人类阴道前壁神经和微血管密度分布的前瞻性研究

Prospective study on the anatomic distribution of nerves and microvascular densityin human anterior vaginal wall

目的:对阴道前壁内是否存在性敏感区G点进行组织学研究。方法:收集32例因子宫脱垂、尿失禁行手术治疗的阴道前壁组织标本,选取阴道前壁外1/3和内1/3作为研究部位和对照部位,组织采用蛋白基因产物9.5(protein gene product 9.5,PGP9.5)特异性神经染色及平滑肌肌动蛋白(smooth muscle actin,SMA)血管平滑肌染色,比较阴道前壁外1/3和内1/3部位神经末梢和微血管分布。结果:阴道PGP9.5阳性神经末梢计数:前壁外1/3和内1/3黏膜固有层分别为(4.34±0.35)/mm2和(2.34±2.86)/mm2(P=0.000);肌层分别为(5.23±0.49)/mm2和(3.61±0.33)/mm2(P=0.006)。阴道α-SMA阳性微血管计数:阴道前壁外1/3和内1/3黏膜固有层分别为(54.25±3.07)/mm2和(47.88±2.2)/mm2(P=0.046);肌层分别为(28.61±2.03)/mm2和(24.71±1.99)/mm2(P=0.002)。阴道前壁外1/3的黏膜固有层和肌层的神经末梢及微血管显著高于阴道前壁内1/3部分。结论:(1)阴道前壁外1/3部分具有丰富的神经血管,可能为G点的组织学基础。(2)阴道前壁修补术时过多修剪外1/3部位的阴道黏膜可能会破坏局部组织结构,降低性感受能力。

Objectives： To investigate the histomorphological presence of the G- spot（ an assumed erotic sensitive area） in the anterior wall of the vagina and the effect of anterior vaginal repair on female sexual function.Methods： Biopsies were drawn from the distal- and proximal- third areas of the anterior vagina of 32 Chinese patients with uterine prolapse or urinary incontinence. The total number of protein gene product 9. 5- immunoreactive nerves and smooth muscle actin- immunoreactive blood vessels in each specimen was quantified using the avidin-biotin- peroxidase assay. Vaginal innervation and vascular density was observed in the lamina propria and muscle layer of the anterior vaginal wall. Results： The distal- third of the anterior vaginal wall had significantly richer small- nerve- fiber innervation in the lamina propria than the proximal- third（ 4. 34 ± 0. 35 / mm2 vs. 2. 34 ± 2. 86mm2,P = 0. 000） and in the vaginal muscle layer（ 5. 23 ± 0. 49 /mm2 vs. 3. 61 ± 0. 33 mm2,P = 0. 006）. Significant differences were noted in the number of microvessels when comparing the distal- with proximal- third parts inthe lamina propria（ 54. 25 ± 3. 07 / mm2 vs. 47. 88 ± 2. 2 / mm2,P = 0. 046） and muscle layer（ 28. 61 ± 2. 03 /mm2 vs. 24. 71 ± 1. 99 / mm2,P = 0. 002）. Conclusion： Significantly increased density of nerves and microvessels in the distal- third of the anterior vaginal wall can serve the histomorphological basis of the G- spot. Distal anterior vaginal repair can disrupt the normal anatomy,neurovascular supply and function of the G- spot,and cause sexual dysfunction.