宫颈周围立体环韧带内血管定性定量研究

Qualitative and quantitative research of blood vessel in the ligament of the three dimensional ring around the cervix

目的探讨宫颈周围立体环中子宫主韧带、骶子宫韧带、阴道旁组织复合体内血管的性质、分布、含量、比例及其临床意义。方法收集广泛性子宫切除术术后主韧带、骶子宫韧带、阴道旁组织复合体的新鲜标本,分别为22条、29条、28条,将标本分为近、中及远三段,主、骶韧带再进一步细分为浅、深两层;对所有标本分别行HE染色、CD34染色及醛品红——高碘酸Schiff氏双染色定性分析后,采用Impro图像分析软件和生物体视学对其进行定量分析。结果(1)定性分析:CD34免疫组化染色证实三条韧带中均存在动静脉;HE染色进一步证实三条韧带内均含有丰富的血管,包括中、小、微动静脉,内含大量红细胞;醛品红——高碘酸Schiff氏双染色改良法显示动脉的弹力纤维为紫红色,动脉腔内容物为玫瑰红色。(2)定量研究:主韧带的血管集中于韧带的浅层(0.2153±0.0992)(P<0.01),近、中、远三段之间无显著差异(P>0.05);骶韧带的血管各段之间无显著差异(P>0.05),深、浅层之间也无显著差异(P>0.05);阴道旁组织复合体中血管主要分布于近段(0.1280±0.1133)和远段(0.1230±0.1152),中段最少(0.0458±0.0439)(P<0.01)。结论宫颈周围立体环中三条主要韧带的血管分布有一定的规律,这些分布特点对指导术中对宫颈周围立体环内韧带的正确处理,减少术中出血及周围脏器损伤具有重要作用。

Objective To explore the disposition, quantity, proportion and clinical significance of blood vessel in the cardinal ligament, uterosacral ligament and paracolpium complex of the three-dimensional ring around the cervix of cervical cancer. Methods Fresh specimens were collected from patients who had underwent radical hysterectomy, and cut into near, middle and far segment. The cardinal ligament, uterosacral ligament were subdivided into superficial and deep part from the middle. Blood vessel were quantitative analysis using Impro image analysis software and biosystem stereology after HE, CD34 immunohistochemistry and aldehyde fuchsin -- periodic acid Schiff＇s double staining. Results （1） Qualitative research： CD34 staining identified the existence of the arteriovenous in three ligaments. HE staining identified the existence of blood vessel that contains a lot of middle, small and micro arteriovenous. Aldehyde fuchsin -- periodic acid Schiff＇s double staining showed that the artery elastic fibers are amaranth and the artery antrum inside was rose Bengal. （2） Quanti- tative research： The vessel in the cardinal ligament was concentrated on the superficial part （0.2153 ±0.0992）（P 〈0.01 ）, and there was no significant difference from near, middle and far segment （ P 〉 0.05 ） . The vessel in the uterosacral ligament had no significant difference among the near, middle and far segment （ P 〉 0. 05 ） , also between the superficial and deep part （P 〉 0. 05 ） . The vessel in the paracolpium complex was mainly distributed in the near segment （0. 1280 ±0. 1133 ） and far segment （0. 1230 ±0. 1152）, little in the middle segment （0. 0458 ±0. 0439） （P 〈0. 01 ） . Conclusions The distribution of the blood vessel in the three primary ligament of the three-dimensional ring around the cervix is regular. These distribution characteristics mean importantly in dealing with the ligament of the three-dimensional ring around the cervix, reducing bleeding and preventing the damage of organs around when surgery.