intact sigmoid colon ( 2. 3 ± 0. 7 vs. 5.3 ± 1.4, P ＜ 0. 05; 2.5 ± 1. 1 vs. 5.5 ± 1.1, P ＜ 0. 05 ) . At 2 to 3 years after surgery, the positive VIP fiber showed initially decreased and subsequently increased tendency. The density of VIP of 3.7 ± 0. 7 in the neovagina at 3 years postoperatively was higher than 2. 3 ±0. 7 at 1 years postoperatively (P ＜ 0. 05 ). No significant up-regulation was observed in NPY-positive expression in the neovagina within 3 years after operation. Conclusions Distribution of sensory PGP 9. 5,VIP and NPY immunoreactive nerve fibers was similar to the pattern observed within the intact sigmoid colon wall. The number of nerve fibers in the neovagina decreased after surgery and then increased subsequently within 3 years after surgery.
