婦女尿失禁之相關韌帶與筋膜的顯微研究

骨盆腔鬆弛症候群（pelvic relaxation）與真性應力性尿失禁（genuine stress incontinence）為常困擾著許多婦女的疾病，但相關的研究文獻並不多。有鑑於此，本研究擬利用光學顯微鏡與電子顯微鏡技術，比較無脫垂症狀的婦女與罹患應力性尿失禁婦女的子宮薦骨韌帶（uterosacral ligament）與陰道旁筋膜（paravaginal fascia）之顯微構造變化；希望藉由顯微構造的觀察，探討子宮脫垂（prolapse of uterus）、膀胱脫垂（cystocele）與應力性尿失禁的原因與彼此之關係。　　本研究採集13位無脫垂症狀婦女作為對照組，而實驗組係採集20位患有子宮脫垂或膀胱脫垂，且經尿路動力學檢查實為應力性尿失禁之婦女。一般依子宮與膀胱脫垂的程度，可分為三級：　　Grade I：子宮與膀胱脫垂由坐骨脊至處女膜之間（14位）。　　Grade II：子宮與膀胱脫垂由坐骨脊至處女膜處（3位）。　　Grade III：子宮與膀胱脫垂到陰道外（3位）。　　為方便顯微的觀察與判讀，將Grade I歸為輕度脫垂（mild prolapse）、另將Grade II與Grade III歸為重度脫垂（severe prolapse）。取直徑約0.5公分的檢體，經過適當的處理後，於顯微底下觀察結構的變化。　　由實驗結果發現，實驗組的纖維母細胞有細胞核變形、粒線體與內質網等胞器崩落的病變，同時也發現許多肌纖維母細胞，膠原纖維亦呈現退化，神經元的粒線體有膨大等退化的現象。由於結締組織退化，導致脂肪小滴侵潤。此外發現許多巨噬細胞與肥胖細胞的聚集，推測有類似炎症反應的發生。而對照組的纖維母細胞、膠原纖維、血管、神經等構造，無論在光學顯微鏡或電子顯微鏡底下觀察，都沒有特別的病理變化。　　由以上實驗證據推測：由於韌帶與筋膜組織的退化，可能引起子宮或膀胱脫垂，進而造成尿失禁。

Pelvic relaxation syndrome and genuine stress incontinence are two of the most commonly-seen disorders in the gynecoloic outpatients that often disturbe the quality of their daily life, yet there has not been mant literatures reported up-to-date. By comparing the ultrastructure of two of the major suspension structures, uterosacral ligament and paravaginal fascia, got from non-prolapse female and patients suffering genuine stress incontinence, we hope to better understanding the cause of and to establish correlations among prolapse of uterus, cystocele, and genuine stress incontinence.　　Samples collected from 20 patients with known conditions of prolaose of uterus and or cystocele, but are all confirmed genuine stress incontinence by urodynamics, wereused to make comparisons with the corresponding samples from 13 non-prolapse females. Of the 20 cases in the experimental group, 14 are diagnosed as under grade I condition, which sre considered here as mild prolapse. Grade II and Grade III condition collected 2 cases each, and are grouped together as severe prolapse.　　A 0.5 cm cube of tissue was obtained from each selected sites from individual subject of both the experimental and control groups. Observation was made using light and transmission electron microscopes followed appropriate sample preparation procedures.　　In the experiment guoup, fibroblasts displayed nuclear distortion, degeneration of mitochondria and endoplasmic reticulum. Myofibroblasts were observed, collagen fibers and mitochondria in the neurons also showed signs of degeneration. Deposition of lipid droplets followed the degradation of the connective tissue and the aggregation of macrophages and mast cells indicated the possibility of a chronically on going inflammation-like reaction. In the control group, no detectable pathological changes was observed on the structures of fibroblasts, collagen fibers, blood vessels, and nerves.　　The results suggest that the degeneration of the ligament and fascia may cause the condetion of prolapse of uterus and cystocele to occur, thus indrces urinary incontinence.