射频自凝刀靶点治疗子宫肌瘤的急性临床病理学试验

目的 :通过观察被射频消融热毁损肌瘤组织的病理形态学改变和雌激素受体 (ER)、孕激素受体 (PR)表达的变化 ,循证射频自凝刀靶点治疗子宫肌瘤微创技术的基本原理。方法 :对需行子宫全切的 30例多发性子宫肌瘤患者 ,分别采用 0 .5cm、1.2cm长的射频自凝刀头对其行射频消融 ,其中 2 8例消融治疗后立即切除子宫 (急性试验组 ) ,征得同意 2例于消融治疗 3d后切除子宫 (慢性试验组 )。试验组从消融灶中心 (A组 )、边缘 (B组 )、边缘外1cm(C组 )、边缘外 2cm(D组 )处取材 ,HE染色下观察病理变化 ,免疫组化检测ER、PR水平 ;对照组取材选同一子宫上未做射频消融的肌瘤组织。结果 :射频消融治疗后 ,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表达仍低于对照组 (P <0 .0 5 ) ;消融灶边缘外 2cm ,ER、PR与对照组相比差异无显著性 (P >0 .0 5 )。结论 :射频消融微创技术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 ,这可能是射频消融治疗子宫肌瘤的主要机制和基本原理。

Test on Acute Pathological Changes and Changes of ER,PR Expression in Uterine Leiomyoma Tissue with Radiofrequency Ablation

Objective: To observe the pathological features and expression of estrogen receptor(ER) and progestin receptor (PR) in human uterine leiomyoma after radiofrequency ablation(RFA) to find out its mechanism. Methods: 30 patients with uterine leiomyoma were treated with 0.5 cm or 1.2 cm long RFA electrodes. Hysterectomy was performed in 28 cases just when the RFA treatment finished and in 2 patients after 3 days of RFA treatment. 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 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 a leiomyoma RFA lesion revealed a sharply demarcated area of coagulative necrosis. There were no expression of ER and PR in Group A. ER and PR optical density in Group B and Group C were significantly lower than that of control group(P<0.05), but that of Group D was similar to control group(P>0.05). Conclusions: This is an important mechanism that RFA could indnce coagulative necrosis and lower expression of ER and PR in hysteromyoma in the treatment of uterine leiomyoma.