压力性尿失禁及盆底组织膨出患者肛提肌形态学的观察

目的 探讨肛提肌组织形态学的变化及其与压力性尿失禁(stress urinary incontinence,SUI)和盆底组织膨出(pelvic organ prolapse,POP)发病的关系。方法 选择15例SUI患者(SUI组)、19例POP患者(POP组)及3例无SUI和POP的直肠癌患者(对照组),术中行肛提肌活检,冰冻切片常规行HE染色、改良Gomori染色及非特异性酯酶(non—specific esterase,NSE)、酸性磷酸酶(acidphosphrase,ACP)、三磷酸腺苷酶(ATPase)染色,镜下观察肛提肌形态学变化。结果 成功获取肛提肌肌肉组织与未取得肛提肌肌肉组织的SUI患者的年龄、产次、绝经时间、疾病严重程度、漏尿点压力等比较,差异均无显著性(P>0.05)。SUI组和POP组患者肛提肌组织形态学表现为肌纤维密度降低,排列紊乱,被大量的结缔组织填充、取代,肌纤维周围炎性细胞浸润;单个肌纤维细胞既有核中心移位、纤维劈裂、外周吞噬及空泡变性等肌源性改变,也有肌纤维萎缩、角形变、同型纤维聚集等神经源性改变。结论 SUI和POP患者的肛提肌同时存在神经源性和肌源性改变,提示持续的盆底肌去神经支配和继发的肌源性改变,可能是SUR及POP的发病原因之一。

Study of morphological changes in levator ani muscle of patients with stress urinary incontinence or pelvic organ prolapse

Objective To investigate the morphological characteristics of levator ani muscle in patients with stress urinary incontinence (SUI) or pelvic organ prolapse (POP) and to explore whether the alterations could contribute to pathogenesis of the diseases. Methods Biopsy specimens of levator ani muscle were obtained from 15 patients with SUI, 19 patients with POP and 3 asymptomatic controls with rectal cancer during operation. The structure of levator ani muscle was examined with routine histological techniques; HE staining, modified Gomori trichrome staining, NSE staining, ACP staining, and adenosine triphosphatase(ATPase) staining. Results There was no significant difference in age, parity, menopausel time, disease severity and leak point pressure between SUI patients with or without muscle fibers(P >0. 05) . The muscular fiber density of levator ani muscles in SUI and POP groups was decreased, fibers were arranged in disorder and separated by large quantities of dense connective tissues with infiltrating inflammatory cells. The muscle fiber fascicles showed obvious grouped denervative atrophy, fiber type grouping and angular in shape. And also there was myopathic degeneration such as centrally located nuclei, peripheral phagocytosis and vacuolated necrosis. Conclusions There are both neurogenic and myopathic alterations in levator ani muscle's structure in patients with SUI and POP. The presence of both acute and chronic abnormalities indicates that the weakness of pelvic floor is a consequence of prolonged denervation.