去除胆碱能副交感神经支配后大鼠良性增生前列腺的变化

Pathological changes of benign hyperplastic prostate after removal of innervation of cholinergic pelvic nerve： experiment with spontaneous hypertension rats

目的 探索去除胆碱能副交感神经支配后大鼠良性增生前列腺的病理变化。方法 30周龄雄性自发性高血压大鼠（SHR）65只，随机分配为手术组、手术对照组和正常对照组。手术组切断双侧盆腔主要神经节的副交感盆神经来源支，然后行膀胱造口术；手术对照组行膀胱造口术。分别于术后3、7、11、15、≥21d分批处死大鼠，观察各组大鼠前列腺大体形态学、组织学和细胞学改变。结果 在手术组，手术7d后开始出现前列腺颗粒性实变并进行性发展；前列腺湿重／大鼠体重比值随术后时间的延长而进行性下降[术后3、≥21d分别为（0．4764±0．0125）mg／g、（0．2749±0．0197）mg／g]，而前列腺组织干重／湿重比值进行性升高（术后3d为0．1966±0．0062，术后≥21d为0．2596±0．0035）；光镜可见：逐渐出现前列腺腺腔扩张、腺腔前列腺液积存、腺体上皮乳头数量减少、高度降低、腺体周围平滑肌拉长变薄，并进行性发展；透射电镜：腺细胞出现空泡变性，并进行性加重直至大部分细胞器被破坏、消失，腺细胞基底膜结构破坏，平滑肌变性进行性加重，胶原增生。手术对照组与正常对照组上述病理变化均不明显。结论 彻底去除胆碱能副交感神经支配后大鼠良性增生的前列腺腺体发生了显著的萎缩性改变，为良性前列腺增生的临床治疗提供了新的靶点。

Objective To study the pathological change of benign hyperplastic prostate after removal of the innervation of cholinergic parasympathetic pelvic nerve. Methods Sixty-five male spontaneous hypertension rats （ SHRs ） were randomly assigned into 3 groups ： operation group （ n = 30 ） undergoing truncation of bilateral originating branches of parasympathetic pelvic nerve of major pelvic ganghon （MPG） followed by cystostomy, sham operation group （operation control group, n = 30 ） undergoing cystostomy, and normal control group （n = 5） not undergoing operation. 3, 7, 11, 15 and ≥21 days after operation 6 rats from the 2 operation groups and 1 from the control group were sacrificed to observe the gross morphology and histological and cellular changes of the prostate glands. Results The prostate of the operation group on post-operational day 7 showed mild granular solidification and such change progressed gradually over time, the ratio of prostate wet weight/rat body weight was（ 0.4764±0.0125 ）mg/g on day 3, then gradually decreased, and became （0.2749 ±0.0197） mg/g ≥21 days post-operationally; while the ratio of prostate tissue dry weight/wet weight on day 3 was （0. 1966±0.0062）, then gradually increased, and became （0. 2596±0. 0035 ） ≥ 21 days post-operationally. HE staining showed that the glandular structure gradually became dilated and rounded, with accumulation of prostatic fluid. 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. Electron microscopy showed that the glandular cells gradually underwent vacuolar degeneration and the structures of the basement membrane became fuzzy. The smooth muscle cells degenerated mildly, and the fibroblasts and collagenous fibers in the stroma overgrew slowly. All these histological changes were not found in the sham operation control and normal control groups.Conclusion Remarkable atrophy occurs in benign hyperplastic prostatic gland after radical removal of the innervation of cholinergie parasympathetic pelvic nerve. Such operation may represent a novel therapy for BPH.