婦產科學課件：子宮肌瘤(英文版)

1、1 Uterine myoma1 Uterine myoma2Definition and IntroductionMyoma, fibroid, fibromyoma One of the most commonest tumors, present in 20-25% of reproductive-age womenBenign uterine neoplasms, composed primarily of smooth muscle2Definition and IntroductionMy33445Pathogenesis Not clearEstrogen and its rec

2、eptors in higher concentrationsProgesterone maybe accelerate the mitosis of cellsHeredity (25%-50%): 12,14,7 chromosome correlated with myoma5Pathogenesis Not clear6Pathology Grossly : buff-coloredroundedsmoothfirm6Pathology Grossly : 7Pathology Microscope:Individual cells are spindleshaped（梭形）, hav

3、e elongated nulcei, and are quite uniform in sizeFibre are intermixed with the smooth muscle bundles7Pathology Microscope:8Classification according to the situation Corpus: 90% Cervical: 10%according to the relationship between myoma and uterine wallSubmucous:10%-15%Intramural: 60%-70%Subserous: 20%

4、8Classification according to t9DegenerationThe myoma lose the typical structure (the spiral shape)Benign degeneration 1、 hyaline 2、cystic 3、 red 4、 calcificationMalignant transformation: sarcomatous change( 0.4-0.8%)9DegenerationThe myoma lose th10Clinical symptom Symptoms: present in 35-50% patient

5、sSymptoms depend on the location, size, degeneration and whether or not the patient is pregnant10Clinical symptom 11Abnormal uterine bleedingPainPressure symptomsInfertilitySpontaneous abortionMassClinical symptom11Abnormal uterine bleedingCli12Clinical symptomSigns Abdominal exam:Speculum exam: cer

6、vical myomaBimanual exam: The diagosis is obvious when the normal uterine contour is distorted by one or more smooth, spherical,firm masses,but often it is difficult to be absolutely certain that such masses are part of the uterus12Clinical symptomSigns 13Clinical symptom Laboratory and special exam

7、inationsUltrasoundLab exam: anemia (menorrhagia)Hysteroscopy: identification ,removal submucousLaparoscopy: the precise origin of myoma, myomectomy13Clinical symptom Laboratory 14DiagnosisHistorySymptoms and signsSpecial exam: especially the outcomes of ultrasound14DiagnosisHistory15Differential dia

8、gnosisOvarian carcinomaHyperplasia and enlarged fallopian tubesTubo-ovarian abscessEndometriosisPregnant uteruspolypsMalformation of uterus15Differential diagnosisOvaria16Treatment16Treatment17Principle of treatmentDepends on the patients age, pregnancy status, desire for future pregnancies, general

9、 health, and symptomsThe size, location, and state of preservation of the myomas17Principle of treatment18Emergency measureSevere Anemia: Blood transfusionIndicate of emergency surgery : infected myoma (submucous) acute torsion intestinal obstruction usually caused by a pedunculated myoma18Emergency

10、 measureSevere Anem19Medicine measuresDo not require surgeryRule out the other causesExamined every 6 months after diagnosis to monitoring growth of the myoma, whether it grows quickly19Medicine measuresDo not requ20No definitive medicine therapy is currently available for myomaThe gonadotropin-rele

11、asing hormone agonists (GnRH-a) may be effective in limiting growth or causing a temporary decrease in tumor size.20No definitive medicine thera21GnRH-a mechanisms:induce hypogonadism through pituitary desensitizationdownregulation of receptorsinhibition of gonadatropins21GnRH-a mechanisms:22Judgmen

12、t must be individualizedUterine Size：beyond 10 weeks pregnancy Anemia；oppressing symptom；infertility；habitual abortion；quickly growth and so onSurgical measure22Judgment must be individuali23Myomectomy（肌瘤挖出術） symptomatic patient who wish to preserve fertility or conserve the uterus hysteroscope :sub

13、mucous myoma laparoscope: subserous myoma23Myomectomy（肌瘤挖出術）24D&Chysteroscope24D&Chysteroscope252526Hysterectomy by vaginal hysterectomy: vaginal relaxation demands repair of cystocele（膀胱膨出）, rectocele（直腸膨出）, enterocele（腸疝） by abdominal hysterectomy26Hysterectomy27Surgical methodsLaparotomy（剖腹手術） La

14、paroscope（腹腔鏡）Hysteroscope（宮腔鏡）myomectomyhysterectomy27Surgical methodsLaparotomy（剖28Advancement of treatmentArterial embolismHIFU ( high intensity focus ultrasound)28Advancement of treatment29Thanks !29Thanks !Submucous myomaSubmucous myomaIntramural myomaIntramural myoma Subserous myoma Subserous

15、myoma33Hyaline degeneration Mature or “old” myoma are white but contain yellow, soft, and often gelatinous（膠狀） areas of hyaline change. These tumors are usually asymptomatic*33Hyaline degeneration*343435Cystic degeneration Liquefaction follows extreme hyalinization the liquid in the cavity and the m

16、yoma becomes soft *35Cystic degeneration*363637Red degeneration Venous thrombosis and congestion with interstitial hemorrhage are responsible for the color of a myoma undergoing red degeneration. Usually occurs in pregnancy or puperium, the vortex myoma structure disappear37Red degeneration38變性38變性3

17、9Calcificate degeneration Subserous leiomyoma are most commonly affected by circulatory deprivation, which causes precipitation of calcium carbonate and phosphate within the tumor*39Calcificate degeneration*40Abnormal uterine bleedingPresent in up to 30% of patients, usually in submucous myoma Inter

18、ruption of the blood supply to the endometriumDistortion and congestion of surrounding vesselsUlceration of overlying endometrium40Abnormal uterine bleedingPre41Prlonged, heavy menstruation (menorrhagia), premenstrual spotting, prolonged light staining following mensesAny type of abnormal bleeding is possibleCause the anemiaAbnormal uterine bleeding41Prlonged, heavy menstruation42Pelvic pain Degeneration associated with vascular occlusion, infection, torsion of a pedunculated tumor, or myometrial contraction to expel myoma from the uterine cavity42Pelvic pain Degeneration43Pre