本文選題：子宮內(nèi)膜　切入點(diǎn)：損傷　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本文從臨床和動物實(shí)驗(yàn)兩方面展開研究,通過口服屈螺酮炔雌醇片(優(yōu)思明)對損傷后子宮內(nèi)膜進(jìn)行干預(yù),探討優(yōu)思明對損傷后子宮內(nèi)膜修復(fù)的影響,旨在為臨床宮腔操作手術(shù)后治療提供理論依據(jù)。方法:(1)回顧性分析2016年12月至2017年4月就診于大連醫(yī)科大學(xué)附屬第一醫(yī)院行人工流產(chǎn)患者232例,征得患者知情同意后,將自愿口服優(yōu)思明的患者設(shè)為實(shí)驗(yàn)組,共92例;另140例患者不行特殊處置,設(shè)為對照組。分析兩組患者年齡、孕產(chǎn)史、人工流產(chǎn)次數(shù)、停經(jīng)時間等各項(xiàng)指標(biāo)。觀察患者術(shù)后陰道流血情況、2周后婦科超聲檢查結(jié)果、術(shù)后第一次月經(jīng)來潮時間、術(shù)后有無不良反應(yīng)等。(2)選取出生后80-110天性成熟雌性未生育SD SPF級大鼠30只,建立子宮內(nèi)膜損傷模型,隨機(jī)數(shù)字表法分為實(shí)驗(yàn)組A組(損傷+服藥)、對照組B組(損傷)和空白組C組(未損傷)3組。取材時開腹觀察子宮外觀、與周圍組織臟器粘連情況及是否存在宮腔粘連。制作冰凍切片,免疫染色后電子顯微鏡觀察子宮內(nèi)膜病理組織學(xué)改變。結(jié)果:(1)實(shí)驗(yàn)組與對照組患者在年齡、孕產(chǎn)史、人工流產(chǎn)次數(shù)、停經(jīng)時間上無顯著差異,術(shù)后陰道流血持續(xù)時間實(shí)驗(yàn)組與對照組分別為:9.79±7.30天和3.59± 1.89天。人流術(shù)后第一次月經(jīng)來潮時間實(shí)驗(yàn)組和對照組為25.16±4.57天和35.83±9.69天,兩者皆有統(tǒng)計學(xué)差異。術(shù)后2周復(fù)查婦科超聲兩組在子宮內(nèi)膜厚度和內(nèi)膜回聲數(shù)據(jù)上均無顯著差異。(2)大鼠子宮內(nèi)膜損傷術(shù)后1日A組與B組子宮內(nèi)膜病理改變無明顯差異;術(shù)后3日,A組及B組輕度損傷模型在子宮內(nèi)膜處可見MHCII及BrdU陽性細(xì)胞,而B組重度損傷的內(nèi)膜形態(tài)與術(shù)后1日無明顯差異。術(shù)后5日,A、B兩組輕度損傷模型的子宮內(nèi)膜可見結(jié)構(gòu)完整的腺體,內(nèi)膜連續(xù)性趨近完整,A組重度損傷模型內(nèi)膜連續(xù)性不如輕度完整,但出現(xiàn)大量BrdU陽性細(xì)胞。而B組重度損傷模型無內(nèi)膜組織形態(tài),無腺體,無BrdU陽性細(xì)胞。術(shù)后7日,A、B兩組輕度損傷及A組重度損傷模型的內(nèi)膜結(jié)構(gòu)基本恢復(fù)正常,而B組重度模型,宮腔中出現(xiàn)與正常子宮內(nèi)膜結(jié)構(gòu)不同的白色纖維化組織,局部宮腔結(jié)構(gòu)紊亂,未見明顯宮腔線,出現(xiàn)宮腔粘連。結(jié)論:在動物實(shí)驗(yàn)中,口服優(yōu)思明可使受損子宮內(nèi)膜巨噬細(xì)胞聚集、促進(jìn)子宮內(nèi)膜細(xì)胞增殖,加快子宮內(nèi)膜的修復(fù),有效防止宮腔粘連。人流術(shù)后患者口服優(yōu)思明,可能會出現(xiàn)較長時間陰道淋漓流血,臨床上可在宮腔手術(shù)操作術(shù)后權(quán)衡利弊,在醫(yī)師指導(dǎo)下予以口服優(yōu)思明作為術(shù)后輔助治療。
[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 鹵7. 30 days and 3. 59 鹵1. 89 days, respectively. The first menstrual onset time after abortion was 25.16 鹵4. 57 days and 35. 83 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R169.42

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