子宫平滑肌瘤

子宫平滑肌瘤第1页，课件共53页，创作于2023年2月Introduction

Uterineenlargementasaresultofleiomyomaiscommoninclinicalpractice.Myomaarethecommonestnewgrowthsoftheuterusandoneofthemostcommontumorsofthehumanbody.Theseoccurinapproximately,20%ofwomenover30,25%ofwomenover40.第2页，课件共53页，创作于2023年2月AetiologicalfactorsFemaleHormonesEstrogensProgestronsGrowthFactorsBasicfibroblastgrowthfactor(BFGF).Insulinlikegrowthfactor(IGF)-I.Epidermalgrowthfactor(EGF).第3页，课件共53页，创作于2023年2月Anatomyofuterus第4页，课件共53页，创作于2023年2月Classification第5页，课件共53页，创作于2023年2月ClassificationAccordingtolocationofuterinemyomatahavebeendividedinCorporealfibromyomata(90%)Cervicalmyomata(10%).第6页，课件共53页，创作于2023年2月ClassificationAndcorporealmyomatahavebeendivided:Intramuralfibromymata60-70%Subserousfibromymata20%Submucousfibromymata10-15%第7页，课件共53页，创作于2023年2月第8页，课件共53页，创作于2023年2月ClassificationIntramuralfibromymata

withintramuralfibromyomataenlargementoftheuterinebodyusuallyoccurs,oftenwithelongationofitscavitysothatthereisincreasedmenstrualloss.第9页，课件共53页，创作于2023年2月Classification

Subserousfibromymata

Size:fromsmallnodulestoenormousmassesof20kgormoreinweight.Pedunculatedmyoma:theytendtogrowupintotheabdomenandthebroadligament,Rarelytorsionmayoccur,resultingininterferencewiththebloodsupplytothetumor.第10页，课件共53页，创作于2023年2月ClassificationSubmucousfibromyoma.Someintramuraltumorsareextrudedtowardstheuterinecavity.Theuteruscontractsinanattempttoexpelthetumoranditmaybeextrudeduntilitisonlyattachedtotheuterinewallbyastalkandisknownasafibro-myomatouspolyp第11页，课件共53页，创作于2023年2月PathologyNackedeyeappearance.onsectionthefibromyomaispaler,harderandmorefibrousthantheuterinewall.Oncomparinganintramuraltumorwiththesurroundingfalsecapsuleofuterinewallthedifferenceiswellmarked.第12页，课件共53页，创作于2023年2月Nackedeyeappearance第13页，课件共53页，创作于2023年2月Smoothmuscletumorsoftheuterusareoftenmultiple.Seenherearesubmucosal,intramural,andsubserosalleiomyomataoftheuterus.第14页，课件共53页，创作于2023年2月PathologyMicroscopicalstructure.Thesegrowthsarecomposedofunstripedmuscleandfibroustissue第15页，课件共53页，创作于2023年2月Hereisthemicroscopicappearanceofabenignleiomyoma.Normalmyometriumisattheleft,andtheneoplasmiswell-differentiatedsothattheleiomyomaattherighthardlyappearsdifferent.Bundlesofsmoothmuscleareinterlacinginthetumormass.第16页，课件共53页，创作于2023年2月DegenerationThesetumorsgrowslowly;insomecasestheremaybenoevidentchangeinsizeformanyyears.Inafewcasesgrowthismorerapidandsecondarychangesmayalsocauseswellingofthetumor.第17页，课件共53页，创作于2023年2月DegenerationHyalinedegenerationisthecommonestchangeseeninfibromyomata.Itiscausedbyagradualinadequacyofthebloodsupply.Cysticdegenerationisnotuncommon,especiallyafterthemenopause,andisduetoliquefactionoftheareasofhyalinechange.第18页，课件共53页，创作于2023年2月DegenerationReddegeneration.Inthisvarietyofdegenerationtheaffectedareaisstainedredandresemblesrawmeat.Itismostfreguentlyseenduringthepregnancyandinpostpartum.第19页，课件共53页，创作于2023年2月Degeneration

Malignantchange

In0.1to1%ofcases,malignancyasleiomyosarcomamaydevelop.Itismostlikelytobeseeninlargetumors.Malignancyismoretypicalinolderpatients,especiallypostmenopausalpatientsPresentionwithrapidlyenlarginguterinemassandpostmenopausalbleeding.Metastasisoccursrapidllyinthesecases.第20页，课件共53页，创作于2023年2月Thisisaleiomyosarcomaprotrudingfrommyometriumintotheendometrialcavityofthisuterusthathasbeenopenedlaterallysothatthehalvesofthecervixappearatrightandleft.Fallopiantubesandovariesprojectfromtopandbottom.Theirregularnatureofthismasssuggeststhatisnotjustanordinaryleiomyoma.第21页，课件共53页，创作于2023年2月SymptomsBleedingisthemostcommonpresentingsymptominuterinefibroids.Menorrhagiaisfreguentreasonforpatientstoseekadvice.Theperiodsincreaseinamountandduration.第22页，课件共53页，创作于2023年2月SymptomsBleeding

