子宫腺肌病患者子宫各部位血管形态的研究

目的　探讨子宫腺肌病患者子宫内膜、子宫肌层和腺肌病病灶部位血管形态的改变。方法　手术切除子宫标本 6 2例 ,其中子宫腺肌病 32例 ,无症状子宫肌瘤 30例。用凝血Ⅷ因子 (VWF)标记腺肌病和肌瘤患者子宫内膜、子宫肌层、腺肌病病灶及子宫肌瘤的血管形态 ,采用MPIAS 5 0 0图像处理系统进行图像分析。结果　腺肌病组子宫内膜血管数量和面积较肌瘤组显著增加 (P <0 0 1) ,并呈现周期性变化。异位内膜的血管数量及面积显著大于在位内膜 (P <0 0 1) ,但无周期性变化。腺肌病组正常子宫肌层血管与肌瘤组相比显著扩张 (P<0 0 1) ,腺肌病病灶周围子宫肌层的血管数量和面积较正常子宫肌层显著增加 (P <0 0 1)。腺肌病组中 ,月经过多者子宫内膜的血管数量 (P <0 0 5 )和面积 (P <0 0 5 )较月经正常者增加 ,而子宫肌层的血管数量 (P <0 0 1)和面积 (P <0 0 1)与子宫大小呈正相关。结论　子宫腺肌病患者子宫内膜和子宫肌层的血管形态发生改变 ,并可能导致月经过多、子宫增大等临床症状。血管生成可能在子宫内膜侵入子宫肌层的过程中发挥一定作用。

Morphometric study on the vascularization in patients with adenomyosis of the uterus

Objective To investigate the morphometric changes of the vessels in the endometrium,myometrium and eutopic endometrium of the adenomyosis uterus.Methods The study included 32 patients with histologically proven adenomyosis and 30 patients with asymptomatic leiomyoma of the uterus.Immunohistochemical staining was used to detect VWF expression in different parts of the uterus.A computerized morphometric study on the vascularization was performed.Results The mean numbers and surface area of microvessels in the endometrium of adenomyosis increased significantly in comparison with leiomyoma(P<0 01),and showed cyclic change.The mean numbers and surface area of microvessels in ectopic endometrium increased compared to that in eutopic one(P<0 01),but showed no cyclic change.The microvessels in normal myometrium of adenomyosis dilated when compared with that of leiomyoma(P<0 01),while myometrium around the ectopic lesions contained more markedly dilated microvessels than that of normal myometrium(P<0 01).In patients with menorrhagia,the numbers(P<0 05)and surface area(P<0 05)of microvessels of the endometrium increased in comparison with patients with normal menstrual flow.Significant relationships were found between the numbers(P0 01) or surface area(P<0 01) of microvessels of the myometrium and the size of the uterus.Conclusion The vascular changes may be one of important factors both for the development of adenomyosis and for attributing some clinical symptoms such as menorrhagia and enlarged uterus.