子宮肌瘤(uterine myoma)雙語教學(xué)張喜

UterineMyoma

Women’sHospital,SchoolofMedicineZhejiangUniversity

Prof.LinJunIntroductionMostcommonbenigntumoroffemalereproductivesystemBenignneoplasmcomposedprimarilyofsmoothmuscleCommoninwomen30-50yUsuallyasymptomatic

Etiology

Notdetectablebeforepubertyandaftermenopause

ProbablyrelatestofemalehormonesEstrogenandER↑Progestinmaypromotemitosis（有絲分裂）

ofmyomaClassificationAccordingtothelocation：Uterinebodymyoma90%Cervicalmyoma10%ClassificationAccordingtotherelationshipbetweenmyomaanduterinemyometrium：

intramuralmyoma

60%-70%

subserousmyoma

20%submucousmyoma10%-15%ClassificationClassificationmultiplemyomaPathologyGrossAppearance：round,smooth,andusuallyfirmfalsecapsularcovering——pseudocapsule

canbeclearlydemarcatedfromthesurroundingmyometriumPathologyGrossAppearance：

Transversesection:lightgrayawhorl-likearrangementoranintertwiningpatternPathologyMicroscopicexamination：composedofsmoothmusclecellsandvaryingamountsofconnectivestissueIndividualcellsarequiteuniforminsize,spindleshaped,haveelongatednuclei.Nonstriatedmusclefibers（平滑肌纖維）arearrangedininterlacingbundlesofvaryingsizerunningindifferentdirections.DegenerationHyalinedegenerationCysticdegenerationReddegenerationSarcomatouschangeDegenerationwithcalcificationDegenerationReddegenerationmostcommonduringpregnancyandpuerperiumvenousthrombosisandcongestionwithinterstitialhemorrhageDegeneration←Reddegeneration

←Hyalinedegeneration

DegenerationSarcomatouschange

malignantrare,0.4-0.8%oldwomenenlargerapidlywithirregularvaginalbleedingDegenerationSarcomatouschangeSymptomsUsuallynosymptomsAssociatewithlocation,anddegenerationsNotassociatewiththesizeandthenumber

Symptoms1.menorrhagiaandprolongedmenseslargeintramuralmyoma

submucousmyoma2.abdominalmass3.leukorrhagiaSymptoms4.pressureeffectspressurebladderorrectum→urinaryfrequency,constipation（便秘）intraligamentousmyoma

andlargecervicalmyoma→obstructureter

infertilityspontaneousabortionabdominalpainSignassociatedwith：sizelocationnumberdegenerationlargemyoma→palpableabdominalmassPelvicexamination：

uterus——enlarged，irregularandhardDiagnosisTypicalsymptomsandsignsUltrasoundHysteroscopyLaparoscopyUltrasound

UltrasoundDiagnosisHysteroscopyDiagnosisLaparoscopyDifferential

diagnosisPregnancyOvarianneoplasmsAdenomyosisMalignanttumorsofuterusuterinesarcomaendometrialcarcinomacervicalcancerTreatmentAccordingto:agedesireforchildbearingsymptomslocation,sizeandamountofmyomaTreatmentObservationandFollowUpSmall，asymptomatic，especiallynearmenopauseInterval：3～6months

MedicalmeasureIndications：smallerthan2monthsinsizeslightsymptomsnearmenopause

Medicalmeasure

1.Androgenicagents（雄激素）：

testosteronepropionate（丙酸睪酮）2.Gonadotropin-releasinghormoneagonist,（GnRH-a）GnRH-a

LH、FSH↓E2↓

shrinkageofmyomaleuprorilin（亮丙瑞林）goserelin（戈舍瑞林）

Medicalmeasure

Sideeffects:HypoestrogenicsideeffectsOsteoporosisSurgicalmeasuresIndications：greaterthan10weeksinsizemenorrhagia→anemiapressureeffectsgrowsrapidlyfailureinmedicaltreatmentinfertilityorrecurrentabortionSurgicalmeasuresMyomectomypreservefertility,<35yearsold2.HysterectomyNumerouslargetumorsObviouslysymptomaticpatientNowishofpreservingfertilitySuspectedtomalignanttransformation

Myomasduringpregnancy

Impactonpregnancy：

abortionImpactondelivery：pretermlabor（早產(chǎn)）fetalmalpresentation（胎位異常）placentaprevia