子宫肌瘤动脉栓塞术后的病理学变化

Pathological changes of hysteromyoma after operating percutaneous uterine arterial embolization

目的 探讨子宫肌瘤动脉栓塞术 (UAE)后的病理学变化。方法 1 999年 6月至 2 0 0 3年 1 0月对广州市第一人民医院 4 86例子宫肌瘤患者行UAE治疗 ,栓塞剂选择PVA或KMG颗粒 ,其中对 4 9例术后获取的肌瘤标本进行病理学观察。结果 UAE后坏死的肌瘤肉眼观早期呈紫黑色 ,中期呈黄白色 ,晚期呈黄色或金黄色 ,假包膜明显增厚 ,在妊娠期更加明显 ;不同直径的肌瘤UAE后在光镜下观察到的坏死时间不同 :直径 0 2～1 0cm、4 0～ 5 0cm、6 0～ 9 0cm及大于 1 0 0cm的肌瘤在UAE后分别于 1 4d、1 8h、1 2h和 6h可观察到明显的坏死 ;UAE后肌瘤、假包膜明显坏死而正常肌层未见明显坏死 ,假包膜内可见含铁血黄素沉积。结论 UAE可导致各种大小的肌瘤坏死 ,肌瘤坏死的时间与肌瘤的大小呈反比。

Objective To explore the pathological changes of the post-uterine arterial embolization(UAE) myoma. Methods Bilateral UAE was performed in 486 patients with hysteromyoma, using PVA and KMG particles as emboli. Among them, 49 post-UAE myoma specimens were pathologically observed. Results Observed with the naked eyes, the post-UAE necrosis myomata showed purplish-black at the early stage, yellow-white at the mid stage, yellow or golden-yellow and pseudoperimembrane growing evidently thicker at the late stage. All of the above appeared more obviously in gestational stage. Under microscope, post-UAE myomas with different diameters showed necrosis at different time. The obvious necrosis was observed respectively at the time of 14 days, 18 hours, 12 hours and 6 hours, according to the diameter of 0.2-1.0cm, 4.0-5.0cm, 6.0-9.0cm and greater than 10.0cm. The sequence of the post-UAE necrosis happened was from outer layer to inner layer. The necrosis of post-UAE myoma and pseudoperimembrane was evident, while that of the normal leiomyoideum wasn't. Meanwhile hemosiderosis was observed in pseudoperimembrane. Conclusion UAE has caused necrosis of myomas with different size. The time when myoma necrosis happened was inversely proportional to the size of the myoma.The larger the myoma was,the earlier necrosis happened.