Objective To investigate re-innervation in the neovaginal mucosa of patients underwent sigmoid colon vaginoplasty in treatment of Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS).Methods Biopsies in the upper third of the posterior neovagina were taken in 20 patients treated by sigmoid colon vaginoplasty at 1, 2 and 3 years after surgery, respectively. Protein gene product 9. 5 ( PGP 9. 5 ),vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) were detected by immunohistochemical method and compared with those in intact sigmoid colon mucosa. Results ( 1 ) Density of nerve fiber:abundant distribution of PGP 9. 5 nerve fibers were observed in the mucosal muscle layer, submucosa, and smooth muscle layer of the neovagina. The nerve fibers of VIP and NPY immunoreactivity were mainly distributed around blood vessels and in the smooth muscles. In the neovagina, the density of nerve fibers of PGP 9. 5 of 17 ± 6 were much more than VIP of 2. 9 ± 1.0 and NPY of 2. 5 ± 0. 8 significantly ( P ＜ 0. 05 ).( 2 ) Expression of PGP 9. 5 in neovagina: at 1 year after surgery, PGP 9. 5 positive expression of 14 ± 4 was significantly lower in the neovagina than 28 ± 7 in the intact sigmoid colon( P ＜ 0. 05 ). However, after 2 to 3 years, its expression displayed an upgrade tendency in the neovagina and was significantly higher at the 3 year postoperatively than that at the 1 years postoperatively ( 22 ± 7 vs. 14 ± 4, P ＜ 0. 05 ). The changes were much more obvious in submucosa. (3) The expression of VIP and NPY in neovagina: at 1 year after surgery, VIP and NPY positive nerve fibers were also decreased in the neovagina when compared with those in the intact sigmoid colon ( 2. 3 ± 0. 7 vs. 5.3 ± 1.4, P ＜ 0. 05; 2.5 ± 1. 1 vs. 5.5 ± 1.1, P ＜ 0. 05 ) . At 2 to 3 years after surgery, the positive VIP fiber showed initially decreased and subsequently increased tendency. The density of VIP of 3.7 ± 0. 7 in the neovagina at 3 years postoperatively was higher than 2. 3 ±0. 7 at 1 years postoperatively (P ＜ 0. 05 ). No significant up-regulation was observed in NPY-positive expression in the neovagina within 3 years after operation. Conclusions Distribution of sensory PGP 9. 5,VIP and NPY immunoreactive nerve fibers was similar to the pattern observed within the intact sigmoid colon wall. The number of nerve fibers in the neovagina decreased after surgery and then increased subsequently within 3 years after surgery.%目的 探讨乙状结肠代阴道成形术后阴道黏膜神经再分布的变化.方法 2002年1月至2010年12月,取在河北医科大学第二医院接受乙状结肠代阴道成形术的20例先天性无阴道患者的人工阴道黏膜组织,采用免疫组化方法检测局部组织中蛋白基因产物9.5(PGP 9.5)的表达及血管活性肠肽(VIP)能神经和神经肽Y(NPY)能神经的分布,取材时间在术后1～3年,并与原位乙状结肠黏膜进行比较.结果 (1)神经纤维密度:人工阴道黏膜组织的黏膜层、黏膜下层和肌层均可见丰富的PGP9.5阳性表达的神经纤维,VIP和NPY阳性表达的神经纤维主要分布在血管周围和肌层;人工阴道黏膜组织中PGP 9.5阳性表达的神经纤维密度为17±6,高于VIP(2.9±1.0)和NPY(2.5±0.8)阳性表达的神经纤维密度,差异有统计学意义(P＜0.05).(2)人工阴道黏膜PGP 9.5的表达:术后1年,人工阴道黏膜PGP 9.5的表达水平为14±4,低于原位乙状结肠黏膜的28±7,差异有统计学意义(P＜0.05);术后2～3年,PGP 9.5的表达水平逐步升高,术后第3年,PGP 9.5的表达水平达22±7,且这种变化以黏膜下层最为明显.(3)人工阴道黏膜VIP和NPY的表达:术后1年,阴道黏膜VIP和NPY的表达水平分别为2.3±0.7、2.5±1.1,低于原位乙状结肠黏膜的5.3±1.4、5.5±1.1,差异均有统计学意义(P＜0.05);术后2～3年,VIP表达水平逐渐回升,术后3年为3.7±0.7,明显高于术后1年的2.3±0.7,差异有统计学意义(P＜0.05),NPY表达水平在术后3年内回升不明显.结论 乙状结肠代阴道成形术后,阴道黏膜的神经分布特征与原位乙状结肠相似.在术后1～3年内,人工阴道黏膜神经纤维密度降低后又有逐步回升趋势.
展开▼
