《女性前列腺炎》PPT课件.ppt

女性前列腺及 前列腺疾病,对女性前列腺认识的历史,300BC，古希腊解剖学家Herophilos（320BC250BC），在其著作中，首次提到“female prostate”;,对女性前列腺认识的历史,1672年，荷兰医学家Reinier De Graaf（1641-1673） 首次对女性前列腺进行了较为深入的介绍；,De Graaf R. New treatise concerning the generative organs of women. First published 1672, reprint in J Reprod Fertil 1972;17(suppl):1037.,Skene 尿道旁腺（1880） 20世纪，女性前列腺一直被认为是一个退化的器官；,对女性前列腺认识的历史,Once claimed by evolutionists as a vestigial organ, the appendix has many known functions,a vestigial organ ？,直到2001年，Federative Committee on Anatomical Terminology（FCAT）同意在下一版的”Histology Terminology“ 中使用“female prostate”这一术语；至此，女性前列腺的概念被现代医学接受；这与斯洛伐克病理学家Milan Zaviacic 的努力是分不开的,对女性前列腺认识的历史,“The female prostate presents, although substantially less frequently, with the same diseases as the male prostate. These include prostatic carcinoma, benign prostate hyperplasia and prostatitis - female urethral syndrome ”Milan Zaviacic,有关女性前列腺的组织解剖,女性的前列腺是一个独立的明确存在的“器官”； 它具有和男性前列腺一样的组织构成； 形态个体差异很大；位于女性尿道远端的尿道壁内；,解 剖 位 置,the female prostate lies within the wall and along the length of the female urethra,The Female Prostate,女性前列腺约： 3.3 x 1.9 x 1 cm ； 重5.2 g,相当于拇指大小,Huffmans wax model 1948,Longitudinal aspect,anterior aspect,This image helps us to understand why the female prostate is stimulated when the vaginal wall is stimulated, and why some women are susceptible to urinary tract infections (UTIs) after engaging in vagina intercourse. It also demonstrates how the vagina is a potential space rather than being an open cavity within the body,The image shown below demonstrates how the female urethra and vagina are contained within a common structure, as indicated by the circular outline that surrounds them. Anatomy illustrations usually lead us to believe they are two separate and distinct organs, which isnt true. They are drawn this way for the sake of visual clarity, but this can be misleading,女性前列腺的组织特征和男性前列腺类似,前列腺特异性组织化学染色PSA和PAP，发现女性前列腺阳性表达率为83； 多种组化方法对比男性前列腺和女性前列腺，发现7种水解酶和8种氧化还原酶，两种腺体均有表达 ；,女性前列腺与女性“射精”,女性性高潮的“射精”现象,Female ejaculate is a fluid that is expelled from the body through the urethra during sexual activities； When released in small quantities it may be a mucous like fluid having a clear, milky, or yellowish coloration. As the volume of the expelled fluid increases it becomes like clear water； In small quantities it may have a distinct scent that is musky or pungent but when the fluid increases in volume and becomes clear there is no longer a detectable scent； The fluid contains PSA and PAP, which are produced in the female prostate,Wimpissinger F, et al. The Female Prostate Revisited: Perineal Ultrasound and Biochemical Studies of Female Ejaculate. J Sex Med. 2007,Wimpissinger F 的研究,Wimpissinger F, et al. The Female Prostate Revisited: Perineal Ultrasound and Biochemical Studies of Female Ejaculate. J Sex Med. 2007,median aspect,sagittal aspect,女性“射精”,女性前列腺的大约能容纳5ml液体； 而有研究表明，女性射液的时候能射出3050ml液体； 女性前列腺如何能容纳如此多的液体？,the bright white area in the lower right, increased in size during sexual arousal in one woman,女性性兴奋时膨胀的“前列腺”,This photograph shows the texture of the front wall of the vagina when the prostate is engorged. The area encircled is normally inside the vagina and out of sight. This woman is using her hands and pelvic muscles to bring this area into full view,有关“G”点与女性前列腺,有关“G”点与女性前列腺,“G”点与女性前列腺并非一回事，也不一定位于同一位置； “G”点只是一个并不恒定的敏感区； 女性只有在充分的性唤起的情况下才会出现“G”点； 如果在充分性唤起及女性前列腺膨胀的情况下，女性可能会感觉到一个明确的敏感区“Grafenberg spot ” or “G-Spot“,女性前列腺的功能,知之甚少； 可能有以下功能：,外分泌腺的功能：产生并储存前列腺液，内含PSA、PAP、Fructose，作用？,内分泌腺的功能：分泌5羟色胺；,女性前列腺炎,女性尿道综合征,a lack of objective findings,a plethora of subjective complaints,Retropubic pressure,Dyspareunia,Urinary frequency,Dysuria,女性前列腺炎的诊断,女性尿道综合征是女性常见疾病：表现类似于下尿路感染，但中段尿细菌培养往往阴性； 女性尿道综合征是一个模糊的概念； 如果这些症状发生在男性，常被认为是“前列腺炎”； 女性前列腺炎往往被忽视对女性前列腺缺乏正确认识； 现在认为女性前列腺炎是女性尿道综合征的主要原因；,Gittes RF. Female prostatitis. Urol Clin North Am. 2002;29(3):613-6.,有尿路刺激症状，确诊原发病变在尿道，而不在膀胱等其他部位； 诱因为性交、分娩、导尿、憋尿、受凉等； 盆腔检查：患者出现典型阳性反应； 二杯细胞学检查：初段和中段尿各50ml，计数细胞含量，正常时两者数量之差5500, 患者初段尿每毫升细胞数高于中段尿20250；,女性前列腺炎的诊断,女性前列腺炎的阴道检查,GITTES. R F. et al. Female Urethral Syndrome A Female Prostatitis? West J Med 1996; 164:435-438),女性前列腺炎的治疗,和男性前列腺一样，女性前列腺不易受药物影响，需要较长时间的抗生素系统治疗，喹诺酮类首选； 小于30岁的女性，衣原体常是主要致病菌；可选用四环素类或大环内酯类治疗24周； 采用治疗