(婦產(chǎn)科學(xué)課件)123(參考翻譯)Uterine-myoma

UterineMyoma

子宮肌瘤

GeneralConsiderationFairlyhighincidenceinwomenbetweenage30

to

50year,about30%Mostlybenign,withoutsymptomComposedofsmoothmuscleandconnectivetissue由平滑肌和結(jié)締組織組成

Pathogenesis

femalehormones:(estrogen雌激素

andprogesterone孕酮)

1.Occurinreproductiveage生育年齡

2.Nonewformation構(gòu)成

aftermenopause更年期

3.IncreaseinsizeduringpregnancyClassificationbyanatomiclocation:1.uterinecorpus子宮體myoma90%2.cervical宮頸

myoma

10%Classificationbyrelationbetweenmyomaandmyometrium子宮肌層:

1.Intramural肌壁間的

myoma60%～70%

2.Subserous漿膜下

myoma20%3.Submucous黏膜下

myoma10%～15%Pathology1.Naked-eye肉眼

appearance

falsecapsule假包膜,gray-colored,rounded,smooth,hard,whorled螺旋狀

pattern2.Microscopicalstructure顯微結(jié)構(gòu)smoothmuscleandfibrous纖維的

tissueDegeneration變性1.Hyalinedegeneration玻璃樣變

2.Cysticdegeneration囊性變

3.Reddegeneration紅色樣變

4.Malignanttransformation惡變

5.Degenerationwithcalcification變性伴鈣化

Degeneration

1.Hyalinedegeneration玻璃樣變

mostcommon

homogeneous均勻的

/transparent透明的

appearance,

absenceofwhorled螺旋狀

pattern,

absenceofmusclecells,

structurelesseosinophilic無(wú)嗜酸性結(jié)構(gòu)2.Cysticdegeneration囊性變liquefaction溶解

oftheareasofhyalinechange,capsular囊狀的

spacecontainingclearfluidDegenerationDegeneration3.Reddegeneration紅色樣變

specialtypeofnecrosis壞死

duringpregnancy,puerperium產(chǎn)褥期

duetovenousthrombosis靜脈血栓andhemolysis溶血withhemorrhage

red-stained紅染,soft“rawmeat生肉”AbdominalpainFeverUterusenlargedwithtenderness

4.Malignanttransformation惡變

(sarcomatouschange肉瘤樣變)rare

0.4%～0.8%DegenerationDegeneration5.Degenerationwithcalcification變性伴鈣化

subserousmyomawithsmallpeduncle

有蒂的漿膜下肌瘤

postmenopause絕經(jīng)后期ClinicalFindingsSymptomsonly35%～50%symptomatic有癥狀的dependingonthelocation,size,numberanddegenerationofthetumorsSymptoms1.Abnormaluterinebleeding

異常子宮出血2.Lowerabdominalmass

下腹部包塊3.Pain

疼痛4.Pressureeffects壓力效應(yīng)

5.Effectsonpregnancyandchildbearing

作用于懷孕和分娩期間1.Abnormaluterinebleedingmenorrhagia經(jīng)量增多

(prolonged延長(zhǎng),heavymenses)Where:largeintramuralmyoma大肌壁間肌瘤submucousmyoma粘膜下肌瘤

Why:Endometrium內(nèi)膜

surfaceincreasesMorebloodsurfaceInfluenceuterinecontraction收縮irregularorincreasedmenstrual月經(jīng)

bleeding2.Lowerabdominalmass

hardmassnotendernesslocaldiscomfort局部不適3.Painrarelyhappenusuallyduetocomplicationsreddegenerationtorsion扭轉(zhuǎn)

ofpedunculated有蒂的

subserousmyoma漿膜下肌瘤expelling壓榨

ofsubmucousmyoma粘膜下肌瘤

4.Pressureeffects

cervicalmyoma宮頸肌瘤Urination排尿frequencyandurgencyofurination尿頻和尿急difficultyinurination排尿困難retentionofurine尿潴留Constipation便秘5.Effectsonpregnancyandchildbearing

submucous粘膜下,intramural肌壁間

infertility不孕

(inabilitytoconceive懷孕)

abortion流產(chǎn)

obstructbirthcanal產(chǎn)道阻塞,difficultlabor難產(chǎn)ClinicalFindingsSigns1.enlargementoftheuterus

symmetricalenlargement對(duì)稱(chēng)型擴(kuò)張:submucous黏膜下

asymmetrical~非對(duì)稱(chēng)型擴(kuò)張:intramural肌壁間,subserous漿膜下

2.tumorpassthroughcervicalcanal子宮頸管

DiagnosisSymptomsPhysicalsignsUltrasoundscanningSpecialexaminations:Hysteroscopy子宮鏡檢查

Ultrasounddetectedanabnormalecho回聲

intheuterinecavityAsubmucousmyomawasverified證實(shí)

byhysteroscopyDifferentialDiagnosisPregnancyAdenomyosis子宮內(nèi)膜異位OvariantumorsTreatmentdependsonsymptoms,sizeandlocation,age,generalhealth,patients’desire患者要求

every3～6months

smallmyomawithnosymptom

closetomenopause更年期1.ObservationorFollow-up

pretreatmentforsurgerycontraindicatedforsurgery2.

Medicaltreatment(1)

Heavyorprolonged長(zhǎng)時(shí)間

bleeding,especially

causinganemia貧血(2)

Torsion扭轉(zhuǎn)

ofsubserousmyoma(3)

Myomawithpressureeffects(4)Myomawhichcauseinfertility不孕

and

recurrentabortion復(fù)發(fā)性流產(chǎn)(5)Possiblemalignantchange3.SurgicaltreatmentA.Myomectomy肌瘤切除術(shù)

preservefertility生育能力

oruterusB.Hysterectomy子宮切除術(shù)

subtotal~次全子宮切除術(shù)

total~

transabdominal經(jīng)腹,transvaginal經(jīng)陰道,

laparoscopy腹腔鏡,hysteroscopy子宮鏡Howtoconsult

咨詢(xún):Apainfeeling?Bmenstrual月經(jīng)

changes?Chowtofind,location?

Dsize,number?Eage,desireforfuturepregnancy?WordsforlearningIntramuralmyoma肌壁間肌瘤Subserousmyoma漿膜下肌瘤Submucousmyoma黏膜下肌瘤falsecapsule假包膜whorledstructure漩渦狀結(jié)構(gòu)Hyalinedegeneration玻璃樣變形Cysticdegeneration