摘要
目的探讨米非司酮联合射频消融治疗较大子宫肌瘤对其组织病理学及雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体（EGFR）的影响，从病理学角度评价该非手术疗法的效果。方法20例B超测量子宫肌瘤直径5～7cm，穿刺活检证实为子宫平滑肌瘤的患者，口服米非司酮12．5mg，1次／d，持续治疗3个月，停药1个月后行射频消融治疗。于米非司酮治疗前、后，射频消融治疗后在B超引导下穿刺行病理活检，同时用免疫组织化学法检测治疗子宫肌瘤组织中ER、PR及EGFR表达水平。结果米非司酮治疗后的肌瘤组织细胞密度、水肿变性、玻璃样变性、梗死、细胞核改变、成纤维细胞及毛细血管增生诸项评分与治疗前比较，差异有统计学意义（P〈0．05或P〈0．01）。在此基础上进行射频消融治疗后，肌瘤细胞水肿变性、钙化、细胞核改变评分更高（P〈0．01或P〈0．05）；成纤维细胞及毛细血管增生评分更低（P〈0．01）。治疗前20例患者肌瘤组织中ER、PR、EGFR表达阳性率均较高，服用米非司酮后PR、EGFR表达阳性率明显下降（P〈0．05）。米非司酮联合射频消融治疗后ER、P取EGFR下降更明显，与治疗前比较差异有统计学意义（P〈0．01或P〈0．05），而与米非司酮治疗后比较仅ER差异有统计学意义（P〈0．05）。结论米非司酮和射频治疗均能使肌瘤组织坏死、细胞及血管生成减少、血管闭塞、血栓形成，肌瘤组织ER、PR、EGFR表达降低等，从而取得治疗效果。
Objective To study the change in histopathology in larger uterine leiomyoma treated with Mifepristone and radiofre- quency ablation. Methods A total of 20 patients with larger uterine leiomyoma （5 - 7 cm in diameter） were treated with Mifepristone 12.5 mg per day for 3 months, and then with radiofrequency ablation after one month. The histopathologic features of the uterine leiomyoma were observed using HE staining and the expression of estrogen receptor （ER） , progestin receptor （PR） and epidermal growth factor receptor （EGFR） were observed using immunohistochemical method before and after treatment. Results After treatment with Mifepristone, the changes in histopathologic features such as cell density, blood vessel, cell nucleus, fibroblast and vascular proliferation were significantly different from that before （P 〈 0.05 or P 〈 0.01 ）. The above-mentioned changes were different more significantly after treating with radiofrequeney ablation （ P 〈 0.01 or P 〈 0.05 ）. Conclusion The treatment of Mifepristone and radiofrequency ablation can induce muscular tumor necrosis, angiogenesis reduction, vascular occlusion, thrombosis and down-regulation of ER, PR and EGFR expression. It＇ s an effective treatment method to larger uterine leiomyoma.
出处
《临床军医杂志》
CAS
2014年第5期491-494,共4页
Clinical Journal of Medical Officers
关键词
射频消融
米非司酮
子宫肌瘤
组织病理学
radiofrequency ablation
Mifepristone
uterine leiomyoma
histopathology
