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目的探讨深部浸润型子宫内膜异位症(DIE)宫骶韧带病灶及阴道直肠隔病灶中神经纤维束状浸润(NFBI)情况及其与患者疼痛的相关性。方法收集2012-06-01—2015-01-01在中山大学附属第一医院妇科行手术治疗的64例DIE患者,采用免疫组化的方法分别检测宫骶韧带病灶和阴道直肠隔病灶中神经纤维蛋白基因产物9.5(PGP9.5)和GAP-43染色阳性的神经纤维。根据是否存在神经纤维束状浸润分为两组:NFBI阳性组和NFBI阴性组。比较两组患者痛经、肛门坠胀痛、性交痛和慢性盆腔痛程度,并探讨二者之间新生神经纤维密度的差异。结果宫骶韧带DIE病灶中NFBI阳性组痛经、肛门坠胀痛和慢性盆腔痛评分均比NFBI阴性组高,差异有统计学意义(均P<0.05);性交痛评分两组差异无统计学意义(P=0.12)。阴道直肠隔DIE病灶中NFBI阳性组痛经、肛门坠胀痛、性交痛和慢性盆腔痛评分均比NFBI阴性组高,差异均有统计学意义(均P<0.05)。宫骶韧带DIE病灶和阴道直肠隔DIE病灶中NFBI阳性患者的新生神经纤维(GAP-43染色阳性的神经)密度均比NFBI阴性患者高,差异均有统计学意义(P=0.001,P=0.007)。结论深部浸润型子宫内膜异位症病灶中神经纤维束状浸润与患者疼痛的严重程度相关,其原因之一可能是刺激新生神经纤维生长增加。
Objective To investigate the correlation between NFBI and pain in patients with deep infiltrative endometriosis (DIE) uterosacral ligament and vaginal rectal septal lesions. Methods Sixty-four patients with DIE underwent surgical treatment at the First Affiliated Hospital of Sun Yat-sen University from June 16 to June 20, 2012. The immunohistochemical methods were used to detect the nerve fibers in uterosacral ligament lesions and vaginal rectal septum, respectively Protein gene product 9.5 (PGP 9.5) and GAP-43 positive staining nerve fibers. Divided into two groups according to the presence or absence of nerve fiber bundle infiltration: NFBI-positive group and NFBI-negative group. Dysmenorrhea, anal pain, painful intercourse and chronic pelvic pain were compared between the two groups, and the difference of neonate nerve fiber density between the two groups was also discussed. Results In the uterosacral ligaments, the scores of dysmenorrhea, anal pain and chronic pelvic pain in NFBI positive group were higher than those in NFBI negative group (all P <0.05). There was no significant difference in pain scores between the two groups (P = 0.12). Vaginal and rectal DIE lesions in the NFBI group dysmenorrhea, anal pain, painful painful pain and chronic pelvic pain score than NFBI negative group, the differences were statistically significant (P <0.05). The density of newborn nerve fibers (GAP-43 positive neurons) in uterine sacral ligament DIE lesion and NFBI positive colorectal DIE lesion were higher than those in NFBI negative group (P = 0.001, P = 0.007 ). Conclusions One of the reasons for the involvement of nerve fiber bundle-like infiltrates in deep infiltrative endometriosis lesions is the severity of pain in patients. One of the reasons may be the stimulation of the growth of newborn nerve fibers.