输卵管妊娠患者的输卵管超微结构与功能改变的研究

发布时间：2018-09-08 19:39

【摘要】：输卵管能够“捡拾”卵子,是精子与卵子受精的场所,也是配子和受精卵转运的通道,为受精卵提供了最初发育时期的适宜环境与营养,在妊娠中起到重要作用。受精卵滞留于输卵管管腔内着床,引起输卵管妊娠。近年来输卵管妊娠发病率增加至2%。输卵管妊娠后生育力降低,20%远期继发不孕、约10-27%再次输卵管妊娠。输卵管妊娠主要原因是输卵管炎症造成的输卵管损害。输卵管炎与输卵管阻塞和非纤毛化有关,范围广泛。除了肉眼形态、管腔通畅度,黏膜结构同样影响输卵管功能。但输卵管妊娠黏膜超微结构改变少见报道。妊娠的输卵管是否应该保留?保留的输卵管对于功能有没有积极意义?这是本研究探讨的问题。目的：研究输卵管妊娠患者,妊娠输卵管黏膜的超微结构改变,探寻输卵管妊娠与妊娠输卵管功能损伤的关系。并研究输卵管妊娠经保守手术后继发不孕患者,保留的输卵管黏膜超微结构改变,了解输卵管妊娠后对输卵管远期结构和功能的影响。为有手术指征的输卵管妊娠患者,选择保留或切除妊娠输卵管打下基础。方法：观察妊娠输卵管黏膜的超微结构改变,实验组取临床诊断为输卵管妊娠,HCG大于5000IU/L,无内出血,需手术治疗者同意行患侧输卵管切除术,腹腔镜诊断及术后病理诊断为输卵管壶腹部妊娠的患者。对照组取生育年龄,因卵巢良性囊肿行一侧附件切除者,无生育要求,无盆腔炎病史,有阴道分娩史,病理证实输卵管结构正常者。输卵管切除后立即取材固定。经生理盐水漂洗数次,洗去血液等,2.5%戊二醛中固定24小时,PBS漂洗标本,梯度酒精脱水,叔丁醇与100%酒精以1：1的比例混合,标本放入纯叔丁醇中一次,吸去叔丁醇,冷冻干燥,粘台,喷金,在扫描电镜下观察并照片。透射电镜采用取材、前固定、后固定、梯度酒精脱水、丙酮置换、树脂浸透、切片、染色、上镜观察并照片。观察输卵管妊娠经保守手术后不孕患者患侧输卵管超微结构改变,研究对象为既往经保守手术治疗,且既往为壶腹部妊娠的输卵管妊娠后继发不孕患者,月经规律、有正常性生活、未避孕未孕1年以上；最后一次妊娠为输卵管妊娠,且输卵管妊娠次数仅一次,已治愈；子宫碘油造影提示患侧输卵管堵塞,要求行腹腔镜探查者。腹腔镜手术不能恢复患侧管腔通畅切除患侧输卵管,取壶腹部和伞端组织作为观察对象。采用上述扫描电镜的方法进行观察。结果：(1)输卵管妊娠患者,妊娠部位输卵管黏膜超微结构改变,扫描电镜观察的结果与透射电镜观察的结果一致。(2)妊娠输卵管壶腹部上皮由纤毛细胞和分泌细胞组成,纤毛细胞数量减少,在单个纤毛细胞上分布的纤毛数量也减少,纤毛稀疏分布,排列无规律,杂乱无章；分泌细胞数量增多,凸向管腔较正常组明显,大小不一致,在分泌细胞顶部的微绒毛数量减少、颗粒状、排列不规则。(3)扫描电镜相同的倍数下,妊娠输卵管分泌细胞数目、纤毛细胞数目分别与对照组比较差异有统计学意义(P0.05),纤毛长度与直径无统计学差异。(4)妊娠输卵管壶腹部纤毛有9+2微管结构,线粒体数量减少,分泌细胞顶部凸起明显,呈高柱状,合成分泌的细胞器减少,固有层水肿明显,非特异性炎细胞浸润明显,基底细胞形态不规则,基底细胞胞浆内大量扩张的粗面内质网,游离核糖体等。(5)妊娠输卵管的非妊娠部位超微结构改变：峡部、伞端可见纤毛细胞比正常相应部位减少,纤毛变浅,纤毛数量减少。分泌细胞数量增多,大小不均,凹凸不平,微绒毛分布不均。(6)输卵管妊娠经保守手术后不孕患者患侧输卵管黏膜,既往妊娠部位的纤毛细胞数量明显减少,纤毛细胞稀疏分布在分泌细胞中。分泌细胞数量明显增加,但留存的纤毛形态完好。分泌细胞大小不均,凸向管腔的程度不一致,微绒毛大小形态不均一。妊娠输卵管伞端上皮存在类似的改变。结论：妊娠的输卵管存在严重超微结构异常改变,损伤不可逆。输卵管妊娠具有手术指征时,建议切除患侧输卵管。
[Abstract]:The oviduct can "pick up" eggs. It is the place where sperm and eggs are fertilized. It is also the passage of gametes and fertilized eggs. It provides the suitable environment and nutrition for the early development of fertilized eggs and plays an important role in pregnancy. The rate increased to 2%. Fertility decreased after tubal pregnancy, 20% long-term secondary infertility, and 10-27% tubal pregnancy again. The main cause of tubal pregnancy is tubal damage caused by tubal inflammation. Tubular function. However, ultrastructural changes of the mucosa of tubal pregnancy are rarely reported. Should the tubal be retained in pregnancy? Is the retained tubal of positive significance to the function? This is the question discussed in this study.
Objective: To study the ultrastructural changes of the tubal mucosa in patients with tubal pregnancy and to explore the relationship between tubal pregnancy and tubal dysfunction during pregnancy. The effect of energy. For patients with tubal pregnancy with indications of surgery, choose to retain or resect the Pregnant Fallopian tube lay the foundation.
