左炔诺孕酮宫内缓释系统对增生过长子宫内膜结构的影响

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。

Effect of LNG-IUS on endometrial ultrastructure

Objectives To explore the endometrial changes after inserting levonorgestrel intrauterine system（LNG-IUS）by pathology and electron microscopy,and evaluate its therapeutic effects on endometrial hyperplasia.Methods Endometrial changes in 25 patients with endometrial hyperplasia were studied by light and electron microscope.Results Endometrium was increased withciliated cells,developed cilia,abundant epithelial microvilli and cellular processes,large nuclei and abundant organelle in cytoplasm before LNG-IUS insertion,showing active proliferation features.After insertion,endometrial proliferation was inhibited,including epithelium pycnosis,less cellular processes,less epithelial microvilli and ciliated cells,scare cilia,wider intercellular space,irregular nuclei,chromatin condensation,incomplete nuclear membrane,dilated endoplasmic reticulum,swollen mitochondrion and decreased glycogen.Conclusions Pathological and ultrastructure studies showed LNG-IUS can inhibit endometrium proliferation and treat simple and complex endometrial hyperplasia.