米非司酮抗早孕宫腔组织的病理学研究  

Study of Histopathology of Endometrium Following Termination of Early Pregnancy Using Mifepristone

作　　者：邱晓燕[1,2] 李大金[1,2] 周先荣[1,2] 酆豫增[1,2] 李超荆[1,2] 

机构地区：[1]上海市第一人民医院妇产科 [2]上海医科大学妇产科医院

出　　处：《中华妇产科杂志》1999年第5期272-274,I006,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨米非司酮终止早孕后异常子宫出血的原因。方法对１９例应用米非司酮终止早孕后即刻刮宫的宫腔组织物、４０例米非司酮终止早孕１周后刮宫的宫腔组织物及２０例米非司酮终止早孕后２～１２周因异常出血刮宫的宫腔刮出物组织石蜡块，应用ＨＥ染色、免疫组织化学技术、嗜焰红和酒石磺染色及网状纤维染色技术，观察不同组织的病理学改变、人绒毛膜促性腺激素（ｈＣＧ）和人胎盘生乳素（ｈＰＬ）的表达及嗜焰红颗粒和网状纤维的变化。结果药物流产时，蜕膜组织排出缓慢，尤其是底蜕膜组织难以排出。有滋养层细胞可以长期存活并具有功能的现象，从而影响局部子宫内膜的修复。米非司酮作用后蜕膜组织颗粒细胞中嗜焰红颗粒明显减少，底蜕膜组织中网状纤维溶解不完全。米非司酮终止早孕２周后异常子宫出血的主要原因是不全流产。结论米非司酮终止早孕异常子宫出血的主要原因是不全流产，底蜕膜组织排出缓慢和局部内分泌因素影响子宫内膜的修复。底蜕膜部位网状纤维溶解不完全，可能是蜕膜组织排出缓慢和不全流产的原因之一。Objective To explore the causes of abnormal uterine bleeding following termination of early pregnancy using mifepristone. Methods 19 specimens were obtained by curettage on the day immediately after expulsion of gestational sac, 40 specimens on the 7th postabortal day and 20 specimens during 212 weeks after induced abortion using mifepristone respectively. The histopathologic changes of the specimens were observed by HE staining, and the expression of human chorionic gonadotropin (hCG) and human placental lactogen (hPL) by immunohistochemical studies as well as phloxinetartrazine staining and Gordon Sweets staining. Results It showed that decidua shedding retarded, especially basal decidua. Immunohistochemical studies demonstrated the trophoblasts were still active and might affect pathological changes of local endometrium. The specific granules of endometrial granulocytes disappeared, together with disintegration of the reticular fibers. But in the group which curettage was indicated for abnormal bleeding 2 weeks after abortion, the main cause was incomplete abortion. Conclusions In addition to incomplete abortion, the retardation of decidua shedding and the impairment of endometrium regeneration were responsible for the abnormal uterine bleeding following termination of early pregnancy using mifepristone. The incomplete dissolution of the reticular fibers in basal decidua may induce decidua shedding retardation and incomplete abortion.

关 键 词：米非司酮 子宫出血 病理学 早孕 终止妊娠 

分 类 号：R169.42[医药卫生—公共卫生与预防医学] R714.461