目的:对阴道前壁内是否存在性敏感区G点进行组织学研究.方法:收集32例因子宫脱垂、尿失禁行手术治疗的阴道前壁组织标本,选取阴道前壁外1/3和内1/3作为研究部位和对照部位,组织采用蛋白基因产物9.5(protein gene product 9.5,PGP9.5)特异性神经染色及平滑肌肌动蛋白(smooth muscle actin,SMA)血管平滑肌染色,比较阴道前壁外1/3和内1/3部位神经末梢和微血管分布.结果:阴道PGP9.5阳性神经末梢计数:前壁外1/3和内1/3黏膜固有层分别为(4.34 ±0.35)/mm2和(2.34±2.86)/mm2(P=0.000);肌层分别为(5.23 ±0.49)/mm2和(3.61±0.33)/mm2(P=0.006).阴道α-SMA阳性微血管计数:阴道前壁外1/3和内1/3黏膜固有层分别为(54.25±3.07)/mm2和(47.88±2.2)/mm2(P=0.046);肌层分别为(28.61±2.03)/mm2和(24.71±1.99)/mm2 (P=0.002).阴道前壁外1/3的黏膜固有层和肌层的神经末梢及微血管显著高于阴道前壁内1/3部分.结论:(1)阴道前壁外1/3部分具有丰富的神经血管,可能为G点的组织学基础.(2)阴道前壁修补术时过多修剪外1/3部位的阴道黏膜可能会破坏局部组织结构,降低性感受能力.%Objectives:To investigate the histomorphological presence of the G-spot (an assumed erotic sensitive area) in the anterior wall of the vagina and the effect of anterior vaginal repair on female sexual function.Methods:Biopsies were drawn from the distal-and proximal-third areas of the anterior vagina of 32 Chinese patients with uterine prolapse or urinary incontinence.The total number of protein gene product 9.5-immunoreactive nerves and smooth muscle actin-immunoreactive blood vessels in each specimen was quantified using the avidin-biotin-peroxidase assay.Vaginal innervation and vascular density was observed in the lamina propria and muscle layer of the anterior vaginal wall.Results:The distal-third of the anterior vaginal wall had significantly richer small-nerve-fiber innervation in the lamina propria than the proximal-third (4.34 ± 0.35/mm2 vs.2.34 ± 2.86 mm2,P =0.000) and in the vaginal muscle layer (5.23 ±0.49/mm2 vs.3.61 ±0.33 mm2,P =0.006).Significant differences were noted in the number of microvessels when comparing the distal-with proximal-third parts in the lamina propria (54.25 ± 3.07/mm2 vs.47.88 ± 2.2/mm2,P =0.046) and muscle layer (28.61 ± 2.03/mm2 vs.24.71 ± 1.99/mm2,P =0.002).Conclusion:Significantly increased density of nerves and microvessels in the distal-third of the anterior vaginal wall can serve the histomorphological basis of the G-spot.Distal anterior vaginal repair can disrupt the normal anatomy,neurovascular supply and function of the G-spot,and cause sexual dysfunction.
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