Imai Kanoko, Furuya Kenichi, Kawada Michihiro, Kinugasa Yusuke, Omote Kiichi, Namiki Akiyoshi, Uchiyama Eiichi, Murakami Gen
Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, 359-8513, Japan.
Surg Radiol Anat. 2006 Dec;28(6):596-605. doi: 10.1007/s00276-006-0156-2. Epub 2006 Oct 11.
In pelvic surgery, much attention is paid to nerve bundles but not to ganglion cells. Using serial section histology of 14 postmortem-treated hemipelvis (eight males, six females; mean, 79 years old), we examined the population number, distribution, and tyrosine hydroxylase-immunoreactivity (TH-IR; suggesting sympathetic neurons) of extramural pelvic ganglion cells. All pelvic ganglion cells were uniformly sized (25-30 microm) contrasting with small intramural rectal neurons. Abundant ganglion cells (30,000-140,000 unilaterally) existed not only along the pelvic viscera except for the rectum, but also along the hypogastric nerve, pelvic splanchnic nerve, pelvic plexus, and associated branches excluding those within the mesorectum. The intrapelvic ganglion cells outside the sympathetic trunk did not form macroscopically identifiable ganglia, but made small clusters (0.1-2.0 mm of maximum diameter) or were diffusely scattered within nerve bundles. More than half of these cells appeared TH-IR positive, although the positive/negative proportion differed between nerves and specimens. Greater numbers of ganglion cells were found in dorsosuperior sites (e.g., around the seminal vesicle) rather than in ventroinferior sites (e.g., along the urethra) in males, and vice versa in females. However, in total cell numbers, interindividual variations were evident rather than intergender difference. Due to significant interindividual variations in cell number, differences are likely to exist between patients in "resistance" to surgical stresses. We hypothesized that pelvic ganglion cells are liable to be damaged due to drying along the surgical margin, hypoxia in venous bleeding, pressure from surgical retractors, extension stress with taping and excess traction and/or direct injury with electrical scalpels.
在盆腔手术中，人们更多关注神经束而非神经节细胞。我们利用14例经尸检处理的半骨盆（8例男性，6例女性；平均年龄79岁）的连续切片组织学方法，研究了壁外盆腔神经节细胞的数量、分布以及酪氨酸羟化酶免疫反应性（TH-IR；提示交感神经元）。所有盆腔神经节细胞大小均匀（25 - 30微米），与直肠壁内的小神经元形成对比。大量神经节细胞（单侧30,000 - 140,000个）不仅存在于除直肠外的盆腔脏器周围，还存在于腹下神经、盆内脏神经、盆腔丛及其相关分支周围，但不包括直肠系膜内的分支。交感干外的盆腔内神经节细胞未形成肉眼可识别的神经节，而是形成小簇（最大直径0.1 - 2.0毫米）或分散在神经束内。尽管神经和标本之间的阳性/阴性比例不同，但超过一半的这些细胞呈现TH-IR阳性。在男性中，背上部区域（如精囊周围）发现的神经节细胞数量多于腹下部区域（如尿道周围），而在女性中则相反。然而，在细胞总数方面，个体间差异明显，而非性别差异。由于细胞数量存在显著的个体间差异，患者对手术应激的“抵抗力”可能存在差异。我们推测，盆腔神经节细胞可能因手术边缘干燥、静脉出血导致的缺氧、手术牵开器的压力、结扎和过度牵引造成的伸展应力以及/或电刀的直接损伤而易于受损。
