压力性尿失禁及盆底组织膨出患者肛提肌肌纤维直径和分型的研究  

Study of morphlogical changes in levator ani muscle of patients with stress urinary incontinence

作　　者：陈娟[1] 郎景和[1] 朱兰[1] 任海涛[2] 赵艳环[2] 关宏志[2] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,100730 [2]中国医学科学院中国协和医科大学北京协和医院神经科实验室,100730

出　　处：《中华妇产科杂志》2003年第12期733-736,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　探讨压力性尿失禁 (stressurinaryincontinence ,SUI)患者肛提肌肌纤维直径和分型的变化及其与SUI和盆底组织膨出 (pelvicorganprolapse ,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 ) ,术中行肛提肌活组织检查 (活检 )。常规组织学染色 ,镜下观察、测量肛提肌肌纤维直径 ,并进行分型。结果　SUI组和POP组患者肛提肌肌纤维密度减小 ,被丰富的纤维结缔组织充填、取代。含肌纤维的 4例SUI患者肛提肌肌纤维直径为 (2 4± 9) μm ,3例POP患者肛提肌肌纤维直径为 (2 4± 5 ) μm ,对照组肛提肌肌纤维直径为 (5 4± 11) μm。SUI组和POP组肛提肌肌纤维直径比较 ,差异无显著性 (P >0 0 5 ) ,但均较对照组肛提肌肌纤维直径缩短 (P <0 0 5 )。SUI、POP、对照组肛提肌肌纤维中Ⅰ型纤维 (慢纤维 )分别占 79 6 %、97 2 %和 77 2 % ,SUI、POP组Ⅱ型纤维 (快纤维 )比例均降低。对照组肛提肌肌纤维直径与年龄、绝经时间呈显著的负相关 (P =0 0 0 0 )。结论　SUI和POP患者肌肉的明显纤维化、退行性改变 ,快纤维减少 ,不利于在腹压增高时产生有力收缩。Objective To observe the the histological changes of levator ani muscle in patients with stress urinary incontinence (SUI) or pelvic organ prolapse(POP)and to determine the alteration that contributed to pathogenesis. Methods Biopsy specimens of levator ani muscle were obtained from 15 patients with SUI,19 patients with POP and 3 asymptomatic control with rectal cancer during operation.Levator ani muscle' s structure was examined with routine histological techniques.At the same time,fiber distribution and diameters were also measured.Results The morphological features of levator ani muscle in SUI and POP group included the muscular fiber density decreased and separated by large amounts of dense connective tissue.The mean diameter of levator ani muscle in 4 SUI patients containing striated muscle fibers was (24±9)μm,the mean diameter in 3 POP patients was(24±5)μm,and the mean diameter in 3 control cases was(54±11)μm.There was no diameter difference between SUI and POP group( P >0.05),and the mean fiber diameters of SUI and POP patients were significantly smaller than that of the control group( P <0.05).The proportion of typeⅠfibers in SUI and POP patients had the tendency to increase(79.6%,97.2% and 77.2%),with relative decrease of typeⅡfibers.In control group the mean diameter of muscle fiber decreased significantly with age and menopausal time( P =0.000).Conclusions There was obvious fibrosis and the muscle fiber atrophy in SUI and POP group,which resulted in the weakness of pelvic floor.The prevalence of typeⅠfibers might be disadvantage to forceful contraction during straining.Aging also contributed to neuromuscular degeneration and then associated with urinary incontinence in elderly women.

关 键 词：压力性尿失禁 盆底组织膨出 肛提肌 肌纤维直径 分型 

分 类 号：R711[医药卫生—妇产科学]