背景: 人類在上身直立狀態時，骨盆底必須承受腹內壓，骨盆內器官的重量及本身的重力，這些力量會集中於生殖泌尿橫膈，最主要會作用於陰道上段及前壁。在Makinen et al. (1986) 的研究中，發現陰道壁的結締組織及膠原蛋白纖維，在骨盆鬆弛的婦女中，有顯著變化。Koelbl et al. (2000) 在婦科泌尿學年會中也報告，尿失禁及生殖泌尿鬆弛的婦女，在尿道旁的支撐結締組織中，膠原蛋白的次級成分與正常的婦女有顯著的差異。因組織血液灌注不足或缺氧狀況下被激發出來的calpain表現，在陰道壁脫垂的婦女有明顯的變化。我們想從膠原蛋白次級成分及其超顯微構造，去探究婦女的陰道前壁脫垂，在組織學、形態學及免疫組織化學等層面上的表現，是否與正常婦女的陰道前壁有所不同，進而找出其相關的影響因子。
方法: 本研究選取在中山醫學大學附設醫院自民國88年10月至民國90年10月之間接受全子宮切除術，以無陰道前壁脫垂的6位婦女列為對照組，另外以有陰道前壁脫垂Stage I、II、III各6位婦女列為實驗組。這些婦女在接受全子宮切除術後，於距子宮頸1.5公分處切取一塊1.0 X 1.0 公分陰道前壁做為檢體。將此檢體一分為二，一塊立即置入組織固定液中固定，並送至電檢室暫時冷藏，另一塊直接放入冷凍管，儲存於液態氮中。待收集足夠檢體後，一組檢體施行免疫組織化學染色法，檢測膠原蛋白次級成分，另一組檢體做光學顯微鏡及電子顯微鏡的觀察。
結果: 在TEM和LM的患者年齡方面，第三期陰道前壁脫垂組與控制組之間無顯著差異 (60.33 ± 17.07 vs. 50.33 ± 13.54 ， p = 0.2873)。在BMI方面，第三期陰道前壁脫垂組與控制組之間有顯著差異(24.93 ± 1.91 vs. 20.33 ± 3.34 , p < 0.05)。在IHC的患者年齡方面，第三期陰道前壁脫垂組與控制組之間無顯著差異(60.6 ± 19.88 vs. 49.5 ± 24.52 ， p = 0.4377)。在BMI方面，第二期、第三期陰道前壁脫垂組分別與控制組之間，也無顯著差異(26.85 ± 5.56 vs. 21.68 ± 3.81， p = 0.1161 ; 26.25 ± 5.63 vs. 21.68 ± 3.81， p = 0.1435)。在小動脈周圍的微血管數目方面，第二期、第三期陰道前壁脫垂組分別與控制組之間有顯著差異(p < 0.05)。在type V Collagen與Vitronectin方面，第三期陰道前壁脫垂組與控制組之間，分別有顯著差異(p < 0.05)。在Fibronectin方面，第一期陰道前壁脫垂組與控制組之間，有顯著差異(p = 0.042)。在Laminin方面，第三期陰道前壁脫垂組與控制組之間有顯著差異
結論: 此次研究的初步報告，雖然在微血管數目、type V collagen、Vitronectin、Fibronectin 與Laminin方面，表現明顯的變化，但是個案數目仍嫌不足，不可遽下斷語。容增加各組個案數目後，再作研究分析。
Background: During a cough and straining event, the suddenly rising intraabdominal pressure exerts a downward effect upon the urethra and the anterior vaginal wall. Weakness of the upper vaginal wall may result in vaginal laxity and eventually lead to symptomatic uterovaginal prolapse. These results are a combination of intrinsic de-fects in the fascia and supporting ligaments such as weakness of the tissue collagen and damage to the pelvic floor and its associated nerves or vascular supply during childbirth. Uterovaginal prolapse has been considered as a long-term failure of the supporting and suspension mechanisms of the uterus and vaginal wall. Calpain (Ca2+ activating proteolytic enzyme) expression is relatively lower in women with uterova-ginal prolapse, which has been under a inadequate long term tissue perfusion, perma-nent tissue changes and refractory to the continuous strain in daily activity. Makinen et al. demonstrated that a correlation between histological changes in vaginal connec-tive tissue and pelvic laxity. This study aims at demonstrating the histologic, mor-phologic and ultrastructural changes in the upper anterior vaginal wall in women with anterior vaginal wall prolapse.
Methods: Between October 1999 and October 2002, 18 patients who underwent total abdominal hysterectomy (TAH) due to a variety of cystocele and uterine myoma had excisional biopsies of the upper vaginal tissues (10 x 10 mm) performed. This group serves as the experimental group. An additional 6 patients who underwent TAH due to various benign gynecologic diseases also had biopsies performed and this group serves as the control group. Each of the specimens was divided into two parts. One was fixed in glutaraldehyde fixative , stored in 4 °C refrigerator and provided for light microscope and transmission electron microscope examinations. The other was stored in liquid nitrogen tank and provided for immunohistochemical staining.
Results: There was significant difference between Stage III cystocele group and control group in body mass index (p < 0.05). There were significant differences between Stage II, III cystocele groups and control group in capillary numbers around a small artery (p < 0.05). There were significant differences between Stage III cys-tocele group and control group in type V Collagen, Vitronectin and Laminin densities ( p < 0.05). There was significant difference between Stage I cystocele group and control group in fibronectin density (p < 0.05).
Conclusion: Although there were significant changes in capillary number, densities of type V Collagen, Vitronectin, Fibronectin and Laminin in this preliminary report, we still considered that increase of the case number was mandatory in each group.
