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目的用组织病理学和电镜检查左炔诺孕酮宫内缓释系统(LNG-IUS)放置前后增生过长子宫内膜局部病理变化,以评估LNG-IUS对子宫内膜增生过长患者的治疗效果。方法在光镜和电镜观察25例增生过长子宫内膜患者LNG-IUS放置前后子宫内膜组织学和超微结构的变化。结果放置前子宫内膜超微结构表现为细胞增殖活跃,纤毛细胞增多,上皮细胞微绒毛丰富,细胞突起增多,细胞核大,细胞浆内细胞器丰富。LNG-IUS放置后6个月,光镜下观察子宫内膜明显变薄,子宫内膜腺体数目明显减少,腺腔变小,腺体发育不良,腺上皮呈立方状或低柱状,间质细胞明显蜕膜样变。子宫内膜超微结构表现为细胞变性,增殖明显受到抑制,上皮细胞固缩,纤毛细胞很少,细胞微绒毛明显减少,细胞间隙增宽,细胞核不规则,染色质边聚,内质网扩张,线粒体肿胀,糖原减少。结论 LNG-IUS对于治疗简单型和复杂型子宫内膜增生过长的患者是有效的,组织病理学和超微结构研究均提示子宫内膜增殖受到明显抑制,逆转增生过长的子宫内膜。
Objective To assess the local pathological changes of endometrial hyperplasia before and after levonorgestrel-releasing intrauterine release system (LNG-IUS) by histopathology and electron microscopy to evaluate the therapeutic effect of LNG-IUS on patients with endometrial hyperplasia effect. Methods The histological and ultrastructural changes of endometrium in 25 patients with hyperproliferative endometrium before and after LNG-IUS placement were observed under light and electron microscopes. Results Before placed, the endometrial ultrastructure showed active proliferation of cells, increased ciliated cells, abundant microvilli of epithelial cells, increased cell protrusion, large nucleus and rich organelles in the cytoplasm. Six months after LNG-IUS placement, the endometrium was significantly thinned by light microscopy, the number of endometrial glands was significantly reduced, the glandular cavity became smaller, the glandular dysplasia was observed, the glandular epithelium was cubic or columnar, Clear decidua cells change. Endometrial ultrastructure showed cell degeneration, proliferation was significantly inhibited, epithelial cells shrink, few ciliated cells, cell microvilli was significantly reduced, cell gap widened, irregular nuclei, chromatin edge poly, endoplasmic reticulum dilatation , Mitochondria swelling, glycogen reduction. Conclusions LNG-IUS is effective in the treatment of patients with simple and complex endometrial hyperplasia. Both histopathology and ultrastructure studies suggest that endometrial hyperplasia can be significantly inhibited and the endometrial hyperplasia can be reversed.