《子宫平滑肌瘤幻灯片.ppt》由会员分享，可在线阅读，更多相关《子宫平滑肌瘤幻灯片.ppt（53页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、子宫平滑肌瘤第1页，共53页，编辑于2022年，星期五Introduction vUterine enlargement as a result of leiomyoma is common in clinical practice.vMyoma are the commonest new growths of the uterus and one of the most common tumors of the human body.vThese occur in approximately,20%of women over 30,25%of women over 40.第2页，共53页，编
2、辑于2022年，星期五Aetiological factorsvFemale Hormones Estrogens Progestrons vGrowth Factors Basic fibroblast growth factor(BFGF).Insulinlike growth factor(IGF)-I.Epidermal growth factor(EGF).第3页，共53页，编辑于2022年，星期五Anatomy of uterus第4页，共53页，编辑于2022年，星期五Classification第5页，共53页，编辑于2022年，星期五ClassificationvAccord
3、ing to location of uterine myomata have been divided in vCorporeal fibromyomata(90%)vCervical myomata(10%).第6页，共53页，编辑于2022年，星期五ClassificationvAnd corporeal myomata have been divided:vIntramural fibromymata 60-70%vSubserous fibromymata 20%vSubmucous fibromymata 10-15%第7页，共53页，编辑于2022年，星期五第8页，共53页，编辑
4、于2022年，星期五ClassificationvIntramural fibromymata with intramural fibromyomata enlargement of the uterine body usually occurs,often with elongation of its cavity so that there is increased menstrual loss.第9页，共53页，编辑于2022年，星期五Classification Subserous fibromymata vSize:from small nodules to enormous mas
5、ses of 20 kg or more in weight.vPedunculated myoma:they tend to grow up into the abdomen and the broad ligament,vRarely torsion may occur,resulting in interference with the blood supply to the tumor.第10页，共53页，编辑于2022年，星期五ClassificationvSubmucous fibromyoma.Some intramural tumors are extruded towards
6、 the uterine cavity.vThe uterus contracts in an attempt to expel the tumor and it may be extruded until it is only attached to the uterine wall by a stalk and is known as a fibro-myomatous polyp 第11页，共53页，编辑于2022年，星期五PathologyvNacked eye appearance.on section the fibromyoma is paler,harder and more
7、fibrous than the uterine wall.vOn comparing an intramural tumor with the surrounding false capsule of uterine wall the difference is well marked.第12页，共53页，编辑于2022年，星期五Nacked eye appearance第13页，共53页，编辑于2022年，星期五Smooth muscle tumors of the uterus are often multiple.Seen here are submucosal,intramural,
8、and subserosal leiomyomata of the uterus.第14页，共53页，编辑于2022年，星期五PathologyvMicroscopical structure.These growths are composed of unstriped muscle and fibrous tissue第15页，共53页，编辑于2022年，星期五Here is the microscopic appearance of a benign leiomyoma.Normal myometrium is at the left,and the neoplasm is well-d
9、ifferentiated so that the leiomyoma at the right hardly appears different.Bundles of smooth muscle are interlacing in the tumor mass.第16页，共53页，编辑于2022年，星期五DegenerationvThese tumors grow slowly;in some cases there may be no evident change in size for many years.vIn a few cases growth is more rapid an
10、d secondary changes may also cause swelling of the tumor.第17页，共53页，编辑于2022年，星期五DegenerationvHyaline degeneration is the commonest change seen in fibromyomata.It is caused by a gradual inadequacy of the blood supply.vCystic degeneration is not uncommon,especially after the menopause,and is due to liq
11、uefaction of the areas of hyaline change.第18页，共53页，编辑于2022年，星期五DegenerationvRed degeneration.In this variety of degeneration the affected area is stained red and resembles raw meat.It is most freguently seen during the pregnancy and in postpartum.第19页，共53页，编辑于2022年，星期五Degeneration Malignant change v
12、In 0.1to 1%of cases,malignancy as leiomyosarcoma may develop.It is most likely to be seen in large tumors.vMalignancy is more typical in older patients,especially postmenopausal patients vPresention with rapidly enlarging uterine mass and postmenopausal bleeding.vMetastasis occurs rapidlly in these
