子宫肌瘤Myomaofuterus妇产科课件.ppt

1、第一节 子子 宫宫 肌肌 瘤瘤 Myoma of uterus武汉大学第一临床学院武汉大学第一临床学院 妇产科妇产科Department of Obstetrics and Gynecology张张 蔚蔚 教教 授授Zhang WeiuMost common benign tumor of female reproductive system.And the most common benign tumor in human body 是女性生殖系统最常见的良性肿瘤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并且是人体最常见的良性肿瘤uPresent in 20-25%of re

2、productive-age women 发生于发生于20-25%的生育年龄妇女的生育年龄妇女病 因 AetiologylHigh concentrations of both estrogen and progesterone receptors 肌瘤组织中含有高浓度的雌、孕激肌瘤组织中含有高浓度的雌、孕激 素受体素受体分类ClassificationAccording to the location,Myoma is divided into:Uterine body myoma(90%)Cervical myoma(10%)依据肌瘤的依据肌瘤的位置分类位置分类:子宫体肌瘤子宫体肌瘤(90

3、%)子宫颈肌瘤子宫颈肌瘤(10%)分分 类类 TypesMyoma of uterus子宫肌瘤子宫肌瘤Intramural myoma肌壁间肌瘤肌壁间肌瘤Subserous myoma浆膜下肌瘤浆膜下肌瘤Submucous myoma粘膜下肌瘤粘膜下肌瘤各型子宫肌瘤示意图各型子宫肌瘤示意图肌肌 壁壁 间间 肌肌 瘤瘤(intramural myoma)Within the uterine wall 肌瘤位于子宫肌壁内，周围均被肌层包围。占6070浆浆 膜膜 下下 肌肌 瘤瘤(subserous myoma)Deforming the external serosa肌瘤向子宫浆膜面生长，突起在子

4、宫表面，肌瘤向子宫浆膜面生长，突起在子宫表面，约占约占20%浆浆 膜膜 下下 肌肌 瘤瘤Extend between the 2 peritoneal layers of the broad ligament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Broad ligament myoma阔韧带肌瘤Broad ligament myoma 粘粘 膜膜 下下 肌肌 瘤瘤 (submucous myoma)Deforming the uterine cavity 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%粘粘 膜膜 下下 肌肌 瘤瘤多发性子宫肌瘤多发性子宫肌

5、瘤(multiple myomata)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 多多 发发 性性 子子 宫宫 肌肌 瘤瘤white-colored,round,smooth,and usually firm,pseudocapsule 呈白色的呈白色的,圆形的圆形的,光滑光滑的的,并且常是并且常是 坚硬的坚硬的,有有假包膜假包膜病病 理理Pathology漩涡状漩涡状whorled appearance 纤维结缔组织纤维结缔组织Fibrous connective tissue sarcomatous change肉瘤变肉瘤变Degeneration肌瘤变性肌瘤变性

6、cystic degeneration囊性变囊性变red degeneration红色变红色变Hyaline degeneration玻璃样变玻璃样变with calcification钙钙 化化透明样变透明样变Hyaline degenerationThe most common degeneration最普遍的变性最普遍的变性Its whorled structure disappears and is replacedby clear substance,white color螺旋状结构消失螺旋状结构消失,由透明结构代替由透明结构代替,呈白色呈白色Under microscope,the

7、 cells in the degeneration area disappear镜下观镜下观,变性区域细胞消失变性区域细胞消失囊性变囊性变Cystic degenerationSecondary change following hyaline degeneration紧随透明样变性的次级变化紧随透明样变性的次级变化Tissue necrosis and liquefaction and forms multiplecysts有组织坏死有组织坏死、液化和形成多发囊性结构液化和形成多发囊性结构红色变红色变Red degenerationWhorled structure disappears

8、and has bad smell螺旋结构消失和有恶臭螺旋结构消失和有恶臭 Most common during pregnancy and puerperium最常见于妊娠期和产褥期最常见于妊娠期和产褥期It is a special type necrosis which cause is not clear为一种特殊类型的坏死为一种特殊类型的坏死,原因不明原因不明Accompanied by pain and fever and rapidly enlarged myoma伴随有疼痛伴随有疼痛,发热和肌瘤迅速增大发热和肌瘤迅速增大肉瘤变肉瘤变Sarcomatous changeMalig

