口服屈螺酮炔雌醇片对损伤后子宫内膜修复的影响

发布时间：2018-03-12 20:36

本文选题：子宫内膜　切入点：损伤　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文从临床和动物实验两方面展开研究,通过口服屈螺酮炔雌醇片(优思明)对损伤后子宫内膜进行干预,探讨优思明对损伤后子宫内膜修复的影响,旨在为临床宫腔操作手术后治疗提供理论依据。方法:(1)回顾性分析2016年12月至2017年4月就诊于大连医科大学附属第一医院行人工流产患者232例,征得患者知情同意后,将自愿口服优思明的患者设为实验组,共92例;另140例患者不行特殊处置,设为对照组。分析两组患者年龄、孕产史、人工流产次数、停经时间等各项指标。观察患者术后阴道流血情况、2周后妇科超声检查结果、术后第一次月经来潮时间、术后有无不良反应等。(2)选取出生后80-110天性成熟雌性未生育SD SPF级大鼠30只,建立子宫内膜损伤模型,随机数字表法分为实验组A组(损伤+服药)、对照组B组(损伤)和空白组C组(未损伤)3组。取材时开腹观察子宫外观、与周围组织脏器粘连情况及是否存在宫腔粘连。制作冰冻切片,免疫染色后电子显微镜观察子宫内膜病理组织学改变。结果:(1)实验组与对照组患者在年龄、孕产史、人工流产次数、停经时间上无显著差异,术后阴道流血持续时间实验组与对照组分别为:9.79±7.30天和3.59± 1.89天。人流术后第一次月经来潮时间实验组和对照组为25.16±4.57天和35.83±9.69天,两者皆有统计学差异。术后2周复查妇科超声两组在子宫内膜厚度和内膜回声数据上均无显著差异。(2)大鼠子宫内膜损伤术后1日A组与B组子宫内膜病理改变无明显差异;术后3日,A组及B组轻度损伤模型在子宫内膜处可见MHCII及BrdU阳性细胞,而B组重度损伤的内膜形态与术后1日无明显差异。术后5日,A、B两组轻度损伤模型的子宫内膜可见结构完整的腺体,内膜连续性趋近完整,A组重度损伤模型内膜连续性不如轻度完整,但出现大量BrdU阳性细胞。而B组重度损伤模型无内膜组织形态,无腺体,无BrdU阳性细胞。术后7日,A、B两组轻度损伤及A组重度损伤模型的内膜结构基本恢复正常,而B组重度模型,宫腔中出现与正常子宫内膜结构不同的白色纤维化组织,局部宫腔结构紊乱,未见明显宫腔线,出现宫腔粘连。结论:在动物实验中,口服优思明可使受损子宫内膜巨噬细胞聚集、促进子宫内膜细胞增殖,加快子宫内膜的修复,有效防止宫腔粘连。人流术后患者口服优思明,可能会出现较长时间阴道淋漓流血,临床上可在宫腔手术操作术后权衡利弊,在医师指导下予以口服优思明作为术后辅助治疗。
[Abstract]:Objective: to investigate the effect of hysterol on the repair of injured endometrium by oral administration of doxoronne ethylstilbestrol (Yosemin) in two aspects of clinical and animal experiments. Methods: from December 2016 to April 2017, 232 cases of induced abortion in the first affiliated Hospital of Dalian Medical University were retrospectively analyzed. Two groups of patients were divided into experimental group (n = 92) and control group (n = 140). Age, history of pregnancy and number of induced abortions were analyzed. Observation of the vaginal bleeding after operation and the results of gynecological ultrasound examination after 2 weeks, the first menstrual onset time after operation, 30 postnatal 80 to 110 postnatal female SD SPF rats were selected to establish a model of endometrial injury. The experimental group (group A) was randomly divided into three groups: group A (injury group), group B (injury group) and group C (group C without injury). Frozen sections were made and the changes of endometrial histopathology were observed by electron microscope after immunostaining. Results the patients in the experimental group and the control group were in age and pregnancy history. There was no significant difference in the number of induced abortion and the time of menopause. The duration of vaginal bleeding in the experimental group and the control group was 9. 79 卤7. 30 days and 3. 59 卤1. 89 days, respectively. The first menstrual onset time after abortion was 25.16 卤4. 57 days and 35. 83 卤9. 69 days in the control group and the experimental group. There was no significant difference in endometrial thickness and endometrial echo data between the two groups 2 weeks after operation) the pathological changes of endometrium in group A and group B had no significant difference on 1st after endometrial injury. On 3rd, MHCII and BrdU positive cells were found in the endometrium of mild injury models in group A and group B. However, there was no significant difference in endometrial morphology between group B and group B. on 5th, the endometrium of group B with mild injury could be seen with intact glands. The intimal continuity of severe injury model in group A was not as good as that in group A, but a large number of BrdU positive cells appeared in group A. while in group B, there were no intimal tissue morphology and no glands in severe injury model. There were no BrdU positive cells. On 7th after operation, the endometrial structure of mild injury and severe injury in group A returned to normal in both groups, while in group B, white fibrosis was found in the uterine cavity, which was different from that in normal endometrium. Conclusion: in animal experiment, Usimin can make the macrophages of damaged endometrium gather, promote the proliferation of endometrial cells, and accelerate the repair of endometrium. Effective prevention of intrauterine adhesions. After abortion patients take Yousimin oral, may appear a long time of vaginal bleeding, clinically can be in the uterine cavity surgery operation after the pros and cons, under the guidance of doctors to give oral Yosmin as postoperative adjuvant treatment.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R169.42

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