雌、孕激素受体及表皮生长因子受体在EP中的表达和宫腔镜对EP的诊治价值
子宫内膜息肉,,子宫内膜息肉;,雌激素受体;,孕激素受体;,表皮生长因子受体;,宫腔镜,摘要,关键词,1资料与方法,2结果
摘要：目的: 探讨雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体(EGFR)在子宫内膜息肉(EP)中的表达及宫腔镜对EP的诊断和治疗价值。方法: 360例EP患者中56例行经宫颈EP电切术(TCRP)，对30例EP患者息肉组织、息肉旁内膜组织和10例正常子宫内膜中EGFR、ER、PR的表达进行检测，并对各组织间质、腺体中EGFR、ER、PR的表达进行比较。 结果:56例行TCRP的EP患者中，2例病理诊断为高分化子宫内膜腺癌，行全子宫切除术，随访6个月～1年，患者预后良好。宫腔镜手术后3个月随访，除4例患者宫腔底部有轻度粘连外，余患者宫腔形态正常，症状明显改善。(3)子宫息肉组织间质和腺体中ER、PR、EGFR的表达均明显高于息肉旁组织及正常内膜的表达(P<0.05)；息肉旁内膜组织腺体和间质中ER、PR及间质中EGFR的表达与正常子宫内膜组织差异无统计学意义(P>0.05)；息肉旁内膜组织腺体EGFR的表达明显高于正常内膜的表达(P<0.05)；息肉组织腺体ER的表达明显高于间质的表达(P<0.05)，息肉组织腺体EGFR的表达明显高于间质的表达(P<0.01)。结论：(1)EP的临床特征以不规则阴道出血为主，绝经期则以绝经后出血为主;(2)EP的发生与EGFR、ER、PR协同作用有关;(3)绝经后妇女体内仍有雌激素持续作用;(4)宫腔镜是EP诊断和治疗的首选方法，切除息肉同时息肉旁内膜也应酌情切除。关键词: 子宫内膜息肉; 雌激素受体; 孕激素受体; 表皮生长因子受体; 宫腔镜
The expression of the receptors of estrogen, progesterone, epidermal growth factor in
endometrial polyps and the value of diagnosis and treatment by hysteroscopy
Aixingzi Ali, Ding Yan, Zulfiya Ali, et al
(Department of Gynecology, First Affiliated Hospital, Xinjiang Medical University,
Urumqi 830054, China)
Abstract: Objectives: To explore the pathogenic mechanism and clinical characteristic of endometrial polyps(EP). To study the value of diagnosis and treatment to endometrial polps by hystoroscopy. Methods: There were 1 676 patients checked by hysteroscope during two year (1999~2000). Among them EP cases were 360. There were 56 cases of EP performed with transcervical resection of polyps (TCRP). Estrogen recepter (ER), progesterone recepter (PR), epidermal growth factor receptor (EGFR) were determined by immunohistochemical ABC method in 30 cases of polyps and the endometrium nearby polyps. In addition, were 10 cases with normol endometrium regarded as control. Routine reexamines proceeded three months later after oprations. Parts of patients had been followed up for more than one year. Results: (1) The study showed that the morbidity of EP was 21.5% (360/1676). The main clinical character was irregular vaginal bleeding. There were 186 patients with postmenopausal uterine bleeding had positive findings, among them EP was 43 cases. (2) Among the 56 cases of EP proceeded TCRP, the pathological diagnosis of 2 cases were welldifferentiated adenocarcinoma of endometrium, which were operated total hysterectomy and followed up well condition about one to two years. The followup survey after operation showed that the appearance of uterine cavity were normal except 4 cases with lowgraded adhesion in fundus uteri. The symptoms improved obviously. (3) ER, PR, EGFR in polyps all were significantly higher than that in the endometrium nearby polyps and normal endometrium (P<0.01); ER, PR of stroma and gland and EGFR of stroma in endometrium nearby polyps and that in normal endometrium had no significant differences (P>0.05), EGFR of gland in endometrium nearby polyps was significantly higher than that in normal endometrium (P<0.01). Conclusions: (1) The main clinical character of EP gave first place to irregular viginal bleeding, but it was postmenopausal uterine bleeding in climacterium. (2) The pathogenic mechanism of EP was relevant to a common effort of estrogen,progesterone and epidermal growth factor. (3) Estrogen still played an important roll in climacterium. (4) Hysteroscope is a chief tool for the diagnosis and treatment of EP. While resecting the polyps,the endometrium of nearby polyps should be taken into consideration to resect. ......
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