CAJ | 학술논문

目的探讨子宫腺肌病(ADS)患者子宫内膜-肌层交界区(EMI)超微结构的改变及其与腺肌病发病的关系.方法选择2010年5月至2013年9月在北京妇产医院妇科微创中心因ADS行全子宫切除术的子宫标本56例为腺肌病组(其中子宫内膜为增殖期26例,分泌期30例);同期因宫颈上皮内瘤变(CIN)Ⅲ切除的子宫标本46例为对照组(其中子宫内膜为增殖期24例,分泌期22例),子宫切除后取EMI肌层及外周肌层组织制作电镜标本,透射电子显微镜观察两组EMI肌层及外周肌层超微结构的改变.结果 (1) ADS组EMI肌细胞增生明显,胞质丰富,线粒体数量增加、体积增大、空泡化明显,粗面内质网明显扩张,但是肌丝、密体、密斑与对照组相比差异无统计学意义;(2)ADS组EMI平滑肌细胞超微结构无明显周期性变化,对照组中存在周期性变化.ADS组增殖期EMI平滑肌细胞的细胞核直径(2.34±0.17) μm,分泌期(2.63 ±0.39) μm,差异无统计学意义(P＞0.05),对照组增殖期细胞核直径(3.24±0.41) μm比分泌[(2.44±0.27) μm明显增长,差异有统计学意义(P＜0.05);(3)与外周肌层平滑肌细胞相比,EMI肌层细胞胞质较稀疏,核较小,肌丝、密体较少,密斑较短.结论 EMI超微结构的异常可能参与ADS的发生发展.
목적 탐토자궁선기병(ADS)환자자궁내막-기층교계구(EMI)초미결구적개변급기여선기병발병적관계.방법 선택2010년5월지2013년9월재북경부산의원부과미창중심인ADS행전자궁절제술적자궁표본56례위선기병조(기중자궁내막위증식기26례,분비기30례);동기인궁경상피내류변(CIN)Ⅲ절제적자궁표본46례위대조조(기중자궁내막위증식기24례,분비기22례),자궁절제후취EMI기층급외주기층조직제작전경표본,투사전자현미경관찰량조EMI기층급외주기층초미결구적개변.결과 (1) ADS조EMI기세포증생명현,포질봉부,선립체수량증가、체적증대、공포화명현,조면내질망명현확장,단시기사、밀체、밀반여대조조상비차이무통계학의의;(2)ADS조EMI평활기세포초미결구무명현주기성변화,대조조중존재주기성변화.ADS조증식기EMI평활기세포적세포핵직경(2.34±0.17) μm,분비기(2.63 ±0.39) μm,차이무통계학의의(P＞0.05),대조조증식기세포핵직경(3.24±0.41) μm비분비[(2.44±0.27) μm명현증장,차이유통계학의의(P＜0.05);(3)여외주기층평활기세포상비,EMI기층세포포질교희소,핵교소,기사、밀체교소,밀반교단.결론 EMI초미결구적이상가능삼여ADS적발생발전.
Objective To explore the ultrastructural features of endometrial-myometrial interface (EMI) of adenomyosis and normal myometrium.Methods From May 2010 to September 2013,102 uterine myometrial specimens were obtained from 102 patients undergoing hysterectomy.There were 56 adenomyosis patients as ADS group (including proliferative endometrium,n =26 and secretory endometrium,n =30) and another 46 with cervical intraepithelial neoplasis (CIN) Ⅲ as control group.The myometrium underneath endometrium and the outer third of myometrium were immediately harvested after operation.And the samples were processed and observed under transmission electron microscopy.Results (1) In the presence of uterine adenomyosis,the nuclei were significantly larger than controls and significantly enlarged with less prominent collagen fibrils.The cytoplasm was abundant,denoting cellular hypertrophy.The rough endoplasmic reticulum and Golgi apparatus became more prominent.But the dense patches and dense bodies appeared similar to the control; (2) EMI myocytes ultrastructure showed cyclic changes in controls.In proliferative cycle,the average nuclear size was larger than that in secretory cycle [(3.24 ± 0.41),(2.44 ± 0.27) μm,P ＜ 0.05].But there was not any differences from different cyclic phases in adenomyosis [(2.34 ± 0.17),(2.63 ± 0.39) μm,P ＞ 0.05] ; (3) EMI myocytes appeared significantly different than that of outer myometrium.The nuclei of EMI myocytes were much smaller than outer myometrium.And there was less prominent collagen fibrils.The dense patches,dense bodies and myofilament-cytoplasm ratio of EMI were smaller than outer myometrium.The nuclei-to-myocyte ratio was larger than outer myometrium.Conclusion Abnormal ultrastructural features of EMI may be correlated with the development of adenomyosis.