微波子宫内膜去除术中高频微波对组织的影响

doi:10.3877/cma.j.issn.1673-5250.2013.01.007

目的

探讨微波子宫内膜去除术(MEA)中高频微波对组织的影响，评价MEA安全性及其术后组织病理学改变。

方法

选择2000年1月至2008年8月于本院因药物治疗无效而行MEA的334例月经过多患者为研究对象，MEA术后采用月经周期、月经量评价量表(PBAC)评分对患者月经改变情况进行1～96个月随访，并对部分患者进行宫腔镜检查及子宫内膜病理学检查(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，并征得受试对象本人的知情同意，与之签署临床研究知情同意书)。

结果

MEA术后1个月患者月经量明显减少为314例(94%)，PBAC平均评分为(53.19±35.88)分。术后24，60，84，96个月的PBAC平均评分分别与术前比较，差异均有统计学意义(P<0.05)。本组MEA术后接受宫腔镜及子宫内膜病理学检查患者为52例(16%)。其中，子宫内膜病理学检查示急性坏死期患者为12例(23%)，慢性修复期患者为28例(54%)，子宫内膜再生患者为10例(19%)，子宫内膜单纯增生为1例(2%)，子宫内膜不典型增生为1例(2%)。

结论

高频微波可有效破坏子宫内膜达基底层，对子宫肌层无损伤。MEA术后组织病理学改变为急性坏死期及随后的慢性修复期，部分病例可伴子宫内膜再生。

关键词: 微波, 子宫内膜去除术, 病理学, 子宫内膜

Objective

To explore the influence of high frequency microwave treatment on microscopic morphology of endometrium.

Methods

From January 2000 to August 2008, 334 women with menorrhagia who accepted microwave endometrial ablation were included in the study. All the patients were followed up.The change of menstrual cycle, the pictorial blood loss assessment chart(PBAC) score were recorded.Some patients took diagnostic hysteroscopy, and the biopsy tissue was taken from the endometrium for histopathological examination. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangdong Women and Children Hospital.Informed consent was obtained from each patients.

Results

There were 314 patients(94%) whose menstrual flow had significantly reduced, and the average PBAC score of them was (53.19±35.88). There had significant differences on PBAC scores between before and 24, 60, 84, 96 months after MEA(P<0.05), respectively. 52 women(16%) accepted hysteroscopy and pathological examination after MEA. The pathological performance showed that the percentage of acute necrosis phase was 23%(12/52), chronic repair phase was 54%(28/52), Endometrial regrowth was 19%(10/52), simple hyperplasia was 2%(1/52) and atypical hyperplasia was 2%(1/52).

Conclusions

MEA can efficiently destroy the endometrium.The pathological performance by thermal damage includes acute necrosis phase and subsequently chronic repair phase, some cases accompanies regenerate of endometrium after MEA.

Key words: microwave, endometrial ablation, pathology, endometrium

图1 MEA前、后PBAC评分变化

Figure 1 Changes of PBAC scores before and after MEA

图2 凝固性坏死的子宫内膜层(HE染色×200)

Figure 2 The basal layer of endometriun was destroyed showing coagulation necrosis (HE×200)

图3 透明样变性的浅层平滑肌细胞，伴间质红细胞渗出、炎细胞浸润及血管扩张栓塞(HE染色×200)

Figure 3 Necrotic endometrium and an acute inflammatory exudates(HE×200)

图4 部分子宫内膜腺体浸入子宫深肌层，结构未被破坏(HE染色×200)

Figure 4 Some complete glands still remained inside the deep muscular layer(HE×200)

图5 再生子宫内膜仅为单层子宫内膜腺体，排列稀疏(HE染色×200)

Figure 5 Endometrial regrowth which was thin and attenuated, the glands were sparse(HE×200)

图6 子宫内膜单纯增生(HE染色×200)

Figure 6 Endometrial completely regrowth which showed simple hyperplasia(HE×200)

图7 子宫内膜单纯增生，伴不典型增生(HE染色×200)

Figure 7 Endometrial completely regrowth which showed atypical hyperplasia(HE×200)

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Influence of High Frequency Microwave Treatment on Microscopic Morphology of Endometrium

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Influence of High Frequency Microwave Treatment on Microscopic Morphology of Endometrium