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目的:探讨子宫腺肌病子宫内膜电切术(TCRE)后辅以甲羟孕酮的临床疗效,从分子水平上阐述其机制。方法:选择自愿接受TCRE的子宫腺肌病患者50例,随机分为两组。治疗组25例,术后给予甲羟孕酮100 mg,2次/d,连续3个月;对照组25例,术后不给甲羟孕酮。另选取30例正常女性为正常对照组。术后6个月随访,用免疫组化的方法测定表皮生长因子受体(EGFR)与血管内皮生长因子(VEGF)及其受体(KDR)的表达情况。结果:TCRE后子宫腺肌病患者子宫内膜EGFR、VEGF及KDR的表达水平明显降低,与手术前子宫内膜比较差异有统计学意义(P<0.05),与正常对照组比较差异也有统计学意义(P<0.05);术后6个月随访,治疗组和对照组手术后子宫内膜的EGFR、VEGF及KDR的表达与正常对照组相比差异无统计学意义,但是治疗组和对照组相比差异有统计学意义(P<0.05)。结论:TCRE对子宫内膜EGFR、VEGF及KDR的表达起降调节作用,术后辅以甲羟孕酮治疗可能有助于抑制复发。
Objective: To investigate the clinical efficacy of medroxyprogesterone acetate after endometrial electrotomy (TCRE) in adenomyosis and elucidate its mechanism at the molecular level. Methods: Fifty patients with adenomyosis who voluntarily accepted TCRE were randomly divided into two groups. In the treatment group, 25 cases were given medroxyprogesterone 100 mg twice a day for 3 consecutive months. In the control group, 25 cases were given no medroxyprogesterone after the operation. Another 30 normal women were selected as normal control group. Six months after the operation, the expression of epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and their receptors (KDR) were determined by immunohistochemistry. Results: The expression of EGFR, VEGF and KDR in endometrium of patients with adenomyosis after TCRE was significantly lower than that of the endometrium before surgery (P <0.05), and the difference was also statistically significant compared with the normal control group (P <0.05). After 6 months’ follow-up, the expression of EGFR, VEGF and KDR in the endometrium of the treated group and the control group had no significant difference compared with that of the normal control group. However, in the treated group and the control group Compared with the difference was statistically significant (P <0.05). Conclusion: TCRE can reduce the expression of EGFR, VEGF and KDR in endometrium, and postoperative medroxyprogesterone acetate may help to inhibit the recurrence.