機能性子宮出血の組織学的並びに臨床的研究

Abstract

Concerning the characteristics of functional uterine bleeding there many studies carried on from various angles such as from the histological, endocrinologic, and autonomic nervous systems, the blood-circulatory system, and the tissue-enzyme system. However, the actual characteristic of this bleeding has not completely been clarified, and therefore, most of therapeutic treatments that we now employ are still on the experimental stage. Histological studies of this bleeding likewise suffer from various clinically confusing problems, although thare are very few reports on the therapeutic method by the histological classification of the functional uterine bleeding. With the purpose of pursuing the relationship between the histological classification on one hand and the clinical symptoms and the aspect of treatment on the other, from the clinical viewpoint the author studied 190 tissue spccimens of the endometrium obtained from the patients with functional uterine bleeding, admitted to the Clinic of Obstetrics and Gynecology, Okayama University Medical School, and 38 tissue specimens obtained by a single scraping of curettage in the patients with functional uterine bleeding, visiting our outpatient clinic, all together 228 specimens. These tissue specimens were fixed in 10% formalin solution, embedded in paraffin, and stained in hematoxin-eosin.Since there are the proliferative phase, the secreatory phase and menstrual phase of the menstrual cycle and because these conditions or the abnormality of these conditions are reflected on the endometrial picture in functional uterine bleeding, the author classified these histological pictures into the proliferative type (Type I), the abnormal-proliferative type (Type II) (the hyperproliferative type (Type II1), the cystic glandular hyperplasia type (Type I2), the secretory phase type (Type III), the abnormal secretory type (Type IV) (mixed type (Type IV1), cystic glandular secretory type (Type IV2)), the abnormal menstruation type (Type V), and the atrophic type (Type VI). These clinical symptoms (especilly the bleeding type is classified into types I-IV) and the results of treatment have been compared statistically, and obtained the following results.1. Although each histological type shows an individual variety of bleeding types, the abnormal proliferative type (Type II) shows abnormal persistent bleeding type (Type I) and the completely irregular bleeding type (Type IV) over 80 per cent of the atrophic type (Type VI).2. The stature, physique, menarchal age, the question of conception and delivery, and dysmenorrhea have no significant difference according to the histological types.3. In the adolescent stage (under 25 years) most of them belong to the abnormal proliferative type, showing a protracted bleeding type.4. In the mature stage various histological types occur, making them difficult to differentiate from clinical findings, but the swelling of the ovaries, a high degree of anemia, and mixture of blood clots often occur in the abnormal proliferative type. In the cases of within one year's lapse of time after an abortion or premature delivery or in the case with displacement of the uterns having persistent bleeding in small amount after menstruation, they can be clasified as the abnormal menstrual type (Type V).5. After climacteric (46-55 years) most of them belong to the abnormal proliferative type and the atrophic type; especially the persistent bleeding type is predominant, and those showing an enlargement of corpus uteri with violet coloration of the vaginal mucous membrane are of the abnormal proliferative type. Those with small and hard corpus uteri and whose vaginal mucous membrane is hyperemic, presenting an irregular bleeding type, are significantly an atrophic type.6. The persistent bleeding type is clinically the worst bleeding type.