Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse
Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse
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DOI：
10.1002/bjs.4065
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发表时间：
2003-04-01
影响因子：
9.6
通讯作者：
Allen-Mersh, TG
中科院分区：
文献类型：
--
作者：
Jones, NHJR;Healy, JC;Allen-Mersh, TG
背景资料：分娩损伤后迟发的盆腔内脏脱垂和失禁可以解释为绝经相关的结缔组织减弱。评估子宫骶韧带弹性（UsR）以确定其是否影响子宫或骨盆底的活动度，或随年龄、阴道分娩、绝经或韧带的组织学变化而变化。通过张力测量法测量了85例子宫切除术标本韧带的UsR，UsR与有症状的子宫颈脱垂、子宫切除术前子宫和肛门直肠活动度、患者年龄、有阴道分娩和绝经史这些韧带中的45个检查韧带厚度，肌肉胶原蛋白的比例，雌激素和孕激素受体密度。结果与UsR.Results：UsR显着降低（P=0.020）在有症状的子宫阴道脱垂，但没有相关性子宫颈或肛门直肠下降的妇女没有症状的脱垂。阴道分娩（P=0.003）、绝经（P=0.009）和高龄（P=0.005）的UsR显著降低。子宫骶韧带显着变薄，绝经后雌激素和孕激素受体较少，但这并不影响UsR.Conclusion：在盆底肌肉被削弱，减少盆腔结缔组织弹性有关的绝经期可能会促进症状性盆腔脏器脱垂的进展。
Background: The late onset of pelvic visceral prolapse and incontinence after childbirth injury could be explained by menopause-associated connective tissue weakening. Uterosacral ligament resilience (UsR) was assessed to determine whether it influenced uterine or pelvic floor mobility, or varied with age, vaginal delivery, menopause or histological variations in the ligament.Methods: UsR was measured by tensiometry in ligaments from 85 hysterectomy specimens, and was correlated with the presence of symptomatic uterocervical prolapse, prehysterectomy uterine and anorectal mobility, patient age, history of vaginal delivery and menopause. Forty-five of these ligaments were examined for ligament thickness, muscle to collagen ratio, and oestrogen and progesterone receptor density. The results were correlated with UsR.Results: UsR was significantly reduced (P=0.020) in symptomatic uterovaginal prolapse, but there was no correlation with either uterocervical or anorectal descent in women without symptomatic prolapse. There was a significant decrease in UsR with vaginal delivery (P=0.003), menopause (P=0.009) and older age (P=0.005). The uterosacral ligament was significantly thinner and contained fewer oestrogen and progesterone receptors after menopause, but this did not affect UsR.Conclusion: Where pelvic floor muscles are weakened, decreases in pelvic connective tissue resilience related to the menopause may facilitate progression to symptomatic pelvic visceral prolapse.