摘要
目的 探讨宫腔镜下子宫内膜电切除术 (TCRE)后创面组织病理学改变及再次治疗的原因。方法 对 1991年 3月至 2 0 0 2年 9月 ,行TCRE后仍有少量出血、腹痛进行再次治疗的患者 38例为研究对象 ,其中行子宫切除 13例、二次TCRE 3例和宫腔镜下刮宫 2 2例 ,将手术获取的组织标本 ,通过病理学和免疫组织化学方法 ,观察行TCRE后宫腔创面的组织病理学改变 ,并分析再次治疗的原因。结果 (1)TCRE后 ,早期 (术后 2 1d内 )创面表层组织坏死 ,肉芽组织增生 ;晚期 (术后 5个月以上 )创面以胶原纤维为主、厚薄不一的瘢痕组织 ;(2 )增生的肉芽组织表面有子宫内膜柱状上皮细胞覆盖 ,瘢痕组织下方平滑肌细胞增生 ,细胞核呈增殖细胞核抗原阳性反应 ;(3)肉芽或瘢痕组织中残存内膜基底层腺体 ,其边缘可见局灶性或弥漫性子宫内膜增生 ,部分瘢痕组织内显示淋巴细胞浸润及大量异物巨细胞反应 ;(4)部分患者子宫内膜异位于子宫肌层 ,刮宫可见破碎的内膜及炎性肉芽组织。结论 行TCRE后创面修复以肉芽组织增生、瘢痕形成为主 ,内膜腺体与平滑肌细胞增生参与创面修复 ;残存内膜再生、子宫内膜异位和术后感染 ,是导致再次治疗的原因。
Objective To study the repairing process and the factors causing subsequent surgery after trancervical resection of endomitrium(TCRE).Methods From March 1991 to September 2002, 1 431 hysteroscopic endometrium resection procedures were performed in Hysteroscopic Center of Fuxing Hospital,and 38 patients who required additional treatment which include 13 hysterectomy, 3 repeat TCRE and 22 uterine curettage were collected and the specimens were stained by hemaloxylin-eosin, Masson' s trichrome and respiratory enzyme dehydronicotinamide adenine dinucleotide phosphate diaphorase as well as proliferative cell nuclear antigen (PCNA) respectively to evaluate the tissue healing process and the histopathological changes.Some of the changes were observed by electron microscope.Results (1)The superficial myometrium presented necroses and granulationingitis in the early stage and then scar formation in the later stage followed TCRE.(2)The granulation structure was covered with columnar epithelial cell and the smouth muscle cell regrowth which showed positive reaction by PCNA staining below the scarred tissue.(3)The undestroyed glands of endometrial floor were showed both inside granulation and scar tissue where lymphocytes infiltration and a great deal of foreign-body giant cells were also found.Focal and diffuse endometrium regeneration located beside these granulation and scar structure.(4)Adenomyosis presented in some of uterine specimens, but the cycle endometrium and inflammatory granulation tissue presented in the uterine curettage tissue.Conclusions The repairing patterns of destroyed myometrium are mainly based on granulationingitis and scar formation followed TCRE procedure, endometrial glands and smooth muscle cells regrowth are also involved in this process.Endometrium regeneration, adenomyosis and inflammation are the main reasons caused subsequent surgery.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2003年第12期741-744,共4页
Chinese Journal of Obstetrics and Gynecology
