leiomyoma 子宫平滑肌瘤 ppt课件

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1、UterineLeiomyoma子宫平滑肌瘤(myoma，fibroid)HuaLinghu令狐华DepartmentofObs/GynPrevalence/incidence25%-50%reproductivewomenIncreasedincidencewithageAgeincidence20-30yr4%30-40yr11-18%40-50yr33%Lurie�S,Piper�I,Woliovitch�I,Glezerman�M.�Age-relatedprevalenceofsonographicallyconfirmeduterinemyomas.�J

2、ObstetGynaecol.�2005;25:42–4Etiology/EpidemiologyEtiologyunknownIncreasedriskfactors40yearsorolderFamilyhistoryofuterinefibroidNulliparityObesityBlackraceAssociatedFactorsFemaleHormones---Estrogen(雌激素)/Progestron(孕激素)Clinicalevidences:ReproducutivepatientsNocasesbeforepubertyNonewcases

3、aftermenopause(停经)IncreasedduringpregnancyEstrogenreceptor(ER-α)highconcentrationinblackwomenIntramural~(60%--70%)肌壁间Subserous(20%)浆膜下Submucous~(10%)粘膜下Cervical~-2%ClassificationIClassificationIISingleMultiplePathology---grossstructureFrequentlymultipleFirm,varyinsizeSphericalorirregul

4、arlylobulatedFalsecapsule(假包膜)Whorledappearance(漩涡状结构)Pathology---microscopicstructureHyaline玻璃样变性yellow,softgelatinousareasCystic囊性变liquefactionfollowsextremehyalinizationRed(carneous)degeneration红色变性Edema&hypertrophyimpedebloodsupplyasepticdegenration&infarctionwithvenousthrombo

5、sis&hemorrhageOtherchangescalcification钙化hemorrhage出血necrosis坏死SECONDARYCHANGES/DEGENERATIONHyaline/CysticDegenerationRed(carneous)degenerationUsuallyoccursduringpregnancyMalignantTransformationrare0.1-0.5%leiomyomaleiomyosarcomaIncreasedcellnumberPathologicalnuclearfission病理性核分裂Depend

6、onlocation,size,changes&pregnancystatusClinicalFindingsAbnormaluterinebleedingmostcommon30%Heavy/prolongedbleeding(menorrhagia月经过多)----submucous/largeintramuralmyomapre&post-menstrualspotting(月经前后淋漓出血)----submucousmyomaintermenstrtualbleeding(月经间期出血)----PedunculatedsubmucousmyomaClinic

7、alFindings---SymptomsPain/discomfortHeavinessfullnessinthepelvicarea(largefibroid)backpainDysparunea(性交痛)PressureEffectsAcutepain---Torsion,ReddegenrationVascularocclusionMyometrialcontractionsClinicalFindings---SymptomsClinicalFindings---SymptomsInfertilityuncertainrelationshipmulti