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  • 2022-04-29 14:26:29 发布

最新子宫肌瘤 Myoma of uterus-妇产科课件PPT课件

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'子宫肌瘤Myomaofuterus-妇产科课件 Mostcommonbenigntumoroffemalereproductivesystem.Andthemostcommonbenigntumorinhumanbody是女性生殖系统最常见的良性肿瘤,并且是人体最常见的良性肿瘤Presentin20-25%ofreproductive-agewomen发生于20-25%的生育年龄妇女 肌壁间肌瘤 (intramuralmyoma)Withintheuterinewall肌瘤位于子宫肌壁内,周围均被肌层包围。占60~70% 浆膜下肌瘤 (subserousmyoma)Deformingtheexternalserosa肌瘤向子宫浆膜面生长,突起在子宫表面,约占20% 浆膜下肌瘤 Extendbetweenthe2peritoneallayersofthebroadligament若肌瘤位于宫体侧壁向宫旁生长,突阔韧带两叶之间称阔韧带肌瘤阔韧带肌瘤Broadligamentmyoma 阔韧带肌瘤Broadligamentmyoma 粘膜下肌瘤 (submucousmyoma)Deformingtheuterinecavity肌瘤向子宫粘膜方向生长,突出于宫腔,仅由粘膜层覆盖,占10-15% 粘膜下肌瘤 多发性子宫肌瘤(multiplemyomata)子宫肌瘤常为多个性,各种类型的肌瘤可发生在同一子宫,称多发性子宫肌瘤 多发性子宫肌瘤 white-colored,round,smooth,andusuallyfirm,pseudocapsule呈白色的,圆形的,光滑的,并且常是坚硬的,有假包膜病理 Pathology 漩涡状whorledappearance纤维结缔组织Fibrousconnectivetissue sarcomatouschange肉瘤变Degeneration肌瘤变性cysticdegeneration囊性变reddegeneration红色变Hyalinedegeneration玻璃样变withcalcification钙化 透明样变 HyalinedegenerationThemostcommondegeneration最普遍的变性Itswhorledstructuredisappearsandisreplacedbyclearsubstance,whitecolor螺旋状结构消失,由透明结构代替,呈白色Undermicroscope,thecellsinthedegenerationareadisappear镜下观,变性区域细胞消失 囊性变 CysticdegenerationSecondarychangefollowinghyalinedegeneration紧随透明样变性的次级变化Tissuenecrosisandliquefactionandformsmultiplecysts有组织坏死、液化和形成多发囊性结构 红色变 ReddegenerationWhorledstructuredisappearsandhasbadsmell螺旋结构消失和有恶臭Mostcommonduringpregnancyandpuerperium最常见于妊娠期和产褥期Itisaspecialtypenecrosiswhichcauseisnotclear为一种特殊类型的坏死,原因不明Accompaniedbypainandfeverandrapidlyenlargedmyoma伴随有疼痛,发热和肌瘤迅速增大 肉瘤变 SarcomatouschangeMalignanttransformationofleiomyoma子宫肌瘤的恶性转变Thefrequencyis0.4-0.8%,oftenoccursinoldwomen发病率为0.4-0.8%,多见于老年妇女Themyomaenlargesrapidlyinshorttermwithirregularvaginalbleeding肌瘤短期迅速增大并伴有不规则阴道流血 钙化 DegenerationwithcalcificationMajorityoccurinthemyomaswiththinpedecleoraftermenopause多发生于蒂小或绝经后肌瘤Causesprecipitationofcalciumcarbonateandphosphate引起碳酸钙和磷酸盐的沉积Oftensecondarytothefattydegeneration常发生于脂肪变之后 脂肪样变 临床表现症状SymptomsDependontheirlocation,thespeedofgrowthanddegenerations取决于肌瘤部位、生长速度及肌瘤变性Itisnotassociatewiththesizeandthenumberofmyomas与肌瘤大小、数目无关 abdominalmass腹块leucorrhea白带增多Abdominalpain腹痛、腰酸、下腹坠胀compresssymptom压迫症状anemia继发性贫血infertility不孕月经改变Symptoms症状AbnormalMenstrualbleeding 体征SignsRelatetomyomasize、location、number、degeneration与肌瘤大小、位置、数目以及有无变性有关 Diagnosisaccordingtotypicalsymptomsandsigns、Ultrasound、HysteroscopyandLaparoscop诊断根据典型的症状和体征、超声、宫腔镜及腹腔镜 Antidiastole鉴别诊断Graviduterus妊娠子宫Tumoroftheovary卵巢肿瘤Adenomyosis子宫腺肌病Pelvicinflammatorytumor盆腔炎性肿块Uterinemalformation子宫畸形Adenomyoma腺肌瘤 治疗 TreatmentDependsonthepatient’sage、parity、symptoms、myomasize根据患者年龄、产次、症状、肌瘤大小等情况全面考虑Followupevery3to6months每3~6个月随访一次 药物治疗androgenichormone雄激素GnRHα促性腺激素释放激素类似物 手术治疗surgeryMyomectomy肌瘤切除术Hysterectomy子宫切除术 子宫肌瘤合并妊娠 MyomasduringpregnancyProduceuterineinertia,fetalmalpresentation,orobstructionofthebirthcanal产生子宫无力,胎先露异常,或者产道阻塞Maynecessitatecesareandelivery有可能进行剖宫产Interferewitheffectiveuterinecontractionafterdelivery干扰分娩后子宫的有效收缩Thepossibilityofpostpartumhemorrhage有产后出血的可能 Latestadvancement最新进展Interventionaltherapy介入治疗Hysteromyomaablation消融术Hysteroscope宫腔镜技术Laparoscopicoperation腹腔镜手术微创手段的联合应用 课堂讨论 QuestionsWhataretheoperationindicationofuterusmyoma?Why?WhataretheSignsandSymptomsofuterusmyoma?Howtotreatthediseaseofuterusmyoma? 主要参考文献 MainReferencesJoanP,AlisonB.P,BrianA.M,etal,ObstetricsandGynaecology[M].EdinburghLondonNewYorkOxfordPhiladelphiaStLouisSydneyToronto,2003;134-139丰有吉,沈铿,马丁,妇产科学[M].人民卫生出版社,2005,316-328 谢谢 '