高强度聚焦超声治疗功能性子宫出血实验研究  

Experimental study on high intensity focused ultrasound in treatment of dysfunctional uterine bleeding

作　　者：郭艳琴[1] 汪芳[2] 石珍[1] 余克涵[3] 肖菊花[4] 周金水[2] 张激 黄汉年 

机构地区：[1]南昌大学第一附属医院妇产科,江西南昌330006 [2]南昌大学第一附属医院HIFU治疗室 [3]南昌大学第一附属医院病理诊断科 [4]江西省妇幼保健院超声诊断科 [5]深圳市普罗惠仁医学科技有限公司

出　　处：《中国妇幼保健》2015年第14期2154-2157,共4页Maternal and Child Health Care of China

基　　金：卫生部医药卫生科技发展研究中心项目〔W2013HF09〕

摘　　要：目的：应用高强度聚焦超声（HIFU）治疗功能性子宫出血（DUB）,观察子宫内膜治疗前后病理改变及孕激素受体（PR）与雌激素受体（ER）的表达,循证HIFU治疗DUB的疗效和作用机制。方法：选取2011年1月~2014年5月在该院自愿接受HIFU治疗并无生育要求的DUB患者42例,治疗前1个月、治疗后1~6个月分别行子宫内膜诊断性刮宫取子宫内膜组织,行HE染色,观察其组织形态学变化及病理类型,同时行免疫组化检测PR及ER的表达水平。结果：HIFU治疗后1~6个月子宫内膜病理切片显示：内膜明显变薄,腺体疏松、萎缩,血管稀少,纤维结缔组织增生;且部分患者治疗后6个月诊断性刮宫刮出物未见明显的内膜组织。HIFU治疗后1~6个月免疫组化检测结果显示：子宫内膜组织中PR、ER的阳性表达率明显低于治疗前,差异有统计学意义（P〈0.05）。结论：HIFU对子宫内膜及基底层有实质性的损毁作用,使子宫内膜不能再生而不再发生周期性脱落,将其用于DUB的治疗是一种安全、有效的新方法。Objective: To treat dysfunctional uterine bleeding( DUB) by high intensity focused ultrasound( HIFU),observe the pathological change before and after treatment,the expressions of progesterone receptor( PR) and estrogen receptor( ER),the evidence-based efficacy,and mechanism of DUB treatment by HIFU. Methods: Forty- two DUB patients without birth demand and receiving HIFU voluntarily in the hospital from January 2011 to May 2014 were selected,diagnostic uterine curettage was performed respectively at one month before treatment and at 1- 6 months after treatment to obtain endometrial tissue,then HE staining was conducted to observe the histomorphological change and pathological types,immunohistochemical staining was carried out at the same time to detect the expression levels of PR and ER. Results: At 1- 6 months after treatment by HIFU,endometrial pathological smears showed that endometrium thinned significantly,the glands were loose and atrophic,vessels were few,fibrous connective tissue proliferation was found; at 6 months after treatment,no obvious endometrial tissue was found in curettage scrapings. At 1- 6 months after treatment by HIFU,immunohistochemical staining showed that the positive expression rates of PR and ER in endometrial tissue were statistically significantly lower than those before treatment( P < 0. 05). Conclusion: HIFU has substantial damage on endometrium and basal layer,it inhibits regeneration of endometrium and stops periodic shedding of endometrium; HIFU is a safe and effective new method used for treatment of DUB.

关 键 词：功能性子宫出血 病理学 高强度聚焦超声 孕激素受体 雌激素受体 

分 类 号：R711.52[医药卫生—妇产科学]