子宫脱垂（uterine_prolapse）狄文_1课件

Uterine Prolapse DI WEN M.D., Ph.D., Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but is usually classified as one of three degrees. Definition 2Uterine Prolapse 3Uterine Prolapse 4Uterine Prolapse 5Uterine Prolapse 6Uterine Prolapse Causes 1. The stretching of muscle and fibrous tissue 2. Increased intra-abdominal pressure 3. A constitutional predisposition to stretching of the ligaments as a response presumably to years in the erect position 7Uterine Prolapse 8Uterine Prolapse 9Uterine Prolapse In recent years,the incidence of prolapse is greatly reduced. The more liberal use of caesarean section and the elimination of labours are probably the two most important factors. 10Uterine Prolapse Symptoms Something coming down Backache Increased frequency of micturition A bearing down sensation Stress incontinence Coital problems Difficulty in voiding urine 11Uterine Prolapse 12Uterine Prolapse 13Uterine Prolapse 14Uterine Prolapse 15Uterine Prolapse 16Uterine Prolapse 17Uterine Prolapse Degrees of uterine prolapse First degree: cervix still inside vagina 18Uterine Prolapse Degrees of uterine prolapse Second degree: the cervix appears outside the vulva. The cervical lips may become congested and ulcerated 19Uterine Prolapse Degrees of uterine prolapse Third degree: complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia. 20Uterine Prolapse Diagnosis A pelvic examination reveals protrusion of the cervix into the lower part of the vagina (mild prolapse), past the vaginal introitus/opening (moderate prolapse), or protrusion of the entire uterus past the vaginal introitus/opening (severe prolapse). 21Uterine Prolapse Treatment Pessary treatment Indications:Patient prefers a pessary. Pelvic surgery unaviodable risks Prolapse amenable to pessary The patient is not fit for surgery Patient wishes to delay operation 22Uterine Prolapse 23Uterine Prolapse 24Uterine Prolapse 25Uterine Prolapse 26Uterine Prolapse * Anterior colporrhaphy (and repair of cystocele) * Posterior colpoperineorrhaphy (including repair of rectocele) * Manchester repair * Vaginal hysterectomy Surgery 27Uterine Prolapse 28Uterine Prolapse 29Uterine Prolapse 30Uterine Prolapse 31Uterine Prolapse 32Uterine Prolapse 33Uterine Prolapse DI WEN M.D., Ph.D. Professor & Chairman Department of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine Thanks for Your Attention DI WEN M.D., Ph