系统保留盆腔自主神经广泛性子宫切除术相关阴道旁组织复合体中神经定量分析

Quantitative analysis of nerves in paracolpium complex associated with systematic nerve sparing radical hysterectomy.

目的探讨阴道旁组织复合体中神经的类型、含量及分布特征,为系统保留盆腔自主神经广泛性子宫切除术(SNSRH)中阴道旁组织复合体处理方法的设计提供组织学依据。方法收集2009年3月至2010年8月南方医科大学南方医院20例广泛性子宫切除术后新鲜离体阴道旁组织复合体标本28条,以1 cm为间距从阴道侧自内向外将标本分为近段、中段和远段,共取得69个标本,对复合体中的神经进行染色;同时采用Impro图像分析软件结合生物体视学原理对阴道旁组织复合体内神经进行定量测定。结果 (1)阴道旁组织复合体富含自主神经与神经节,包括交感与副交感神经。(2)阴道旁组织复合体中交感神经体积密度(Vv):总的交感神经体积密度为0.0246±0.0298,其中近段0.0391±0.0356、中段0.0075±0.0085、远段0.0284±0.0280;交感神经主要分布在近段和远段,均显著高于中段。(3)副交感神经Vv:总的副交感神经体积密度为0.0078±0.0108,其中近段0.0083±0.0131、中段0.0071±0.0067、远段0.0083±0.0125;副交感神经在近段和远段相对中段呈增高趋势,但差异无统计学意义。(4)交感神经总Vv大于副交感神经,两者比值为3.14∶1。结论神经主要集中于复合体的近段和远段,中段为"少神经区";根据神经的分布特征,制定SNSRH术中阴道旁组织复合体合理的处理步骤,可提高SNSRH手术的成功率。

Objective To explore the type, content and distribution pattern of the nerves in the paracolpium complex, providing histological evidence for the design of management of the paracolpimn complex in systematic nerve sparing radi- cal hysterectomy （SNSRH）. Methods Total 28 paravaginal tissue specimens were collected from 20 patients underwent SNSRH ; The specimens were divided into proximal, middle and distal segments from side of vagina by the inside-out to 1 cm separalion distance, a to^al of 69 specimens. Application of HE staining, special staining and immunohistoehemieal staining techniques to the complex of nerve were stained. To quantitative test of the nerves in the paracolpium complex was carried out by using Impro image analysis software combined with the principle of biological stereology. Results （ 1 ） The paraeolpium complex contains a large number of autonomic nerve and nerve node , include sympathetic nerve and parasympathetic nerve. （2）The volume density（Vv） of paracolpium complex ：Total of sympathetic nerves that the volum density was （ 0. 0246±0. 0298 ） , Therein, proximal segment mean （ 0. 0391± 0. 0356）, middle segment mean （ 0. 0075± 0. 0085 ）and distal segment mean（0. 0284±0. 0280）. The sympathetic nerve main distribution at proximal and distal seg- ment. Compared with the middle, there were significant statistical difference. （3） Total of parasympathetic nerves that the volum density was （ 0. 0078 ±0. 0108 ） ; Therein, proximal segment mean （ 0. 0083±0. 0131 ）, middle segment mean （0. 0071±0. 0067 ） and distal segment mean （ 0. 0083±0. 0125）Parasympathetic nerve relatively proximal and distal middle tended to increase, but the difference was not signifi- cant;（4） Sympathetic nerve overall content is greater than the parasympathetic nerve, the ratio of 3. 14 ： l. Conclusion Nerves are mainly centralized in the proximal and distal seg-ments of the complex, the middle segment being the ＂less nerve zone＂ ; according to the distribution pattern, proper pro- cedure for the management of the paracolpium complex in the SNSRH is determined in order to elevate the success rate of SNSRH.