子宫内膜异位症Endometriosis课件.ppt
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- 子宫 内膜 异位症 Endometriosis 课件
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1、子宫内膜异位症Endometriosis张喜1Definition 子宫内膜异位症Endometriosis张喜2Common sites of endometriosisThe most common sites:uterosacral ligament rectouterine pouch ovaryOthers:uterine serosa fallopian tube sigmoid colon(乙状结肠)outside of the pelvis:Umbilicus(脐),bladder,kidney子宫内膜异位症Endometriosis张喜3Prevalence present
2、in 10%-15%of women in reproductive age group,especially from age 25 to 45 normally not seen before age 15 or after menopause early and more childbearing latest study:more frequent menses(cycle length 27 days)and prolonged menstrual flow(1 week)2 times risk子宫内膜异位症Endometriosis张喜4 Theories of sources
3、of ectopic endometrium Endometrial implanting theory(种植学说种植学说)Sampson 1921 endometrium transfer implant grow retrograde menstruation(经血逆流)theory transport by lymph and vein iatrogenic(医源性的医源性的)implantation子宫内膜异位症Endometriosis张喜5Theories of source of ectopic endometrium metaplasia theory(化生学说)inducem
4、ent theory(诱导学说)子宫内膜异位症Endometriosis张喜6 Factors related with endometriosis Genetic Abnormalities:high risk in first-degree relatives Immunologic Factors:increased concentrations of white blood cells,cytokines,and growth factors IL-6、IL-8、TNF-、MCP-1 inflammation:EMs lesions chronic pelvic inflammatio
5、n 子宫内膜异位症Endometriosis张喜7Pathology ectopic endometrium hemorrhage proliferation of fibrous tissue adhesions dark blue or dark brown spots scarring nodules or cysts 子宫内膜异位症Endometriosis张喜8Gross appearance:ovarian endometriosis red,blue,or brown spots endometriomas chocolate cysts子宫内膜异位症Endometriosis张
6、喜9Gross appearance:peritoneal endometriosiscommon sites:uterosacral ligament、rectouterine pouch upurple spotsudark brown spotsured lesionsuwhite lesionsuperitoneum lack 子宫内膜异位症Endometriosis张喜10peritoneal endometriosis子宫内膜异位症Endometriosis张喜11peritoneal endometriosis子宫内膜异位症Endometriosis张喜12cervix umbi
7、licus(脐)子宫内膜异位症Endometriosis张喜13:endometrial glands endometrial stroma fibrin red blood cells and hemosiderin(含铁血黄素)2 findings to be diagnosed子宫内膜异位症Endometriosis张喜14 symptoms:dysmenorrhoea(痛经)(痛经)and chronic pelvic pain the most typical symptom:secondary dysmenorrhea that worsens over time dyspareu
8、nia(性交痛)(性交痛)abnormal uterine bleeding heavy menses,prolonged menstruation or premenstrual spotting infertility:40%of patients acute abdomen:inter-cyst hemorrhage(囊内出血),or rupture子宫内膜异位症Endometriosis张喜15symptoms:others:diarrhoea(腹泻)constipation(便秘)bloody stool painful urination bloody urine backache
9、子宫内膜异位症Endometriosis张喜16Causes of infertility1)Mechanical reason2)Environmental change in the peritoneal cavity3)Abnormal immune function4)Abnormal ovarian function(anovulation,LPD,Lufs)5)Increase in spontaneous abortion子宫内膜异位症Endometriosis张喜17Pelvic Examination:fixed retroverted uterine tender nodu
10、les on uterosacral ligament or rectouterine pouch tender and fixed adnexal masses 子宫内膜异位症Endometriosis张喜18Diagnosis history pelvic examination laparoscopy golden diagnosis standard diagnosis,classification treatment ultrasound,(CT and MRI,expensive)serum CA125 but usually 100IU/ml anti-endometrium a
11、ntibody 子宫内膜异位症Endometriosis张喜19DiagnosisClinical classificationRevised American Fertility Society(r-AFS),1985Useful for:Assessment of severity Selection of therapeutic regimen Comparison Prognosis子宫内膜异位症Endometriosis张喜20r-AFS子宫内膜异位症Endometriosis张喜21Differential Diagnosis Ovarian tumor ascites(腹水)(腹
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