【作者】 陈晓明； 陆骊工； 李勇； 胡宝山； 罗鹏飞；

【机构】 广东省人民医院肿瘤中心介入治疗科；

【摘要】 目的:探讨碘油平阳霉素乳剂(LPE)子宫动脉检塞后肌瘤组织与正常子宫组织的病理变化及临床意义。方法: 20例子宫肌瘤患者行经导管子宫动脉LPE栓塞治疗后3d至1 年,再分别接受全子宫切除术(10例)、全子宫加双侧附件切除术(2例)、肌瘤剔除术(2例)和经阴道宫颈口肌瘤钳出术(6例),所有标本送病理检查。选择同期在我院直接行妇产科手术的20例子宫肌瘤患者作为对照组,标本行相同处理和研究。结果:肌瘤栓塞后的病理改变呈现一定的时间规律性变化,即栓塞后1w以炎性反应为主,栓塞后2w可见散在分布的点状坏死,栓塞后3w及更长时间则见广泛的片状坏死,至栓塞后2-3月时坏死范围达到最高峰,同时坏死肌瘤周围开始出现纤维组织增生,栓塞后3-6月可见广泛纤维组织增生和肌瘤内钙化。坏死性质均为凝固性坏死,粘膜下肌瘤坏死范围普遍大于壁间肌瘤,研究组20例标本肌瘤坏死范围0％-100%(平均82．7％)。对照组20例标本16例可见散在分布的肌瘤玻璃样变性,范围均在10％以下。另外,脂肪染色显示,碘油仅在肌瘤组织内可见,HE染色证实,正常子宫肌层和子宫内膜未见坏死改变。结论:LPE作为一种栓塞剂,用于TUAE的治疗是安全有效的,TUAE主要是通过中断肌瘤供血来达到缩小肌瘤的目的,TUAE并非一种根治性治疗,肌瘤残存和复发是可能的。更多还原

【Abstract】 Objective: To investigate the pathological changes of fibroids and normal uterine tissues and their clinical significance after transcatheter uterine ar-tery embolization (TUAE) using lipiodol-pingyangmycine emulsion (LPE) for treatment of uterine fibroids. Methods: TUAE using LPE was performed in 20 women with uterine fibroids. Among of them, 10 women underwent hysterectomy, 2 did hysterectomy with bilateral salpingo-oophorectomy, 2 did myomectomy and 6 did vaginal myomectomy from 3 days to 1 year after TUAE. All specimens were sent to study by a pathologist. 20 cases of uterine fibroids treated by gynecological operation during the same period without interventional treatment were set as control group to make a comparison. Their specimens were studied by the same pathologist. Results: A regular pathological change with elapse of duration after TUAE was found. Influmation occurred in fibroid one week after TUAE and sporadic spotty necrosis 2 weeks after TUAE and extensive patchy necrosis 3 weeks after TUAE. The largest range of necrosis companied with proliferation of fibrous tissue occurred in 2 to 3 months after TUAE. The extensive proliferation of fibrous tissue and calcification occurred in 3 to 6 months after TUAE. All necrosis were found to be coagulation necrosis. The range of necrosis, being larger in submucous leiomyoma than in intermural leiomyoma, was from 0% to 100% (average 82.7%) in 20 specimens. Fibroids tissues were found to have sporadic hyaline necrosis in 16 of 20 specimens ranged less than 10% in the control group. Significance was found when the range of necrosis was compared between two groups. Fat stains showed that lipiodol was only seen in fibroid tissues. HE stains showed that no necrosis was found in myometrium and endometria. Conclusion: LPE as a embolizing agent is safe and effective in the treatment of uterine fibroids. Ischemic necrosis of fibroids and secondary fibrosis and calcification because of stopping of blood supply of fibroids after TUAE are main mechanism that TUAE results in shrinking of fibroids. TUAE is not a radical treatment for uterine fibroids because the survival and recurrence of fibroids after TUAE is possible.更多还原