射频消融技术对子宫肌瘤组织中ER、PR表达影响的临床试验研究

目的 :开腹直视下射频消融子宫肌瘤后 ,观察射频消融对子宫肌瘤组织中ER、PR表达的影响 ,初探射频治疗子宫肌瘤的机制。方法 :30例需开腹行子宫切除术的多发性子宫肌瘤患者 ,分别用 0 .5cm、1.2cm长的射频自凝刀行肌瘤部位射频消融 ,治疗后立即切除子宫 ,作为试验组 ,并于消融灶中心 (A组 )、边缘 (B组 )、边缘外 1cm(C组 )、边缘外 2cm(D组 )处取材 ,HE染色观察病理变化 ,免疫组化检测ER、PR水平 ;选同一子宫上未做射频治疗的肌瘤组织作为对照组。结果 :射频治疗后 ,消融灶中心肌瘤组织呈凝固性坏死 ,ER、PR无表达 ;消融灶边缘肌瘤细胞变性 ,ER、PR表达减少 (P <0 .0 5 ) ;消融灶边缘外1cm ,肌瘤细胞无变性、坏死 ,但ER、PR表达低于对照组 (P <0 .0 5 ) ;消融灶边缘外 2cm ,ER、PR与对照组差异无显著性 (P >0 .0 5 )。结论 :射频消融技术使肌瘤组织凝固性坏死 ,ER、PR的表达丧失及低表达是射频消融技术能够治疗子宫肌瘤的循证依据

Changes of ER, PR expression in uterine leiomyoma tissue with radiofrequency ablation

Objective:To observe the expression changes of estrogen receptor(ER) and progestin receptor (PR) in human uterine leiomyoma after radiofrequency ablation(RFA) in order to find out its mechanism.Methods:30 patients with uterine leiomyoma were treated with 0.5cm or 1.2cm length RFA electrodes.Hysterectomy was performed in 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 1cm far from the margin (group C),and tissues of 2cm far from the margin(group D) for immunohistochemical ER and PR analyses.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 leiomyoma RFA lesion revealed a sharply demarcated area of coagulative necrosis.There was no expression of ER or PR in group A.ER and PR optical density in group B and group C was significantly lower than that of control group(P<0.05),but that of group D was similar to the control group(P>0.05).Conclusions:Inducing coagulative necrosis and the lower expression of ER and PR in hysteromyoma are important mechanism that RFA could treat uterine leiomyoma.