Submucousfibromyomatamenorrhagiaisnearlyalwayspresent,andquitesmalltumorscanleadtosevereanaemia.IntramuraltumorsmayincreasethelossSubserousgrowthsdonotaffectthemenstrualloss.第23页，课件共53页，创作于2023年2月SymptomsBleeding

Mechanismsforincreasedbleeding:AlterationofnormalmyometrialcontractilefunctionInabilityoftheoverlyingendometriumtorespondtothenormalE/Pmenstrualphases.Pressurenecrosisoftheoverlyingendometrialbed.第24页，课件共53页，创作于2023年2月SymptomsAnabdominaltumourissometimesthefirstthingthatthepatientnotices.Thetumorisnottenderandrarelygivesrisetopain.Dischargeisrarelyaprominentsymptomexceptduringtheextrusionoffibromyomatospolypthroughthecervicalcanal.第25页，课件共53页，创作于2023年2月SymptomsPainisnotacommonsymptom.whenitoccuritisgenerallyanindicationthatthereisassociatedendometriosisorpelvicinflammatorydisease,orsomecomplicationofthetumorsuchasreddegenerationortorsion.第26页，课件共53页，创作于2023年2月SymptomsPelvicpressure:pressureonthebladderleadingtofrequencyandretentionofurine.第27页，课件共53页，创作于2023年2月PhysicalsignsThephysicalsignsvarywiththesize,positionandnumberofthetumors.Asymmetricalenlargementoftheuterusisfoundwithasubmucosgrowth.Moreoftentheenlargementisasymmetrical;itisoftennodularonthesurfacebecausetherearemultipletumor.Subseroustumorswithlittlemyometrialcoveringoftenfellparticularlyhard.第28页，课件共53页，创作于2023年2月PhysicalsignsOnpelvicexaminationthecervixmaybefoundtobepusheddownordisplacedtooneside.Ifitisexpandedbyanintracervicaltumor,oritmaybedilatedwiththelowerpoleofatumorleftwithinit.第29页，课件共53页，创作于2023年2月DiagnosisThediagnosisofthesetumorsisusuallymadebyclinicalexamination,includeabdominalandbimanualpalpation,orimagingstudies.Inaddition,irregularitiesoftheuterinecavitycanbedetectedatthetimeofendometrialcurrettage.第30页，课件共53页，创作于2023年2月DiagnosisPelvicultrasoundisthemostcommonlyusedforconfirmationofuterinemyomas.Dilationandcurettagemayproviderelevantinformation,becauselargertissuespecimens,includingsmallsubmucousmyomas,maybeobtained.第31页，课件共53页，创作于2023年2月Pelvicultrasound第32页，课件共53页，创作于2023年2月Pelvicultrasound第33页，课件共53页，创作于2023年2月HysteroscopyHysteroscopymayalsobeusedtoevaluatetheenlargeduterusbydirectlyvisualizingtheendometrialcavity.第34页，课件共53页，创作于2023年2月DifferentialdiagnosisOtherconditionswhichcausemenorrhagiaDysfunctionaluterinebleedingCarcinomaoftheuterusEndometrialpolypofuterusOtherconditionswhichgiverisetoaswellinginthepelvisAdenomyoma,ovariantumors,inflammatoryswellinginthepelvis,pregnancy第35页，课件共53页，创作于2023年2月Thisuterushasbeenopenedanteriorlythroughcervixandintotheendometrialcavity.Highinthefundusandprojectingintotheendometrialcavityisasmallendometrialpolyp.Suchbenignpolypsmaycauseuterinebleeding.第36页，课件共53页，创作于2023年2月Thethickenedandspongyappearingmyometrialwallofthissectioneduterusistypicalofadenomyosis.Thereisalsoasmallwhiteleiomyomaatthelowerleft.第37页，课件共53页，创作于2023年2月第38页，课件共53页，创作于2023年2月Thisadenocarcinomaoftheendometriumismoreobvious.Irregularmassesofwhitetumorareseenoverthesurfaceofthisuterusthathasbeenopenedanteriorly.Thecervixisatthebottomofthepicture.Thisenlargeduteruswasnodoubtpalpableonphysicalexamination.第39页，课件共53页，创作于2023年2月Abnormalityofuterus第40页，课件共53页，创作于2023年2月TreatmentFollowuphormonaltreatmentfibroidembolisationSurgicalmanagementhysterectomymyomectomymyolysis第41页，课件共53页，创作于2023年2月TreatmentFollowup:themajorityofpatientswithuterinemyomasdonotrequiresurgicaltreatment.SmalltumorsandnotcausingsymptomsPatientsinthelatereproductiveorperimenopausalyears.Management:repeatpelvicexminationsandassistedbyserialpelvicultrasoundmeasurementsEvery3-6months.第42页，课件共53页，创作于2023年2月TreatmentDrugtherapy:bleedingisnotheavyenoughtocauseanemiaandsmallmyoma.Mechanisms:PharmacologicinhibitionofestrogensecretionAnattemptmaybemadetominimizeuterinebleedingThistreatmentiscommonlyusedfor3to6months.第43页，课件共53页，创作于2023年2月TreatmentDrugsandrogenGnRH-asupplementation.GestrinoneMifepristoneChinesemedicine第44页，课件共53页，创作于2023年2月TreatmentSurgicaltreatmen