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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。
Objective: To investigate the expression of estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor (EGFR) in endometrial polyps (EP) and the value of hysteroscopy in the diagnosis and treatment of EP. Methods: Fifty-six patients with EP were enrolled in this study. The expression of EGFR, ER and PR in 30 cases of EP patients with polyp, endometrial polyps and 10 cases of normal endometrium were examined by cervical EP (TCRP) , And compared the expression of EGFR, ER and PR in interstitial and gland of each tissue. Results: Of the 56 EP patients with TCRP, 2 cases were diagnosed as well-differentiated endometrial adenocarcinoma with total hysterectomy. The patients were followed up for 6 months to 1 year. The prognosis was good. Hysteroscopic surgery 3 months follow-up, in addition to 4 patients with mild adhesions at the bottom of the uterine cavity, the remaining patients with normal uterine morphology, symptoms improved significantly. (3) The expressions of ER, PR and EGFR in interstitial and gland of uterine polyps were significantly higher than those in paracancerous tissues and normal endometrium (P <0.05) The expression of EGFR in PR and stroma was not significantly different from that in normal endometrium (P> 0.05). The expression of EGFR in endometrial tissue was significantly higher than that in normal endometrium (P <0.05). The expression of ER in the polyps was significantly higher than that in the stroma (P <0.05). The expression of EGFR in the polyps was significantly higher than that in the stroma (P <0.01). Conclusions: (1) The clinical features of EP are predominantly irregular vaginal bleeding, and menopausal bleeding predominates. (2) The occurrence of EP is associated with the synergistic effects of EGFR, ER and PR. (3) (4) hysteroscopy is the preferred method of diagnosis and treatment of EP, polyp resection of polyp should be removed as appropriate.