CAJ | 학술논문

目的：探讨激光共聚焦显微镜下子宫腺肌病的子宫内膜-肌层交界区（EMI）的血管形态学改变。方法选取2012年10月～2015年4月在大连大学附属中山医院妇科病房住院患者，25例子宫腺肌病子宫标本与25例子宫平滑肌瘤子宫标本分别称子宫腺肌病组和子宫肌瘤组。均于标本宫底“子宫内膜肌层交界区”（Endometrial Myometrial Interface，EMI）取材，石蜡切片HE染色后确诊为子宫腺肌病和子宫肌瘤后，在荧光显微镜下识别幼稚型和成熟型血管，计算血管密度。Zeiss LSM 510激光共聚焦显微镜观察测量计算单个血管内皮面积、血管直径及周长。结果荧光显微镜观察结果显示，子宫腺肌病组EMI检出血管223条，成熟型127条（57%），幼稚型96条（43%）；子宫肌瘤组EMI检出血管52条，成熟型51条（98%），幼稚型1条（2%）， P＜0.05，差异具有统计学意义。子宫腺肌病组子宫底EMI血管密度（8.92±0.84）条，大于子宫肌瘤组宫底EMI血管密度（2.20±0.19）条，P=0.001，差异具有统计学意义。共聚焦显微镜观察结果显示，子宫腺肌症组EMI血管直径、周长、面积分别为（23.79±4.82）μm，（74.71±11.82）μm，（177.81±21.42）μm2。子宫肌瘤组EMI血管直径、周长、面积分别为（6.46±2.68）μm，（42.68±6.88）μm，（68.93±6.90）μm2。子宫腺肌病组血管直径、周长、面积均大于子宫肌瘤组，P＜0.05，差异具有统计学意义。结论子宫腺肌病EMI与子宫肌瘤组EMI比较，血管密度增大；幼稚型血管血管比例增大，单个血管直径、周长、面积均大于子宫肌瘤EMI。子宫腺肌病组EMI血管改变提示子宫内膜向子宫肌层侵入同时有新生血管增生，影像学所示EMI增厚主要组织学成分为增生血管。采用手术或药物减少EMI可能治疗子宫腺肌病。
목적：탐토격광공취초현미경하자궁선기병적자궁내막-기층교계구（EMI）적혈관형태학개변。방법선취2012년10월～2015년4월재대련대학부속중산의원부과병방주원환자，25례자궁선기병자궁표본여25례자궁평활기류자궁표본분별칭자궁선기병조화자궁기류조。균우표본궁저“자궁내막기층교계구”（Endometrial Myometrial Interface，EMI）취재，석사절편HE염색후학진위자궁선기병화자궁기류후，재형광현미경하식별유치형화성숙형혈관，계산혈관밀도。Zeiss LSM 510격광공취초현미경관찰측량계산단개혈관내피면적、혈관직경급주장。결과형광현미경관찰결과현시，자궁선기병조EMI검출혈관223조，성숙형127조（57%），유치형96조（43%）；자궁기류조EMI검출혈관52조，성숙형51조（98%），유치형1조（2%）， P＜0.05，차이구유통계학의의。자궁선기병조자궁저EMI혈관밀도（8.92±0.84）조，대우자궁기류조궁저EMI혈관밀도（2.20±0.19）조，P=0.001，차이구유통계학의의。공취초현미경관찰결과현시，자궁선기증조EMI혈관직경、주장、면적분별위（23.79±4.82）μm，（74.71±11.82）μm，（177.81±21.42）μm2。자궁기류조EMI혈관직경、주장、면적분별위（6.46±2.68）μm，（42.68±6.88）μm，（68.93±6.90）μm2。자궁선기병조혈관직경、주장、면적균대우자궁기류조，P＜0.05，차이구유통계학의의。결론자궁선기병EMI여자궁기류조EMI비교，혈관밀도증대；유치형혈관혈관비례증대，단개혈관직경、주장、면적균대우자궁기류EMI。자궁선기병조EMI혈관개변제시자궁내막향자궁기층침입동시유신생혈관증생，영상학소시EMI증후주요조직학성분위증생혈관。채용수술혹약물감소EMI가능치료자궁선기병。
Objective To explore the changes of the vascular morphology of endometrial myometrial interface ( EMI ) in adenomyosis with the laser scanning confocal microscope.Methods All the cases were hospitalized in zhongshan hospital of dalian university from October 2012 to April 2015, 25 cases of adenomyosis and 25 cases of uterine myoma were referred to as the adenomyosis group and the control group. The specimens of EMI were taken from the bottom of uterine. After the diagnosis of the adenomyosis and uterine myoma were confirmed by fluorescence microscopy. Zeiss LSM510 laser scanning confocal microscope was used to calculate the area, diameter and perimeter of each blood vessel.Results Fluorescence microscope observation showed, 223 blood vessels were detected, 127 ( 57% ) of which were mature and 96 ( 43% ) were naive, in the adenomyosis group; while 52 blood vessels were detected, 51( 98%) of which were mature and 1( 43% ) were naive, in the control group,P<0.05, the difference was statistically significant. The vascular density of EMI in the adenomyosis grop was ( 8.92±0.84 ) μm2, which was higher than that in the control grop( 2.20±0.19 ) μm2,P<0.001, the difference was statistically signiifcant. A result of confocal microscope showed, diameter, perimeter, area of vascular in the adenomyosis group was ( 23.79±4.82 )μm, (74.71±11.82 )μm, ( 177.81±21.42 )μm2, respectively. That was ( 6.46±2.68) μm, ( 42.68±6.88 ) μm, ( 8.93±6.90 )μm2 in the control group, spectively. The vessel diameter, perimeter and area of the adenomyosis group were higher than those of the the control group,P<0.05, the difference was statistically significant .Conclusion Vascular density and the percentage of infantile vessels, compared with control group, were increased in the adenomyosis group.And diameter, perimeter and area of blood vessels of EMI in the adenomyosis group were larger.The changes of EMI in the adenomyosis suggest that the neovascular hyperplasia in the endometrium. Adenomyosis may be treated by induce EMI with drugs or surgery.