[Research on repairing patterns and factors causing subsequent surgery after trancervical resection of endometrium].

OBJECTIVE: To study the repairing process and the factors causing subsequent surgery after trancervical resection of endomitrium (TCRE). METHODS: From March 1991 to September 2002, 1 431 hysteroscopic endometrium resection procedures were performed in Hysteroscopic Center of Fuxing Hospital, and 38 patients who required additional treatment which include 13 hysterectomy, 3 repeat TCRE and 22 uterine curettage were collected and the specimens were stained by hemaloxylin-eosin, Masson's trichrome and respiratory enzyme dehydronicotinamide adenine dinucleotide phosphate diaphorase as well as proliferative cell nuclear antigen (PCNA) respectively to evaluate the tissue healing process and the histopathological changes. Some of the changes were observed by electron microscope. RESULTS: (1) The superficial myometrium presented necroses and granulationingitis in the early stage and then scar formation in the later stage followed TCRE. (2) The granulation structure was covered with columnar epithelial cell and the smouth muscle cell regrowth which showed positive reaction by PCNA staining below the scarred tissue. (3) The undestroyed glands of endometrial floor were showed both inside granulation and scar tissue where lymphocytes infiltration and a great deal of foreign-body giant cells were also found. Focal and diffuse endometrium regeneration located beside these granulation and scar structure. (4) Adenomyosis presented in some of uterine specimens, but the cycle endometrium and inflammatory granulation tissue presented in the uterine curettage tissue. CONCLUSIONS: The repairing patterns of destroyed myometrium are mainly based on granulationingitis and scar formation followed TCRE procedure, endometrial glands and smooth muscle cells regrowth are also involved in this process. Endometrium regeneration, adenomyosis and inflammation are the main reasons caused subsequent surgery.