Methods: The ultrastructural changes of tubal mucosa in pregnancy were observed. The patients in the experimental group were diagnosed as tubal pregnancy with HCG greater than 5000IU/L and no internal bleeding. The patients in the experimental group were consented to salpingectomy, laparoscopic diagnosis and postoperative pathological diagnosis as tubal ampulla pregnancy. No fertility requirement, no history of pelvic inflammation, vaginal delivery, and pathologically confirmed normal tubal structure were found in the cyst patients who underwent unilateral adnexal excision. The specimens were mixed in proportion and put into pure tert-butanol once. The specimens were sucked out tert-butanol, freeze-dried, plated and sprayed with gold. The samples were observed and photographed under scanning electron microscope. Patients with tubal ultrastructural changes in the affected side, the object of study for conservative surgical treatment, and previous ampullary pregnancy after tubal pregnancy secondary infertility patients, menstrual regularity, normal sexual life, no contraception not more than one year; the last pregnancy for tubal pregnancy, and tubal pregnancy only once, has been cured uterus; Laparoscopic operation can not restore the lumen of the affected side to resect the fallopian tube unobstructed. The tissue of ampulla and umbrella end was taken as the object of observation. The method of scanning electron microscope was used for observation.
Results: (1) The ultrastructural changes of oviduct mucosa were observed by scanning electron microscopy and transmission electron microscopy in tubal pregnancy. (2) The epithelium of ampulla of tubal pregnancy consisted of ciliated cells and secretory cells, the number of ciliated cells decreased, and the number of ciliated cells distributed on single ciliated cells decreased. The number of secretory cells increased and the number of ciliary cells increased. The number of microvilli on the top of secretory cells decreased, granular and arranged irregularly. (3) Under the same multiple of scanning electron microscope, the number of secretory cells and the number of ciliary cells in pregnancy fallopian tubes were compared with the control group, respectively. There was no significant difference in cilia length and diameter between the two groups (P 0.05). (4) There were 9+2 microtubules in the ampulla of tubal ampulla during pregnancy. The number of mitochondria was reduced, the top of secretory cells was prominently raised, the number of organelles synthesized and secreted was reduced, the lamina propria edema was obvious, the infiltration of non-specific inflammatory cells was obvious, and the morphology of basal cells was obvious. (5) Ultrastructural changes of the non-pregnant parts of the fallopian tube during pregnancy: the isthmus and fimbria showed that the cilia were less than the normal corresponding parts, the cilia became shallow, the cilia decreased. The secretory cells increased, the size of uneven, uneven, and the distribution of microvilli was not uniform. (6) The number of ciliated cells in the fallopian tube mucosa of the infertile patients after conservative surgery decreased significantly, and the secretory cells were sparsely distributed in the secretory cells. There was a similar change in the epithelium of the fallopian tube.
Conclusion: There are serious ultrastructural abnormalities in the fallopian tube of pregnancy, and the injury is irreversible.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R714.22

【参考文献】