子宫内膜电切术对子宫内膜表皮生长因子受体和血管内皮生长因子表达的影响

Effect on expression of EGFR and VEGF in endometrium after transcervical resection of endometrium

目的观察子宫内膜电切术(TCRE)后宫腔镜下宫腔形态学、病理学及子宫内膜表皮生长因子受体(EGFR)和血管内皮生长因子(VEGF)表达的变化。方法选择无排卵性功能失调性子宫出血患者60例,达那唑组(30例)应用达那唑预处理后行TCRE术,对照组(30例)直接行TCRE术,术后3-6个月随访,进行宫腔镜检查取材,观察病理改变,同时测定子宫内膜EGFR及VEGF表达的变化。结果术后宫腔镜检查见大部分宫腔呈现粘连状态,宫腔缩小、宫腔内色灰白或苍白,少数可见局部散在的内膜样组织,位于宫颈口处。镜下见内膜均为类似于增生早期表现,腺体分散、稀少,间质致密、伴炎症细胞浸润。术后达那唑组子宫内膜的检出率明显低于对照组。术后两组EGFR在内膜腺体的表达均低于术前,术后达那唑组EGFR的表达低于对照组;术后两组VEGF的表达强度无差别,均较术前表达升高,对照组术后内膜腺体VEGF的表达率较术前明显升高(P<0.05),达那唑组手术前、后及与对照组术后内膜腺体VEGF的表达率无差异(P>0.05)。结论TCRE术后的子宫内膜均处于增生早期的病理改变;TCRE术可降低子宫内膜EGFR的表达,提高子宫内膜VEGF的表达强度,提示TCRE术可能对子宫内膜的增生能力有一定的抑制作用。

Objective To study the expression of epidermal growth factor receptor （EGFR） and vascular endothelial growth factor （VEGF） in endometrium after transcervical resection of endometrium （TCRE）, the pathologic change of uterus endometrium. Methods Totally 60 patients with anovulartory functional bleeding were admitted. Danazol group （30 cases） was procedured with TCRE after pretreatment with danazol; control group （30 cases） was procedured with TCRE directly. The patients were examined by hysteroscopy 3- 6 months later, biospy endometrium were sent for pathological assessment to determine the expression of EGFR and VEGF in endometrium. Results The outcome after hysteroscopy examination showed that the uterine cavity was adhesive, the length shortened, and the uterine cavity showed pale. The endometriums were found in few uterus, almost scattered in internal orifice of uterus. The pathological assessment showed that endometrium was similar to that at early proliferative phase, the glands were disperse, sparse, the stromal components were compact, had profuse inflammatory cells. The detection rate of endometrium in danazol group was lower than that in control group. The expression of EGFR in endometrium after operation was lower than that before operation and danazol group lower than control group. The staining intensity of VEGF was no different between two groups after operation, it was all enhanced compared with preoperation. The positive rate of VEGF in endometrium was higher after operation than before operation in control group, there were no differences among preoperation and postoperation of danazol group and postoperation of control group. Conclusion The endometrium of patients in both groups after operation is similar to early proliferation phase in histological assessment. TCRE can depress the expression rate and intensity of EGFR, and elevate the expression intensity of VEGF in endometrium. TCRE may have an inhibitory action on the endometrial hyperplastic ability.