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目的:应用高强度聚焦超声(HIFU)治疗功能性子宫出血(DUB),观察子宫内膜治疗前后病理改变及孕激素受体(PR)与雌激素受体(ER)的表达,循证HIFU治疗DUB的疗效和作用机制。方法:选取2011年1月~2014年5月在该院自愿接受HIFU治疗并无生育要求的DUB患者42例,治疗前1个月、治疗后1~6个月分别行子宫内膜诊断性刮宫取子宫内膜组织,行HE染色,观察其组织形态学变化及病理类型,同时行免疫组化检测PR及ER的表达水平。结果:HIFU治疗后1~6个月子宫内膜病理切片显示:内膜明显变薄,腺体疏松、萎缩,血管稀少,纤维结缔组织增生;且部分患者治疗后6个月诊断性刮宫刮出物未见明显的内膜组织。HIFU治疗后1~6个月免疫组化检测结果显示:子宫内膜组织中PR、ER的阳性表达率明显低于治疗前,差异有统计学意义(P<0.05)。结论:HIFU对子宫内膜及基底层有实质性的损毁作用,使子宫内膜不能再生而不再发生周期性脱落,将其用于DUB的治疗是一种安全、有效的新方法。
Objective: To observe the pathological changes and the expression of progesterone receptor (PR) and estrogen receptor (ER) in patients with functional uterine bleeding (HUBU) treated with high intensity focused ultrasound (HIFU) DUB efficacy and mechanism of action. Methods: From January 2011 to May 2014, 42 patients with DUB who voluntarily received HIFU and had no fertility requirements in the hospital from January 2011 to January 2014 were enrolled. One month before treatment and one to six months after treatment, endometrial diagnostic curettage Endometrial tissues were taken and stained with hematoxylin and eosin (HE). Morphological changes and pathological types were observed. The expression of PR and ER were detected by immunohistochemistry. Results: Histological examination of endometrium from 1 to 6 months after HIFU treatment showed that the intima became thinner, the gland became loose and atrophied, the blood vessels were sparse and the fibrous connective tissue hyperplasia. In some patients, the diagnostic curettage occurred at 6 months No obvious endometrial tissue. Immunohistochemical results of HIFU 1 to 6 months after treatment showed that the positive expression rates of PR and ER in endometrial tissues were significantly lower than those before treatment (P <0.05). Conclusion: HIFU has a substantial damage to the endometrium and basal layer, so that the endometrium can not be regenerated and no recurrence occurs. It is a safe and effective new method for the treatment of DUB.