三丙烯微球栓塞子宫动脉对子宫内膜血管的影响

Microvessel density and neovascularization of endometrium after uterine artery embolization with trisacryl gelatin microspheres

背景:子宫动脉栓塞已广泛应用于临床治疗多种妇产科疾病,但对于子宫动脉栓塞后子宫内膜微血管密度的有何变化及新生血管的形成至今少有文献报道。目的:观察子宫动脉栓塞对子宫内膜微血管密度及新生血管形成的影响。方法:60只雌性豚鼠随机分为对照组(n=15)及子宫动脉栓塞组(n=45),子宫动脉栓塞组动物应用三丙烯微球行双侧子宫动脉栓塞。子宫动脉栓塞组再随机分为E1,E2及E3三个亚组(n=15),分别于子宫动脉栓塞后7-15 d,16-30 d及31-45 d内获取子宫标本。结果与结论:常规病理染色显示豚鼠子宫动脉一级分支、浆膜下动脉支及子宫肌层微小动脉血管内均可见大小不等栓塞微球分布。子宫动脉栓塞豚鼠子宫内膜基底层微血管密度CD34在子宫动脉栓塞后降低,而后随时间的延长而增加(P<0.05);而子宫动脉栓塞豚鼠子宫内膜基底层微血管密度CD105在子宫动脉栓塞后增加,而后随时间的延长而降低(P<0.05)。提示随着栓塞后时间推延,新生微血管数量显著增加,基底层微血管密度有逐渐恢复趋势。

BACKGROUND： Uterine arterial embolization is a minimally invasive technique and widely used for the treatment of several obstetrics and genecology diseases. However, reports about the influence of uterine arterial embolization on the pathophysiological microvessel density and angiogenesis changes in the endometrium have been very limited.OBJECTIVE： To investigate the influence of uterine artery embolization on endometrial microvessel density and neovascularization.METHODS： Sixty female guinea pigs were randomly divided into control group（n=15） and uterine artery embolization group（n=45）. In the uterine artery embolization group, trisacryl gelatin microspheres（Embosphere）was used to perform uterine artery embolization and animals were further divided into three subgroups including E1, E2, and E3（n=15 in each subgroup）. Uterine specimens were collected at 7-15 days, 16-30 days, and 31-45days after uterine artery embolization respectively in the three subgroups.RESULTS AND CONCLUSION： Microspheres were visible in the lumen of primary branch of uterine artery,subserosal arteriole and intramuscular arteriole. Statistical analysis demonstrated that CD34-positive microvessel density of the endometrial basal layer significantly decreased after uterine artery embolization, and reverted to the normal level（P 0.05）. Increase of neovascularization with CD105-postive microvessel density presented after uterine artery embolization, and then returned to the normal（P 0.05）. These findings indicate that uterine artery embolization may lead to a temporal decrease of microvessel density in the endometrium which will recover overtime as a result of the increase of CD105-postive neovascularization.