13周妇产科Endometrial Carcinoma.ppt

EndometrialCarcinoma子宫内膜癌,carcinomaofcorpusuteri,corpusuteri子宫体,cervix子宫颈,Structureofuterus,endometrium,myometrium,Serouslayer,Prevalencefourthmostmalignancyinwomen（女性恶性肿瘤中第四位）ranksthirdinthemalignanttumorsoffemalereproductivesystem（女性生殖系统恶性肿瘤中第3位）,Epidemiology,55-69years75%postmenopausal绝经后25%pre-menopausal绝经前(5%50%,Serous,Clear-cell,SpreadPatterns转移方式,Directextension（直接蔓延）Lymphaticspread（淋巴转移）Hematogenousspread（血行播散）Transtubalpassageofexfoliatedcells（脱落细胞经输卵管转移）,Directextension,Cervicalinvolvement宫颈受累,Myometriuminvasion肌层浸润,Lymphaticspreading,Pelviclymphnode,盆腔淋巴结，PLNPara-aorticlymphnode,腹主动脉旁淋巴结，PAN,ClinicalFindings,Vaginalbleeding（阴道流血）Esp.postmenopausalbleeding（绝经后阴道流血）Uterineenlargement,Diagnosis,1.Fractionaldilationandcurretage（分段诊刮）,扩张棒,刮匙,Diagnosis-Fractionaldilation&currettage,1,2,EstablishthediagnosisHelpidentifycervicalinvolvement,LimitMisseddiagnosisFalsepositivecervicalinvolvement,EndometrialSampler,Diagnosis-Endometrialsampling,*Simple,non-traumaticprocedure.*Moldabilitypermitseasyinsertionintoamarkedlyanteverted(前屈)orretroverted(后屈)uterus.*Nocervicaldilationnecessaryinmostcases.*Lessdiscomfort,bleeding,tissueabrasionthanD&Cmethod.,Normalendometrium,Hyperplasia,Hyperplasiawithatypia,Endometrialcarcinoma,Diagnosis-endometrialcytology,Diagnosis-endometrialassessmentsonographically,Normalendometriumstripe正常子宫内膜线,5mm,Diagnosis-hysteroscopy,EndometrialCarcinoma,Simplehyperplasia,Complexhyperplasia,Normalendometrium,Atrophicendometrium,Normalendometrium,EMCaIa,EMCaIb,EMCaII,Diagnosis-MRI,DifferentiationDiagnosis,CervicalCancerpostcoitalbleeding,Staging,ClinicalStaging（临床分期）pre-treatmentevaluationSurgicallypathologicalstaging（手术病理分期）,ClinicalStaging,StageCharacteristics_IConfinedtothecorpus（限于宫体）IAUterinecavity8cmIBUterinecavity8cmIIInvolvementofcervix（宫颈受累）_,StageCharacteristics_IIIExtendsoutsidetheuterusbutnotoutsidethetruepelvis,mayinvolveparametriumIVExtendsoutsidethetruepelvisorinvolvesthebladderorrectum_,Surgical-pathologicalstaging,StageCharacteristics_IAlimitedtotheendometrium限于内膜IBInvasion1/2themyometrium肌层浸润1/2IIAEndocervicalglandinvolvementonlyIIBCervicalstromalinvasion_,StageCharacteristics_IIIATumorinvadesserousand/oradnexes,and/orpositiveperitonealcytologyIIIBVaginalmetastasesIIICMetastasestopelvicand/orparaaorticlymphnodesIVATumorinvasionofbladderand/orrectumIVBDistantmetastases,includingintra-abdominaland/oringuinalnodes_,Treatment,1.operationStageItotalabdominalhysterectomy经腹全子切除）+bilateralsalpingo-oophorectomy双侧输卵管卵巢切