子宫脱垂（Uterine prolapse）－狄文.ppt

uterineprolapse,diwenm.d.,ph.d.,professor&chairmandepartmentofobstetrics&gynecologyrenjihospitalaffiliatedtosjtuschoolofmedicine,uterineprolapse,2,theuterusgraduallydescendsintheaxisofthevaginatakingthevaginalwallwithit.itmaypresentclinicallyatanylevel,butisusuallyclassifiedasoneofthreedegrees.,definition,uterineprolapse,3,uterineprolapse,4,uterineprolapse,5,uterineprolapse,6,uterineprolapse,7,causes,1.thestretchingofmuscleandfibroustissue2.increasedintra-abdominalpressure3.aconstitutionalpredispositiontostretchingoftheligamentsasaresponsepresumablytoyearsintheerectposition,uterineprolapse,8,uterineprolapse,9,uterineprolapse,10,inrecentyears,theincidenceofprolapseisgreatlyreduced.themoreliberaluseofcaesareansectionandtheeliminationoflaboursareprobablythetwomostimportantfactors.,uterineprolapse,11,symptoms,somethingcomingdownbackacheincreasedfrequencyofmicturitionabearingdownsensationstressincontinencecoitalproblemsdifficultyinvoidingurine,uterineprolapse,12,uterineprolapse,13,uterineprolapse,14,uterineprolapse,15,uterineprolapse,16,uterineprolapse,17,uterineprolapse,18,degreesofuterineprolapse,firstdegree:cervixstillinsidevagina,uterineprolapse,19,degreesofuterineprolapse,seconddegree:thecervixappearsoutsidethevulva.thecervicallipsmaybecomecongestedandulcerated,uterineprolapse,20,degreesofuterineprolapse,thirddegree:completeprolapse.inthepicturetheuterusisretroflexed,andtheoutlineofbladdercanbeseen.thisissometimescalledcompleteprocidentia.,uterineprolapse,21,diagnosis,apelvicexaminationrevealsprotrusionofthecervixintothelowerpartofthevagina(mildprolapse),pastthevaginalintroitus/opening(moderateprolapse),orprotrusionoftheentireuteruspastthevaginalintroitus/opening(severeprolapse).,uterineprolapse,22,treatment,pessarytreatmentindications:patientprefersapessary.pelvicsurgeryunaviodablerisksprolapseamenabletopessarythepatientisnotfitforsurgerypatientwishestodelayoperation,uterineprolapse,23,uterineprolapse,24,uterineprolapse,25,uterineprolapse,26,uterineprolapse,27,*anteriorcolporrhaphy(andrepairofcystocele)*posteriorcolpoperineorrhaphy(includingrepairofrectocele)*manchesterrepair*vaginalhysterectomy,surgery,uterineprolapse,28,uterineprolapse,29,uterineprolapse,30,uterineprolapse,31,uterineprolapse,32,uterineprolapse,33,diwenm.d.,ph.d.professor&chairmandepartmentofobstetrics&gynecologyrenjihospitalaffiliatedtosjtuschoolofmedicine,thanksforyourattention,diwenm.d.