吲哚美辛治疗置IUD后出血者子宫内膜形态学变化观察

Effect of indomethacin on endometrial morphology in intrauterine device users with bleeding disorders

目的:研究吲哚美辛对放置宫内节育器后出血副反应者子宫内膜不同部位形态学影响。方法:纳入宫内节育器出血副反应者(治疗组)49例;输卵管性不孕行输卵管插管术及子宫全切术患者(对照组)20例。治疗组给予吲哚美辛口服,定点获取治疗组宫内节育器压迫区、移行区、远器区子宫内膜及对照组相应部位子宫内膜,观察两组子宫内膜形态学、显微和超微结构,对内膜不同区域进行比较。结果:治疗前,治疗组子宫内膜显微、超微结构明显异常,较之对照组存在内膜发育不同步的剥脱/修复障碍,内膜损伤程度与距离宫内节育器的远近成反比;治疗后,治愈者子宫内膜剥脱/修复障碍消失或明显减轻,未愈者不同区域子宫内膜仍存在程度不一的形态学损伤和剥脱/修复障碍。结论:放置宫内节育器出血副反应者存在以剥脱/修复障碍为主的内膜形态学异常,纠正和预防其形态学改变可能是有效的防治机制。

Objective：To explore the endometrial morphological changes after treatment with indomethacin in the intrauterine device（IUD）users with bleeding disorders.Methods：Fourty-nine IUD users with bleeding disorders（the treatment group）and twenty women conducting hysterosalpingography cannula for tubal infertility and hysterectomy for hysteromyoma（the control group）were enrolled.Indomethacin was given orally to women in the treatment group.Different parts of endometrial tissues were obtained from the fixed points that contained the areas oppressed by IUD,close to IUD and away from IUD.The corresponding parts were selected in the control group.The gross,microscopic and ultramicro characteristics of the samples were observed and evaluated.Results：Compared with the control group,the microscopic and ultramicro characteristics of the treatment group were abnormal obviously,showing abnormalities and growth uncoordination caused by abnormal exfoliation and recovery of the endometrium before the treatment.The shorter the distance was,the severer the endometrial injury was.After the treatment,the abnormal exfoliation and recovery of the endometrium in the cured women disappeared or decreased,while it remained unchangeable in those who had not been cured.Conclusion：The abnormal exfoliation and recovery of the endometrium exists in the IUD users with side effect of bleeding disorders,which may be the pathogenesis of bleeding disorders in the IUD users.