子宫肌瘤 Myoma of uterus妇产科.ppt

第一节子宫肌瘤Myomaofuterus,武汉大学第一临床学院妇产科DepartmentofObstetricsandGynecology张蔚教授ZhangWei,Mostcommonbenigntumoroffemalereproductivesystem.Andthemostcommonbenigntumorinhumanbody是女性生殖系统最常见的良性肿瘤,并且是人体最常见的良性肿瘤Presentin20-25%ofreproductive-agewomen发生于20-25%的生育年龄妇女,病因Aetiology,Highconcentrationsofbothestrogenandprogesteronereceptors肌瘤组织中含有高浓度的雌、孕激素受体,分类Classification,Accordingtothelocation,Myomaisdividedinto:Uterinebodymyoma(90%)Cervicalmyoma(10%),依据肌瘤的位置分类:子宫体肌瘤(90%)子宫颈肌瘤(10%),分类Types,各型子宫肌瘤示意图,肌壁间肌瘤(intramuralmyoma),Withintheuterinewall肌瘤位于子宫肌壁内，周围均被肌层包围。占6070,浆膜下肌瘤(subserousmyoma),Deformingtheexternalserosa肌瘤向子宫浆膜面生长，突起在子宫表面，约占20%,浆膜下肌瘤,Extendbetweenthe2peritoneallayersofthebroadligament若肌瘤位于宫体侧壁向宫旁生长，突阔韧带两叶之间称阔韧带肌瘤,阔韧带肌瘤Broadligamentmyoma,阔韧带肌瘤Broadligamentmyoma,粘膜下肌瘤(submucousmyoma),Deformingtheuterinecavity肌瘤向子宫粘膜方向生长,突出于宫腔,仅由粘膜层覆盖,占10-15%,粘膜下肌瘤,多发性子宫肌瘤(multiplemyomata)子宫肌瘤常为多个性,各种类型的肌瘤可发生在同一子宫，称多发性子宫肌瘤,多发性子宫肌瘤,white-colored,round,smooth,andusuallyfirm,pseudocapsule呈白色的,圆形的,光滑的,并且常是坚硬的,有假包膜,病理Pathology,漩涡状whorledappearance纤维结缔组织Fibrousconnectivetissue,sarcomatouschange肉瘤变,Degeneration肌瘤变性,cysticdegeneration囊性变,reddegeneration红色变,Hyalinedegeneration玻璃样变,withcalcification钙化,透明样变Hyalinedegeneration,Themostcommondegeneration最普遍的变性Itswhorledstructuredisappearsandisreplacedbyclearsubstance,whitecolor螺旋状结构消失,由透明结构代替,呈白色Undermicroscope,thecellsinthedegenerationareadisappear镜下观,变性区域细胞消失,囊性变Cysticdegeneration,Secondarychangefollowinghyalinedegeneration紧随透明样变性的次级变化Tissuenecrosisandliquefactionandformsmultiplecysts有组织坏死、液化和形成多发囊性结构,红色变Reddegeneration,Whorledstructuredisappearsandhasbadsmell螺旋结构消失和有恶臭Mostcommonduringpregnancyandpuerperium最常见于妊娠期和产褥期Itisaspecialtypenecrosiswhichcauseisnotclear为一种特殊类型的坏死,原因不明Accompaniedbypainandfeverandrapidlyenlargedmyoma伴随有疼痛,发热和肌瘤迅速增大,肉瘤变Sarcomatouschange,Malignanttransformationofleiomyoma子宫肌瘤的恶性转变Thefrequencyis0.4-0.8%,oftenoccursinoldwomen发病率为0.4-0.8%,多见于老年妇女Themyomaenlargesrapidlyinshorttermwithirregularvaginalbleeding肌瘤短期迅速增大并伴有不规则阴道流血,钙化Degenerationwithcalcification,Majorityoccurinthemyomaswiththinpedecleoraftermenopause多发生于蒂小或绝经后肌瘤Causesprecipitationofcalciumcarbonateandphosphate引起碳酸钙和磷酸盐的沉积Oftensecondarytothefattydegeneration常发生于脂肪变之后,脂肪样变,临床表现,症状SymptomsDependontheirlocation,thespeedofgrowthanddegenerations取决于肌瘤部位、生长速度及肌瘤变性Itisnotassociatewiththesizeandthenumberofmyomas与肌瘤大小、数目无关,AbnormalMenstrualbleeding,体征SignsRelatetomyomasize、location、number、degeneration与肌瘤大小、位置、数目以及有无变性有关,Diagnosisaccordingtotypicalsymptomsandsigns、Ultrasound、HysteroscopyandLaparoscop,诊断根据典型的症状和体征、超声、宫腔镜及腹腔镜,治疗Treatment,Dependsonthepatientsage、parity、symptoms、myomasize根据患者年龄、产次、症状、肌瘤大小等情况全面考虑Followupevery3to6months每36个月随访一次,药物治疗androgenichormone雄激素GnRH促性腺激素释放激素类似物,手术治疗surgeryMyomectomy肌瘤切除术Hysterectomy子宫切除术,子宫肌瘤合并妊娠Myomasduringpregnancy,Produceuterineinertia,fetalmalpresentation,orobstructionofthebirthcanal产生子宫无力,胎先露异常,或者产道阻塞Maynecessitatecesareandelivery有可能进行剖宫产Interferewitheffectiveuterinecontractionafterdelivery干扰分娩后子宫的有效收缩Thepossibilityofpostpartumhemorrhage有产后出血的可能,课堂讨论Questions,Whataretheoperationindicationofuterusmyoma?Why?WhataretheSignsandSymptomsofuterusmyoma?Howtotreatthediseaseofuterusmyoma?,主要参考文献MainReferences,Jo