【摘要】 【目的】观察左炔诺孕酮宫内缓释系统 (Mirena)治疗无排卵型功能失调性子宫出血 (下简称功血 )的疗效及其对增生过长的子宫内膜病理学及超微结构的影响。【方法】对 2 5例年龄 30岁～ 5 1岁 ,确诊为无排卵型功血并有子宫内膜增生过长 ,已无生育要求的病例 ,于月经第 4～ 7天放置左炔诺孕酮宫内缓释系统 (Mirena)治疗。【结果】置环后患者月经量明显减少 ,多数表现为点滴出血 ,置环 3个月和 6个月复诊时月经量已较置环前减少 2 /3及以上 ,与置环前相比 ,PBAC法月经评分显著下降 (P <0 0 1)。置环后 6个月复查 ,患者血红蛋白基本恢复正常 ,与置环前比较 ,差异有显著性 (P <0 .0 5 )。置环前子宫内膜厚度为 (8.5± 3.5 )mm ,置环 6个月子宫内膜厚度为 (3.5± 1.5 )mm ,差异有显著性意义 (P <0 .0 5 )。置环 3～ 12个月复查 ,子宫内膜病理显示子宫内膜增生过长改变全部消失 ,内膜呈现分泌现象或间质蜕膜样改变。电镜显示子宫内膜上皮细胞固缩 ,细胞突起和微绒毛明显减少 ,细胞间隙增宽 ,可见脱落的上皮细胞 ;细胞核常染色质呈小凝块状 ,可见染色质边集现象 ,核膜不整、凹陷 ,内质网扩张 ,有时极度扩张的内质网呈囊状 ,线粒体肿胀 ,总体表现为细胞变性 ,增生受阻。【结论】Mirena不但能从临床方面有效地控制更多还原

【Abstract】 To evaluate the efficacy of the levonorgestrel releasing intrauterine device (Mirena) in the treatment of hyperplasia of the endometrium and its effects on the changes of pathological structure and ultramicrostructure of the endometrium. 25 cases of dysfunctional uterine bleeding with endometrial hyperplasia in the age of 30 to 51 years without the request of having baby were included. Levonorgestrel releasing intrauterine devices (Mirena) were inserted in the patients at the 4～7th day of menstrual cycle. There was a more than 2/3 reduction in menstrual blood loss in 3 months and 6 months after the insertion, the PBAC score was reduced significantly (P<0.01). Hemoglobin level was returned to normal at 6 months after the insertion (P<0.05). Endometrial thickness measured by ultrasonography reduced significantly from (8.5±3.5) mm to (3.5±1.5) mm (P<0.05). Pathological examinations performed 3～12 months after the insertion demonstrated endometrial hyperplasia had been reversed in all cases. The endometrium exhibited visible secretion and a pseudo decidual reaction. The electron microscopy demonstrated the presence of solidified endometrial epithelia, the loss of cellular prominency and microvilli, enlargement of gap junction, and the shedding epithelia. Euchromatin in nuclei concreted as a small mass and accumulated around the membrane. The membrane of the nuclei was irregular and depressed. Distended endoplasmic reticulum swelling mitochondria have been found morphologically. Changes could be concluded as cell denaturalization and inhibition of proliferation. [Conclusion] Levonorgestrel releasing intrauterine device is an effective non operative therapy in endometrial hyperplasia. It can not only significantly reduce the menstrual blood loss but also reverse the endometrial hyperplasia effectively.更多还原