9、nant transformation of leiomyoma子宫肌瘤的恶性转变子宫肌瘤的恶性转变The frequency is 0.4-0.8%,often occurs in old women发病率为发病率为0.4-0.8%,多见于老年妇女多见于老年妇女The myoma enlarges rapidly in short term with irregular vaginal bleeding肌瘤短期迅速增大并伴有不规则阴道流血肌瘤短期迅速增大并伴有不规则阴道流血钙化钙化Degeneration with calcificationMajority occur in the myo

10、mas with thinpedecle or after menopause多发生于蒂小或绝经后肌瘤多发生于蒂小或绝经后肌瘤Causes precipitation of calcium carbonate and phosphate 引起碳酸钙和磷酸盐的沉积引起碳酸钙和磷酸盐的沉积 Often secondary to the fatty degeneration常发生于脂肪变之后常发生于脂肪变之后脂脂 肪肪 样样 变变临临 床床 表表 现现症症 状状 SymptomsDepend on their location,the speed of growth and degeneration

11、s取决于肌瘤部位、生长速度及肌瘤变性取决于肌瘤部位、生长速度及肌瘤变性It is not associate with the size and the number of myomas与肌瘤大小、数目无关与肌瘤大小、数目无关 abdominal mass腹腹 块块leucorrhea白带增多白带增多Abdominal pain腹痛、腹痛、腰酸、腰酸、下腹坠胀下腹坠胀compress symptom压迫症状压迫症状anemia继发性贫血继发性贫血infertility不不 孕孕月经改变月经改变Symptoms症症 状状AbnormalMenstrualbleeding 体体 征征 Signs

12、Relate to myoma size、location、number、degeneration与肌瘤大小、位置、数目以及有无变性有关与肌瘤大小、位置、数目以及有无变性有关Diagnosis according to typical symptoms and signs、Ultrasound、Hysteroscopy and Laparoscop诊诊 断断根据典型的根据典型的症状和体征、症状和体征、超声、超声、宫腔镜及腹腔镜宫腔镜及腹腔镜Antidiastole鉴别诊断鉴别诊断Gravid uterus妊娠子宫妊娠子宫Tumor of the ovary卵巢肿瘤卵巢肿瘤Adenomyosis

13、 子宫腺肌病子宫腺肌病Pelvic inflammatory tumor盆腔炎性肿块盆腔炎性肿块Uterine malformation子宫畸形子宫畸形Adenomyoma腺肌瘤腺肌瘤治治 疗疗TreatmentDepends on the patients age、parity、symptoms、myoma size根据患者年龄、产次、症状、肌瘤大小等情况全面考虑根据患者年龄、产次、症状、肌瘤大小等情况全面考虑Follow up every 3 to 6 months 每每36个月随访一次个月随访一次 药药 物物 治治 疗疗 androgenic hormone 雄激素雄激素 GnRH 促性

14、腺激素释放激素类似物促性腺激素释放激素类似物手手 术术 治治 疗疗 surgery Myomectomy 肌瘤切除术肌瘤切除术 Hysterectomy 子宫切除术子宫切除术子子 宫宫 肌肌 瘤瘤 合合 并并 妊妊 娠娠Myomas during pregnancyProduce uterine inertia,fetal malpresentation,or obstruction of the birth canal产生子宫无力产生子宫无力,胎先露异常胎先露异常,或者产道阻塞或者产道阻塞May necessitate cesarean delivery有可能进行剖宫产有可能进行剖宫产Int

15、erfere with effective uterine contraction after delivery干扰分娩后子宫的有效收缩干扰分娩后子宫的有效收缩The possibility of postpartum hemorrhage 有产后出血的可能有产后出血的可能Latest advancement 最新进展最新进展Interventional therapy 介入治疗介入治疗Hysteromyoma ablation 消融术消融术Hysteroscope 宫腔镜技术宫腔镜技术Laparoscopic operation 腹腔镜手术腹腔镜手术微创手段的联合应用微创手段的联合应用课课

16、堂堂 讨讨 论论QuestionsuWhat are the operation indication of uterus myoma?Why?uWhat are the Signs and Symptoms of uterus myoma?uHow to treat the disease of uterus myoma?主要参考文献主要参考文献Main ReferencesJoan P,Alison B.P,Brian A.M,et al,Obstetrics and GynaecologyM.Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto,2019;134-139丰有吉丰有吉,沈铿沈铿,马丁马丁,妇产科学妇产科学M.人民卫生出版人民卫生出版社社,2019,316-328谢 谢