女性尿道控尿机制的组织学研究及其临床意义

Histologic Study on the Mechanism of Urinary Continence on Female Corpse and Its Clinical Significance

目的：探讨女性尿道相关肌肉的形态、比例、分布和类型等,以明确女性控尿机制的组织学基础.方法：对10例女性尸体进行下尿路的组织切片检查,其中5例行纵切片、5例行横切片.切片均予HE染色、结缔组织染色（Masson三色染色法）、肌肉染色（Mallory磷钨酸-苏木素染色法,PTAH）和神经组织染色（Bielschowsky改良法）.结果：膀胱肌肉与尿道平滑肌相延续,尿道平滑肌仍分为内层纵形肌、中间的环形肌、外层的纵形肌;平滑肌在近端1/3丰富,向远端逐渐变薄,但仍然保持三层结构.横纹括约肌在尿道的内中1/3交界处出现并与平滑肌相互交错,至中1/3段尿道最厚,在远端1/3有肌纤维同时包饶阴道;整个横纹括约肌、尿道平滑肌与盆底其它肌肉没有联系,是一个独立的形态学单位.结论：女性控尿肌肉称为括约肌复合体,为独立的形态学单位,是女性控尿的主要组织学基础.

Objective：To study the morphology, proportion, distribution and types of female urethral muscles in order to explore its function in female urinary continence. Methods： 10 representative female corpse specimens were collected and lower urinary was checked for histologic study. Large longitudinal and transverse sections were made on each sample and stained with hematoxylin - eosin, PTAH, Modified Bielschowsky and Masson＇ s trichrome staining. Results ：The smooth muscles were sequent to the bladder muscles and distributed in the whole urethra. The smooth muscle had three structures, circular in middle, longitudinal in inner and outer. In histologie examination, the urethral sphincter distributed the outsight 2/3 urethra and wrapped the vagina in the outsight 1/3 of urethra. And in the inner - middle urethra, the smooth muscle and sphincter were intermingled. The shape of sphincter was omega shape （Ω） in the middle 1/3 of urethra and ring shape （O） in the outsight 1/3 of urethra. The sphincter muscle and the smooth muscle had no coalesce with the pelvic floor. Conclusions：The sphincter muscle and the smooth muscle are called as rhabado - sphincter muscle complexity, which is an independent morphologic unit and the main urinary continent mechanism.