子宫脱垂（uterine_prolapse）狄文_1课件

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1、UterineProlapseDIWENM.D.,Ph.D.,Professor&ChairmanDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicineTheuterusgraduallydescendsintheaxisofthevaginatakingthevaginalwallwithit.Itmaypresentclinicallyatanylevel,butisusuallyclassifiedasoneofthreedegrees.Definition2UterinePro

2、lapse3UterineProlapse4UterineProlapse5UterineProlapse6UterineProlapseCauses1.Thestretchingofmuscleandfibroustissue2.Increasedintra-abdominalpressure3.Aconstitutionalpredispositiontostretchingoftheligamentsasaresponsepresumablytoyearsintheerectposition7UterineProlapse8UterineProlapse9UterineProla

3、pseInrecentyears,theincidenceofprolapseisgreatlyreduced.Themoreliberaluseofcaesareansectionandtheeliminationoflaboursareprobablythetwomostimportantfactors.10UterineProlapseSymptomsSomethingcomingdownBackacheIncreasedfrequencyofmicturitionA‘bearingdown’sensationStressincontinenceCoitalproblemsDif

4、ficultyinvoidingurine11UterineProlapse12UterineProlapse13UterineProlapse14UterineProlapse15UterineProlapse16UterineProlapse17UterineProlapseDegreesofuterineprolapseFirstdegree:cervixstillinsidevagina18UterineProlapseDegreesofuterineprolapseSeconddegree:thecervixappearsoutsidethevulva.Thecervical

5、lipsmaybecomecongestedandulcerated19UterineProlapseDegreesofuterineprolapseThirddegree:completeprolapse.Inthepicturetheuterusisretroflexed,andtheoutlineofbladdercanbeseen.Thisissometimescalledcompleteprocidentia.20UterineProlapseDiagnosisApelvicexaminationrevealsprotrusionofthecervixintothelower

6、partofthevagina(mildprolapse),pastthevaginalintroitus/opening(moderateprolapse),orprotrusionoftheentireuteruspastthevaginalintroitus/opening(severeprolapse).21UterineProlapseTreatmentPessarytreatmentIndications:Patientprefersapessary.PelvicsurgeryunaviodablerisksProlapseamenabletopessaryThepatie

7、ntisnotfitforsurgeryPatientwishestodelayoperation22UterineProlapse23UterineProlapse24UterineProlapse25UterineProlapse26UterineProlapse*Anteriorcolporrhaphy(andrepairofcystocele)*Posteriorcolpoperineorrhaphy(includingrepairof