宫骶韧带神经损伤与异位妊娠的关系

目的：通过比较异位妊娠患者中人流组和非人流组的宫骶韧带形态及其输卵管峡部神经纤维分布情况，分析人工流产与异位妊娠的关系，为输卵管妊娠的发病机制提供新的研究思路。方法：选取20例生育史为0-0-N-0（N均为人流）的异位妊娠患者作为人流组，12例生育史为0-0-0-0的异位妊娠患者作为非人流组，比较输卵管峡部抗蛋白基因产物9.5（PGP 9.5）表达情况并结合腹腔镜下宫骶韧带形态进行分析。结果：①非人流组宫骶韧带表现为对称的、光滑的、完整的拱形（10/12，P＜0.05）；人流组的宫骶韧带在腹腔镜下表现为1条和（或）2条损伤（19/20，P＜0.05），覆盖于韧带表面的腹膜、邻近宫骶韧带的腹膜和输卵管系膜表面出现新生血管；②与非人流组相比，人流组患者输卵管峡部内侧肌层及外侧肌层PGP 9.5免疫反应阳性的神经明显减少，差异有统计学意义（P＜0.05）；③2组患者输卵管系膜区PGP 9.5染色均为强阳性（P＞0.05）。结论：人流术可能会损伤宫骶韧带和子宫内膜-肌层的神经，导致输卵管峡部肌层PGP 9.5免疫反应阳性的神经纤维分布减少，可能是引起输卵管妊娠的病因之一。

The relationship between injured uterosacral ligaments and ectopic pregnancy

Objective: To compare the morphology of uterosacral ligaments and the distribution of nerve fibers in the isthmus of the fallopian tube in patients who presented with ectopic pregnancy with previous history of induced abortion and patients who presented with ectopic pregnancy with out history of prior surgical procedures. The relationship between abortion and ectopic pregnancy were also explore and investigated to offer new research ideas into the pathogenesis and management of tubal pregnancy. Methods: The patients with ectopic pregnancy were subdivided into two main groups per their history of induced abortion. The induced abortion group comprised of 20 cases with reproductive history of 0-0-N-0 and the no-abortion group comprised of 12 cases with reproductive history of 0-0-0-0. The isthmuses of the fallopian tube from these two groups were obtained and were immunohistochemically analyzed to detect the protein gene product 9.5 in comparison with results from the morphology of the uterosacral ligaments. Results: ①The uterosacral ligaments were symmetrical and smooth with complete arches connecting the right and left ligaments (10/12, P<0.05) in the no-abortion group. In the nulliparous women with prior surgical evacuations, there was evidence of injury to one, or both, uterosacral ligaments (19/20, P<0.05), and possible neovascularisation of peritoneal surfaces over the ligament and adjacent peritoneum and mesosalpinx. ②The strong positive expression of PGP 9.5 in the nerve fiber from the inner and outer muscle layer of the isthmus of fallopian tube in abortion group was significantly reduced when compared with the no-abortion group (P<0.05). ③PGP 9.5 showed a strong positive expression in the mesosalpinx of the fallopian tube among the two groups (P>0.05). Conclusion: Induced abortion may damage the nerves in the uterosacral liagments and the endometrial-muscular interface and the decrease of PGP 9.5 positive nerve fibers expression in the muscle layer of the isthmus of fallopian tube may lead to the occurrence of ectopic pregnancy.