UterineLeiomyoma子宫平滑肌瘤

2021/10/10星期日12021/10/10星期日2Etiology/EpidemiologyEtiologyunknownIncreasedriskfactors

40yearsorolderFamilyhistoryofuterinefibroidNulliparityObesityBlackrace2021/10/10星期日3AssociatedFactorsFemaleHormones---Estrogen(雌激素)/Progestron(孕激素)Clinicalevidences:ReproducutivepatientsNocasesbeforepubertyNonewcasesaftermenopause(停经)Increasedduringpregnancy

Estrogenreceptor(ER-α)highconcentrationinblackwomen2021/10/10星期日4Intramural~(60%--70%)

肌壁间Subserous(20%)

浆膜下Submucous~(10%)

粘膜下

Cervical~-2%

ClassificationI2021/10/10星期日5ClassificationIISingleMultiple2021/10/10星期日6Pathology

---grossstructureFrequentlymultipleFirm,varyinsizeSphericalorirregularlylobulatedFalsecapsule(假包膜)Whorledappearance(漩涡状结构)2021/10/10星期日7Pathology

---microscopicstructure2021/10/10星期日8Hyaline

玻璃样变性yellow,softgelatinousareasCystic

囊性变liquefactionfollowsextremehyalinizationRed(carneous)degeneration红色变性

Edema&hypertrophyimpedebloodsupplyasepticdegenration&infarctionwithvenousthrombosis&hemorrhageOtherchanges

calcification钙化hemorrhage出血necrosis坏死

SECONDARYCHANGES/DEGENERATION2021/10/10星期日9Hyaline/Cystic

Degeneration2021/10/10星期日10Red(carneous)degenerationUsuallyoccursduringpregnancy2021/10/10星期日11MalignantTransformationrare

0.1-0.5%

leiomyomaleiomyosarcomaIncreasedcellnumberPathologicalnuclearfission病理性核分裂2021/10/10星期日12Dependon

location,size,changes&pregnancystatusClinicalFindings2021/10/10星期日13Abnormaluterinebleeding

mostcommon30%Heavy/prolongedbleeding(menorrhagia月经过多

)----submucous/largeintramuralmyomapre&post-menstrualspotting(月经前后淋漓出血

)----submucous

myomaintermenstrtualbleeding(月经间期出血

)----Pedunculatedsubmucous

myoma

ClinicalFindings---Symptoms2021/10/10星期日14Pain/discomfortHeavinessfullnessinthepelvicarea(largefibroid

)backpainDysparunea(性交痛

)PressureEffectsAcutepain---Torsion,Reddegenration

Vascularocclusion

MyometrialcontractionsClinicalFindings---Symptoms2021/10/10星期日15ClinicalFindings---Symptoms

Infertility

uncertainrelationshipmultiplefibroids20-40%Endocavitary70%SpontaneousAbortionincidencebeforemyomectomy40%aftermyomectomy20%intracavitarytumors2021/10/10星期日16Enlargeduterus(regular/irregular)orNormaluterus(small～)

orMidlinemasscontiguouswithcervix

ClinicalFindings---Signs2021/10/10星期日17ComplicationsinPregnancyInfertility

≥

2/3ofwomenwithfibroids&unexplainedinfertilityconceiveaftermyomectomyRedDegenerationDuringLabor

Malpresentation胎先露异常

ObstructionofthebirthcanalCervicaloristhmeicmyomanecessitateCS2021/10/10星期日18SymptomsPhysicalsignsUltrasonographicscanningHysteroscopy宫腔镜检查MRIDiagnosis2021/10/10星期日19Diagnosis—ultrasonographicscanningTASTVS2021/10/10星期日20Diagnosis

---MRIleiomyomaleiomyosarcomaleiomyomacysticchange2021/10/10星期日21Diagnosis

--hysteroscopy宫腔镜检查Stalk,pedicle2021/10/10星期日22pregnancyotherpelvicmasses

ovariantumor卵巢肿瘤,Tubo-ovarianabscess输卵管卵巢脓肿

othercausesofuterineenlargement

Adenomyosis子宫腺肌症

othercausesofabnormalbleeding

Endometrialhyperplasia子宫内膜增生EndometrialCa子宫内膜癌DifferentialDiagnosis2021/10/10星期日23Treatment

IndividulizationDependsonAgeParityPregnancystatusDesireforfuturepregnancyGeneralhealthSymptomsSizeLocation2021/10/10星期日24TreatmentChoicesofManagementFollow-upMedication

FocusedUltrasound(highintensityfocusedultrasound,HIFU)UterinearteryembolizationSurgeryMyomectomyHysterectomy2021/10/10星期日25Expectantmanagement

smalllesion,perimenopausalpt.Medication

(herbalmedicine,GnRH-a)suppresstumorpreoperativelyFocusedUltrasound(highintensityfocusedultrasound,HIFU

)

sonographicablation海扶公司Uterinearteryembolization

blockbloodsupply

Treatment2021/10/10星期日26ModelJCfocusedultrasoundtumortherapeuticsystemmanufacturedbyChongqingHaifuTechnologyCo.,Ltd.(Chongqing,China)

ablationfocus2021/10/10星期日27Uterinearteryembolization2021/10/10星期日28

Surgery

myomectomy

肌瘤摘除术

Transabdominal经腹手术

Transvaginal经阴道手术

Laparoscopic

腹腔镜手术

Hysteroscopic

阴道镜手术