宫内节育器引起子宫出血原因的研究

对61例置器组及14例正常对照组的子宫内膜进行光镜、扫描电镜及透射电镜的观察;并采用组织化学方法测定子宫内膜组织的纤溶活性、上皮细胞酸性磷酸酶、碱性磷酸酶活性及糖原含量的变化,探索子宫出血的原因。发现:IUD可引起子宫内膜表面立体结构及内膜超微结构的改变,上皮细胞变性,内膜浅层血管内皮细胞变性、甚至断裂形成裂缝,但无凝血现象;血管充血,且密度增加,内膜间质水肿、出血炎性细胞浸润;内膜纤溶活性增强;增生期内膜上皮细胞酸性磷酶活性增强,碱性磷酸酶活性减弱;分泌期内膜上皮细胞糖原含量减少且在腺体间的分布不均。以上多种因素综合作用导致置器后异常的子宫出血。

ABSTRACT STUDIS OF THE CAUSES OF IUD-INDUCED UTERINE BLEEDING

We tried to determine the causes of IUD-induced uterine haemor-rhage by means of observing the endometrial changes of 61 specimensin IUD group and of 14 ones in control group with light microscope, scanning electron microscope or transmission electron microscope, andmeasuring the fibrinolytic activities of endometrium, the alkaline and theacidic phosphatase activities and the glycogen contents in epithelial cells. The results showed: IUD might cause the changes of trimensionalsurface and of ultrastructure in the epithelial cells. The epithelial cellsbecame degenerated, even necrosed and sloughed. The endothelial cells ofsuperficial vessels also became degenerated and broken down into gaps.The vessels in the endometrial stroma congested and the densities ofthem increased. The endometrial stroma became edematous, haemorrhageand infiltrated by WBC. The fibrinolytic activities in the endometriumincreased. The ACP in the epithelial cells increased and the AKPdecreased during proliferative phase. The glycogen contents of the epith-elial cells decreased and distributed unevenly among the glands duringsecretory phase. The combined effects of those factors above mentionedcan lead to IUD-assosiated abnormal uterine bleeding. Therefore VitamineE and antifibrinolytic agents are used for treating the problem. It isthe most important to develope a new IUD of which material issuitable, shape and size are fit to uterine.