| Objective：The aim of the study was to evaluate the changes in thehistological morphology, the expression of mucin2(MUC2), aquaporin9(AQP9), aquaporin2(AQP2)and cystic tibrosis fransmembrane conductanceregulator(CFTR)in the sigmoid neovaginal mucosa of the patients undergoingvaginal construction by sigmoid colon, to explore the putative reason for theneovaginal secretion function after artificial vaginal construction, to evaluatethe quality of their sexal life through FSFI, and the impact of the surgery onquality of life of in the patients with neovagina through SF-36scale.Methods:1Cases and groups：The objects were selected from the patients whounderwent vaginal reconstruction by sigmoid colon in the Second Hospital ofHebei Medical University and were followed-up from January1999toNovember2011. After having gained the consents of the Ethics Committee ofthe hospital and having known the fact, if they agreed to take part in presentstudy，they would be the study group. According to the postoperative time,they were divided into study group1(postoperative time≦5years) and studygroup2(postoperative time>5years). The postoperative results were analyzedregarding the patient’s sexual life situation and quality of life were analyzedthrough questionnaires, and anatomical and functional status through physicalexamination. Biopsies of the neovaginal mucosa were taken in the upperone-third mucosa of the sigmoid neovagina(15objects of the study group1,13objects of the study group2). In the control group, biopsies of the normalcolonic mucosa were taken during the operation of sigmoid vaginalconstruction in the corresponding time period. Biopsies of natural vagina were obtained at the same position to neovagina age-matched female withoutvaginal diseases(natural vagina group, n=15). The morphologic changes of thesigmoid neovaginal mucosa were investigated by the light microscope afterthe samples had been dyed with the HE dyeing method.Immunohistochemistry was used to detect the expression of MUC2, AQP2,AQP9, and CFTR for the all specimens. The results of the staining weremeasured by IPP6software.2Statistics analysis:SPSS13.0was used. The measurement data were shown with mean±SDand analyzed by variance analysis.If the date did not meet normality orhomogeneity of variances, they were analyzed using rank-sum test. There wassignificant difference on statistics if pvalues less than0.05.Results:1Follow-up results(1) The general situation: The follow-up was10to163months.100%ofthe objects undergoing vaginal reconstruction by sigmoid colon were satisfiedwith the appearance of the neovagina, which is similar to the normal vagina.The average time was6.71±2.13(3~12)months when the secretion of theneovagina became to decrease after the operation. The mean depth and widthof the neovaginal cavity were8~12cm and3~4cm respectively. Theneovaginal mucosa was moist, soft and flexible. The interval time betweenoperation and biopsy was10to163months.(2) Sexual life qualityThere were no statistical differences in the total FSFI score of the studygroup1(25.30±3.58), the study group2(25.37±3.72) and the normal vaginagroup (26.54±3.57) and in the score of6sides (P>0.05).(3) Qualityof lifeIn the SF-36performance test, the mental health(MH) score of thenormal vagina group were higher than the study group1and the study group2，and differences had statistical significance(P=0.001,0.001<0.05). Therewere no statistical differences among the three group in other seven scales (p>0.005).2Pathological observationsCompared with the control group，in the upper one-third of the neovaginain the study group1, mucosal epithelial gland size is not consistent. While, inthe study group2of the neovagina, the number of the glands in the mucosawas decreased significantly, size became smaller, and goblet cells of eachgland contained decreased. Besides, the percentage of goblet cells in glandsalso fell (from>80%to <40%). Even some glands no longer contained gobletcells.3The expression of the MUC2MUC2was mainly expressed in the mucus of the goblet cells. Comparedwith the control group, the expression of the MUC2decreased slightly in theneovagina of study group1(from>80%to<60%), while in the neovagina ofstudy group2the expression of the MUC2decreased significantly(<40%)，and some glands even no longer expressed MUC2. The normal vagina groupdid not express MUC2.The IOD of the study group1, the study group2and the control groupwere taken analysis of variance, and differences had statistical significance(P=0.000<0.05). There were statistical differences between the control groupand the study group1, the study group2(P=0.000,0.000<0.05). There wasstatistical difference between the study group1and the study group2(P=0.000<0.05).4The expression of the AQP9AQP9was mainly expressed in the cytoplasm of gland cells. Comparedwith the control group, in the neovagina of study group1, the expression ofthe AQP9had no obvious change，while in the neovagina of study group2,the expression of the AQP9decreased significantly. The normal vagina groupdid not express AQP9.The IOD of the study group1, the study group2and the control grouptook analysis of variance, and differences had statistical significance(P=0.000<0.05). There was no statistical difference between the control group and the study group1(P=0.164>0.005). There were statistical differencesbetween the study group2and the study group1, the control group (P=0.001,0.001<0.05).5The expression of the AQP2AQP2was mainly expressed in the cytoplasm of gland cells. Comparedwith the control group, in the study group1of the neovagina, the expressionof the AQP2had no obvious change, while in the study group2of theneovagina, the expression of the AQP2made something increase. In thenormal vagina, AQP2was mainly expressed in the cytoplasm of thesquamous cells of the mucous layer, near the basal layer.The IOD of the four group took analysis of variance, and differences hadstatistical significance (P=0.000<0.05). There was no statistical differencebetween the control group and the study group1(P=0.508>0.005). There werestatistical differences between the study group2and the study group1, thecontrol group (P=0.006,0.001<0.05). The expression of AQP2of normalvaginal group were higher than the study group1, the study group2, thecontrol group, and the differences had statistically significant (P=0.000,0.000,0.000).6The expression of the CFTRCFTR was mainly expressed in the cytoplasm of gland cells. Comparedwith the control group, in the study group1of the neovagina, the expressionof the CFTR had no obvious change, while in the study group2of theneovagina, the expression of the CFTR made something decrease. In thenormal vagina, CFTR was mainly expressed in the cytoplasm and nucleus ofthe squamous cells of the mucous layer, near the basal layer.The IOD of the four group took analysis of variance, and differences hadstatistical significance (P=0.000<0.05). There was no statistical differencebetween the control group and the study group1(P=0.501>0.005). There werestatistical differences between the study group2and the study group1, thecontrol group (P=0.000,0.000<0.05). The expression of CFTR of normalvaginal group were lower than the study group1, the control group, and the differences had statistically significance (P=0.000,0.000), lower than thestudy group2, and the difference had no statistically significant (P=0.261>0.005).Conclusion:1Most of the objects were satisfied with the appearance of the sigmoidneovagina and their sexual lives, and almost has no obvious influence onquality of life. Therefore, we consider that vaginal construction performedusing is olated sigmoid segment is a feasible method.2With extension of time after surgery, the expression of the MUC2ofthe neovagina in the study group, and the expression of the AQP9, CRTR ofthe study group2decreased. These changes showed that with the extension oftime after surgery, the secretion of artificial vagina gradually decreased.3With extension of time after surgery, expression of the MUC2of theneovagina of the study group, and the expression of the AQP9, CRTR of thestudy group2decreased, and the expression of the AQP2of the study group2increased. These changes showed that with the extension of time after surgery,the artificial vagina mucosa happened adaptative change.4CFTR might take part in the secretion of the normal vagina. |
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