盆腔器官脱垂患者盆底支持组织超微结构特征的研究

目的了解盆腔器官脱垂(pelvicorganprolapse,POP)患者盆底支持组织的超微结构特征。方法选择2004年7月至2004年8月于我院手术治疗的POP患者5例,同期因卵巢单纯囊肿行全子宫切除术的绝经后患者2例作为老年对照,宫颈癌手术治疗2例作为年轻对照。在光镜及透射电镜下观察子宫主韧带、阴道壁、肛提肌组织的超微结构特征。结果光镜下POP组标本中平滑肌弥漫性萎缩、变性、纤维化。阴道粘膜固有层广泛小血管周围炎,血管内皮肿胀。电镜下POP组平滑肌细胞共同超微结构特征为细胞膜结构不完整;胞核异染色质增多;线粒体呈基质型肿胀甚至消失。阴道粘膜固有层终末小动脉内皮肿胀,中膜平滑肌萎缩断裂,甚至消失。老年非脱垂组可见平滑肌萎缩,灶状纤维化,但平滑肌变性、血管病变不明显。年轻非脱垂组未见平滑肌萎缩变性及血管病变。同时发现POP组肛提肌中骨骼肌成分损伤不明显,而平滑肌成分出现损伤性改变。结论POP患者主要盆底支持组织如主韧带、阴道壁、肛提肌普遍存在平滑肌细胞不可逆损伤性超微结构改变,可造成盆底组织松弛、支持能力减弱,导致POP的发生。肛提肌中平滑肌成分与POP发生密切相关。

Study of the ultrastructural characteristics of pelvic floor tissues in patients with POP

Objective:To investigate the ultrastructural characteristics of pelvic floor tissues in patients with pelvic organ prolapse (POP).Methods:The cardinal ligament of uterus,vaginal wall and levator ani were obtained from 5 patients with POP who underwent surgery from July 2004 to Aug 2004 in our department,as well as from 2 postmenopausal patients with ovarian simple cyst who underwent hysterectomy served as an old control group and 2 patients with uterine cervical cancer served as a young control group.These specimens were observed with light and transmission electron microscope(TEM).Results:Under light microscope,extensive atrophy,degeneration,fibrosis of smooth muscle cells(SMCs),extensive periangiitis were noted in specimens of POP.Under TEM,common ultrastructural characteristics were observed in SMCs in specimens of POP,such as imperfection or dissolving of cellular membrane,increase of heterochromatin in cellular nucleus;stromal swelling or disappearing in mitochondria.In vaginal wall,there were such changes as swelling of terminal arteriole's endothelium,atrophy,rupture or disappearing of SMCs in terminal arteriole's middle membrane.Atrophy of SMCs and local fibrosis were also observed in old control group,but degeneration of SMCs and vascular lesion were unapparent.Atrophy of SMCs and vascular lesion were not found in young control group.In levator ani of POP,the skeletal muscle cells showed little injury,while the SMCs showed obvious injury.Conclusions:Ultrastructural changes of SMCs characterized by irreversible alteration are approved consisting in main pelvic floor tissues including cardinal ligament of uterus,vaginal wall and levator ani in patients with POP under TEM,which perhaps lead to pelvic floor tissue weaken and relaxant and result in POP finally.The smooth muscles in levator ani are related closly to the development of POP.