(妇产科学课件)123(参考翻译)Uterine-myoma

UterineMyoma

子宫肌瘤

GeneralConsiderationFairlyhighincidenceinwomenbetweenage30

to

50year,about30%Mostlybenign,withoutsymptomComposedofsmoothmuscleandconnectivetissue由平滑肌和结缔组织组成

Pathogenesis

femalehormones:(estrogen雌激素

andprogesterone孕酮)

1.Occurinreproductiveage生育年龄

2.Nonewformation构成

aftermenopause更年期

3.IncreaseinsizeduringpregnancyClassificationbyanatomiclocation:1.uterinecorpus子宫体myoma90%2.cervical宫颈

myoma

10%Classificationbyrelationbetweenmyomaandmyometrium子宫肌层:

1.Intramural肌壁间的

myoma60%～70%

2.Subserous浆膜下

myoma20%3.Submucous黏膜下

myoma10%～15%Pathology1.Naked-eye肉眼

appearance

falsecapsule假包膜,gray-colored,rounded,smooth,hard,whorled螺旋状

pattern2.Microscopicalstructure显微结构smoothmuscleandfibrous纤维的

tissueDegeneration变性1.Hyalinedegeneration玻璃样变

2.Cysticdegeneration囊性变

3.Reddegeneration红色样变

4.Malignanttransformation恶变

5.Degenerationwithcalcification变性伴钙化

Degeneration

1.Hyalinedegeneration玻璃样变

mostcommon

homogeneous均匀的

/transparent透明的

appearance,

absenceofwhorled螺旋状

pattern,

absenceofmusclecells,

structurelesseosinophilic无嗜酸性结构2.Cysticdegeneration囊性变liquefaction溶解

oftheareasofhyalinechange,capsular囊状的

spacecontainingclearfluidDegenerationDegeneration3.Reddegeneration红色样变

specialtypeofnecrosis坏死

duringpregnancy,puerperium产褥期

duetovenousthrombosis静脉血栓andhemolysis溶血withhemorrhage

red-stained红染,soft“rawmeat生肉”AbdominalpainFeverUterusenlargedwithtenderness

4.Malignanttransformation恶变

(sarcomatouschange肉瘤样变)rare

0.4%～0.8%DegenerationDegeneration5.Degenerationwithcalcification变性伴钙化

subserousmyomawithsmallpeduncle

有蒂的浆膜下肌瘤

postmenopause绝经后期ClinicalFindingsSymptomsonly35%～50%symptomatic有症状的dependingonthelocation,size,numberanddegenerationofthetumorsSymptoms1.Abnormaluterinebleeding

异常子宫出血2.Lowerabdominalmass

下腹部包块3.Pain

疼痛4.Pressureeffects压力效应

5.Effectsonpregnancyandchildbearing

作用于怀孕和分娩期间1.Abnormaluterinebleedingmenorrhagia经量增多

(prolonged延长,heavymenses)Where:largeintramuralmyoma大肌壁间肌瘤submucousmyoma粘膜下肌瘤

Why:Endometrium内膜

surfaceincreasesMorebloodsurfaceInfluenceuterinecontraction收缩irregularorincreasedmenstrual月经

bleeding2.Lowerabdominalmass

hardmassnotendernesslocaldiscomfort局部不适3.Painrarelyhappenusuallyduetocomplicationsreddegenerationtorsion扭转

ofpedunculated有蒂的

subserousmyoma浆膜下肌瘤expelling压榨

ofsubmucousmyoma粘膜下肌瘤

4.Pressureeffects

cervicalmyoma宫颈肌瘤Urination排尿frequencyandurgencyofurination尿频和尿急difficultyinurination排尿困难retentionofurine尿潴留Constipation便秘5.Effectsonpregnancyandchildbearing

submucous粘膜下,intramural肌壁间

infertility不孕

(inabilitytoconceive怀孕)

abortion流产

obstructbirthcanal产道阻塞,difficultlabor难产ClinicalFindingsSigns1.enlargementoftheuterus

symmetricalenlargement对称型扩张:submucous黏膜下

asymmetrical~非对称型扩张:intramural肌壁间,subserous浆膜下

2.tumorpassthroughcervicalcanal子宫颈管

DiagnosisSymptomsPhysicalsignsUltrasoundscanningSpecialexaminations:Hysteroscopy子宫镜检查

Ultrasounddetectedanabnormalecho回声

intheuterinecavityAsubmucousmyomawasverified证实

byhysteroscopyDifferentialDiagnosisPregnancyAdenomyosis子宫内膜异位OvariantumorsTreatmentdependsonsymptoms,sizeandlocation,age,generalhealth,patients’desire患者要求

every3～6months

smallmyomawithnosymptom

closetomenopause更年期1.ObservationorFollow-up

pretreatmentforsurgerycontraindicatedforsurgery2.

Medicaltreatment(1)

Heavyorprolonged长时间

bleeding,especially

causinganemia贫血(2)

Torsion扭转

ofsubserousmyoma(3)

Myomawithpressureeffects(4)Myomawhichcauseinfertility不孕

and

recurrentabortion复发性流产(5)Possiblemalignantchange3.SurgicaltreatmentA.Myomectomy肌瘤切除术

preservefertility生育能力

oruterusB.Hysterectomy子宫切除术

subtotal~次全子宫切除术

total~

transabdominal经腹,transvaginal经阴道,

laparoscopy腹腔镜,hysteroscopy子宫镜Howtoconsult

咨询:Apainfeeling?Bmenstrual月经

changes?Chowtofind,location?

Dsize,number?Eage,desireforfuturepregnancy?WordsforlearningIntramuralmyoma肌壁间肌瘤Subserousmyoma浆膜下肌瘤Submucousmyoma黏膜下肌瘤falsecapsule假包膜whorledstructure漩涡状结构Hyalinedegeneration玻璃样变形Cysticdegeneration