良性增生前列腺去除神经后病理变化的实验研究

目的 研究完全去神经支配对大鼠良性增生前列腺的影响。方法 30周龄雄性自发性高血压大鼠65只,随机分配为手术组（n=30）、手术对照组（n=30）和正常对照组（n=5）。手术组切断大鼠双侧盆腔主要神经节发出至前列腺的全部神经纤维,再行膀胱造口术;手术对照组仅行膀胱造口术。分别于术后3、7、11、15、≥21d分批处死大鼠,观察前列腺大体形态学、组织学和细胞学改变。结果 手术组大鼠前列腺术后3d出现颗粒状实变和体积缩小,并进行性发展。前列腺湿重／大鼠体重比值随术后时间的延长进行性下降,而前列腺组织干重／湿重比值进行性升高。HE染色显示腺腔扩张,腺上皮层、平滑肌进行性变薄,最后消失,间质成分逐步增生。透射电镜显示腺细胞空泡变性、基底膜结构模糊、平滑肌细胞变性、间质中纤维母细胞及胶原纤维增生进行性加重;后期腺细胞大部分坏死、崩解,基底膜及平滑肌细胞消失,胶原纤维高度增生。神经纤维染色显示术后3d出现S100染色弥散,11d后染色消失。而手术对照组无上述相应病理改变。结论彻底失神经支配后大鼠良性增生的前列腺发生了极为显著的萎缩性改变,提示去神经支配可能是治疗良性前列腺增生的新思路。

The pathological change of rats' benign hyperplastic prostate after radical denervation

OBJECTIVE: To study the pathological change of rats' benign hyperplastic prostate (BHP) after radical denervation. METHODS: A total of 65 male spontaneous hypertension rats (SHR) at 30 weeks age were randomly assigned into treatment group, sham surgery control group and normal control group. In surgery group, all the axonal branches of the major pelvic ganglion (MPG) supplying the bilateral prostate were truncated, followed performing of cystostomy; In sham surgery control group, only cystostomy was performed; In normal control group, no procedure was performed. The rats were sacrificed at 3, 7, 11, 15 and >or= 21 d post-operation respectively. The gross morphological changes of prostate in all animals were observed. RESULTS: In treatment group, the prostate in 3 d post-operation showed granular solidification and shrunken volume and the changes occurred gradually over time. The glandular epithelial cells showed gradual degeneration, necrosis and detachment. The glandular epithelium became progressively thinner, the smooth muscles elongated and thinned progressively and the stromal components showed mild to moderate overgrowth. At the later stage, the glandular epithelium, glandular lumen and smooth muscles gradually disappeared and the prostate was largely replaced by connective tissues. Electron microscopic study showed that the glandular cells gradually underwent vacuolar degeneration and the structures of basement membrane became fuzzy. The smooth muscles cells degenerated overtime and the fibroblasts and collagenous fibers in the stroma overgrew slowly. At the late stage, most of the glandular cells became necrotic, the basal membrane and smooth muscle cells disappeared and collagenous fibers were highly hyperplasic. In surgery group in 3 d post-operation, the S-100 staining of nerve fiber was diffuse and disappeared after 11 d while it persisted normally in other groups. The two values in sham surgery control group showed no significant changes post-operatively. CONCLUSIONS: After radical denervation, the rat prostate with benign hyperplasia (gland and smooth muscles) undergoes dramatic atrophic changes and the volume decreases significantly. It suggests that this treatment may represent a novel therapy for BPH.