电切手术治疗子宫肌病前后子宫内膜VEGF、受体KDR及MVD的表达变化

Variety of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor KDR expression and microvessels density in endometrium before and after transcervical resection of endometrium

目的探讨经宫颈子宫内膜电切手术治疗子宫肌瘤病的分子机制.方法对2000年10月～2002年11月行子宫内膜电切手术的21例子宫腺肌病患者术后随访.采用免疫组化LSAB法检测手术前后子宫内膜组织中VEGF及其受体KDR表达和MVD的变化.10例腺肌病患者的手术中子宫内膜为术前实验组;7例腺肌病患者于TCRE术后6～18个月取内膜为术后实验组;8例正常子宫内膜为对照组.结果术后腺肌病之子宫内膜其VEGF、KDR的表达及MVD明显降低,与术前子宫内膜的表达相比差异有显著性;与正常对照组相比无明显差异.手术后6个月行再次电切的腺肌病内膜间质微血管较为密集,管径比较小;VEGF及KDR表达也较强,腺体染色较深.结论子宫内膜电切手术对腺肌病子宫内膜的VEGF、KDR的表达及MVD呈下降调节;TCRE术后子宫内膜VEGF的表达和MVD下降可能与手术预后相关.

Objective: To evaluate the molecular mechanism of Transcervical Resection of Endometrium (TCRE) surgery on patient with adenomyosis. Methods: There were 21 cases of TCRE for adenomyosis from October 2000 to November 2002. Using immunohistochemistry (LSAB) on endometrial sections, ten adenomyosis endometrium before TCRE, seven adenomyosis endometrium after TCRE, eight normal controls. The VEGF, KDR staining indices were determined with an computerized image analyzer. Results: The MVD, VEGF and KDR staining indices were significantly lower in adenomyosis after the surgery than in normal endometrium and before the surgery (P<0.05), just same as that of the control. One case of adenomyosis endometrium having second TCRE had high-score of VEGF, KDR expression and MVD. Conclusions: TCRE have lowed significantly the score of KDR, VEGF and MVD expression of the endometrium with adenomysis, the lower-score of MVD, VEGF and KDR may be related to the prognosis of TCRE.