射频消融热毁损子宫肌瘤的组织病理学变化

Histopathological Changes and Changes of ER, PR Expression in Uterine Leiomyoma Tissue with Radiogrequency Ablation.

目的 循证射频自凝刀治疗子宫肌瘤的基本原理。方法 28例需开腹切除的多发性子宫肌瘤患者,直视下对肌瘤行射频消融后立即切除子宫。从消融灶中心(A组)、边缘(B组)、边缘外1 cm(C组)、连缘外2 cm(D组)处取材,HE染色下观察病理变化,免疫组化检测雌激素受体(ER)、孕激素受体(PR)水平;对照组取材选同一子宫上未做射频消融治疗的肌瘤组织。结果 A组肌瘤组织呈凝固性坏死,ER、PR无表达;B组肌瘤细胞变性,ER、PR表达减少(P<0.05);C组肌瘤细胞无变性、坏死,但ER、PR表达仍低于对照组(P<0.05);D组ER、PR与对照组相比差异无显著性(P>0.05)。结论射频消融使肌瘤组织凝固性坏死,ER、PR的表达消失或减低,从而达到治疗子宫肌瘤的目的。

Objective To observe the pathological features and expression of estrogen receptor (ER) and progestin receptor (PR) in human uterine leiomyoma after radiofrequency ablation (RFA) in order to find out its mechanism. Methods 28 patients with uterine leiomyoma were treated. Hysterectomy was performed on these cases just when the RFA treatment finished. Specimens were obtained from the center tissue of ablation (group A), marginal tissue of the ablation (group B), tissues of 1 cm far from the margin (group C) and tissues of 2 cm far from the margin (group D) for immunohistochemical ER and PR analysis. All of the specimens were stained with hematoxylin-eosion for pathologic examination. Specimens obtained from untreated leiomyoma in the same uterine served as control group. Results Pathologic section of a leiomyoma RFA lesion revealed a sharply demarcated area of coagulatire necrosis. There was no expression of ER and PR in group A. ER and PR optical density in groups B and C was significantly less than that of control group (P<0.05), but that of gronp D is similar to control group (P>05). Conclusion It is an important mechanism that RFA induces coagulative necrosis and decreases the expression of ER and PR.