宫内节育器致异常出血子宫内膜止血反应的形态学改变

The Morphologic Changes of Endometrial Hematostatic Reaction in Intrauterine Devices Induced Menorrhagia

选择２５例放置宫内节育器（ＩＵＤ）后出血病例（ＩＵＤ出血组）为研究对象，以２０例放置ＩＵＤ后无出血的病例（ＩＵＤ无出血组）、及２０例未放置ＩＵＤ者（非ＩＵＤ组）为对照。于月经前点滴状出血期的２４小时内刮取子宫内膜，光镜下观察子宫内膜表浅微血管及螺旋动脉的形态学改变，测量螺旋动脉管腔直径和分别计数表浅微血管中纤维蛋白性及血小板性血栓；电镜下观察子宫内膜螺旋动脉超微结构的变化。结果：ＩＵＤ出血组螺旋动脉变性、扩张最明显，尤以海绵层为甚。ＩＵＤ无出血组螺旋动脉轻度变性、扩张。血小板性及纤维蛋白性血栓计数以ＩＵＤ无出血组最多，ＩＵＤ出血组最少。提示：放置ＩＵＤ致子宫异常出血可能与螺旋动脉收缩功能下降及血栓形成减少有关。ＩＵＤ无出血组螺旋动脉收缩功能虽有轻度下降，但其血栓形成较多，这可能是该组月经量较放置ＩＵＤ前无明显增多的形态学依据。

bjective To investigate the relationship between intrauterine contraceptive devices(IUD)in-duced menorrhagia and endometrial spiral arteriolar contractive function and endometrial superficial vessels thrombus formation function.Methods Sixty five subjects were admitted and divided into IUD bleeding group (25 cases),IUD non- bleeding group(20 cases)and IUD non-user group(20 cases).The samples were obtained by curettage within 24 hours prior to menstruation and observed under light and electron microscope.The morphologic changes of endometrial micro-vessels,spiral arterioles were observed and diameter of spiral arterioles were measured.Results Compared with IUD non-user group,the degenerative changes of spiral arteriolar wall were more severe and the dilatation of spiral arteriolar lumen was obvious especially in spongious lay-er. In IUD non-bleeding group,these changes were mild.The platelet and fibrin thrombus count was the highest in IUD non-bleeding group and the lowest in IUD bleeding group.Conclusions These results suggested that IUD induced menorrhagia might correlated with poor contraction of spiral arterolars in spongious layer and poor thrombus formation, Mild degeneration and dilatation of spiral arterioles and a lot of thrombus were seen in IUD non-bleeding group,and this might be the cause that the mentrual blood loss in this group did not increase obviously.