经尿道前列腺切除术中对前叶区域的组织学分析  

Histological analysis of the anterior lobe region in transurethral prostatectomy

作　　者：杨立[1] 冯波[1] 李正金[2] 萧芝松[1] 杨银桂[1] 

机构地区：[1]大理学院附属医院 泌尿外科 [2]大理学院附属医院 病理科,云南大理671000

出　　处：《中华男科学杂志》2012年第12期1083-1087,共5页National Journal of Andrology

摘　　要：目的:探讨经尿道前列腺切除术(TURP)中对前叶区域切割是否损伤尿道横纹肌括约肌可能。方法:对60例经尿道前列腺切除术患者进行前叶切割,根据切割范围分为近端浅、深层组(1、2组),远端浅、深层组(3、4组),将切割区域前叶组织作HE染色,并通过免疫组化方法鉴定肌动蛋白(SMA)和肌红蛋白来检测切割组织中的平滑肌及横纹肌成分;计算横纹肌阳性及阴性结果所对应病例的前列腺体积、年龄、PSA,比较2、3、4组中横纹肌相对含量,用独立样本组间t检验进行统计分析。结果:切割前叶区域组织经HE染色和免疫组化检测提示确实存在尿道横纹肌括约肌分布,且平滑肌与横纹肌的组织学结构相互嵌杂;尿道横纹肌括约肌的切割损伤与前列腺体积有关;前叶组织中尿道横纹肌的分布趋势为近前列腺尖部增加,且向尿道腔方向伸入。结论:经尿道前列腺切除术中不应过多切割前叶区域,以避免尿道横纹肌括约肌的直接损伤。对于前列腺体积相对较小的患者,以及对前列腺尖部附近操作时,这一原则尤为重要。Objective： To explore the possibility of injury to the striated urethral sphincter by incision to the anterior lobe region in transurethral prostatectomy. Methods： We incised the anterior lobe region of 60 patients with benign prostatic hyperplasia （BPH） undergoing transurethral prostatectomy. The patients were divided into four groups according to the incision fields ： proximate superficial （ group 1 ）, proximate deep （ group 2）, distal superficial （ group 3 ） and distal deep （ group 4）. The tissues taken from the anterior lobe region were subjected to HE staining, and the smooth and striated muscles were detected by immunohistochemieal identification of smooth muscle actin （SMA） and myoglobin （MYO） in the tissues. The prostate volume, age, and PSA level of the patients were ana- lyzed against their positive or negative results. The relative contents of the striated muscle were compared among groups 2, 3 and 4. The independent-sample between-group t-test was used for statistic analysis. Results： The urethral rhabdosphincter was found in the anterior lobe region, with the smooth muscle intermixed with the striated muscle. The incision injury of the urethral rhabdosphincter was associated with the prostate volume. Increased urethral rhabdosphincter was observed in the anterior lobe region, approaching the apex of the prostate and extending to the urethral lumen. Conclusion ： The anterior lobe region should not be excessively incised in transurethral prostatectomy so as to avoid direct injury of the striated urethral sphincter, which is especially important for prostates of smaller volume or operation near the apex of the prostate.

关 键 词：经尿道前列腺切除术 尿道横纹肌括约肌 前列腺前列腺叶 组织学 

分 类 号：R699[医药卫生—泌尿科学]