13、cases.第20页，共53页，编辑于2022年，星期五This is a leiomyosarcoma protruding from myometrium into the endometrial cavity of this uterus that has been opened laterally so that the halves of the cervix appear at right and left.Fallopian tubes and ovaries project from top and bottom.The irregular nature of this mas
14、s suggests that is not just an ordinary leiomyoma.第21页，共53页，编辑于2022年，星期五SymptomsvBleeding is the most common presenting symptom in uterine fibroids.vMenorrhagia is freguent reason for patients to seek advice.vThe periods increase in amount and duration.第22页，共53页，编辑于2022年，星期五SymptomsvBleeding vSubmuc
15、ous fibromyomata menorrhagia is nearly always present,and quite small tumors can lead to severe anaemia.vIntramural tumors may increase the lossvSubserous growths do not affect the menstrual loss.第23页，共53页，编辑于2022年，星期五SymptomsvBleeding vMechanisms for increased bleeding:vAlteration of normal myometr
16、ial contractile functionvInability of the overlying endometrium to respond to the normal E/P menstrual phases.vPressure necrosis of the overlying endometrial bed.第24页，共53页，编辑于2022年，星期五SymptomsvAn abdominal tumour is sometimes the first thing that the patient notices.The tumor is not tender and rarel
17、y gives rise to pain.vDischarge is rarely a prominent symptom except during the extrusion of fibromyomatos polyp through the cervical canal.第25页，共53页，编辑于2022年，星期五SymptomsvPain is not a common symptom.vwhen it occur it is generally an indication that there is associated vendometriosis vor pelvic infl
18、ammatory disease,vor some complication of the tumor such as red degeneration or torsion.第26页，共53页，编辑于2022年，星期五SymptomsvPelvic pressure:pressure on the bladder leading to frequency and retention of urine.第27页，共53页，编辑于2022年，星期五Physical signsvThe physical signs vary with the size,position and number of
19、 the tumors.vA symmetrical enlargement of the uterus is found with a submucos growth.vMore often the enlargement is asymmetrical;it is often nodular on the surface because there are multiple tumor.vSubserous tumors with little myometrial covering often fell particularly hard.第28页，共53页，编辑于2022年，星期五Ph
20、ysical signsvOn pelvic examination the cervix may be found to be pushed down or displaced to one side.If it is expanded by an intracervical tumor,or it may be dilated with the lower pole of a tumor left within it.第29页，共53页，编辑于2022年，星期五DiagnosisvThe diagnosis of these tumors is usually made vby clini
21、cal examination,include abdominal and bimanual palpation,vor imaging studies.vIn addition,irregularities of the uterine cavity can be detected at the time of endometrial currettage.第30页，共53页，编辑于2022年，星期五DiagnosisvPelvic ultrasound is the most commonly used for confirmation of uterine myomas.vDilatio
22、n and curettage may provide relevant information,because larger tissue specimens,including small submucous myomas,may be obtained.第31页，共53页，编辑于2022年，星期五Pelvic ultrasound第32页，共53页，编辑于2022年，星期五Pelvic ultrasound第33页，共53页，编辑于2022年，星期五HysteroscopyvHysteroscopy may also be used to evaluate the enlarged ut
23、erus by directly visualizing the endometrial cavity.第34页，共53页，编辑于2022年，星期五Differential diagnosisvOther conditions which cause menorrhagiavDysfunctional uterine bleedingvCarcinoma of the uterusvEndometrial polyp of uterusvOther conditions which give rise to a swelling in the pelvisvAdenomyoma,ovarian
24、 tumors,inflammatory swelling in the pelvis,pregnancy 第35页，共53页，编辑于2022年，星期五This uterus has been opened anteriorly through cervix and into the endometrial cavity.High in the fundus and projecting into the endometrial cavity is a small endometrial polyp.Such benign polyps may cause uterine bleeding.第
25、36页，共53页，编辑于2022年，星期五The thickened and spongy appearing myometrial wall of this sectioned uterus is typical of adenomyosis.There is also a small white leiomyoma at the lower left.第37页，共53页，编辑于2022年，星期五第38页，共53页，编辑于2022年，星期五This adenocarcinoma of the endometrium is more obvious.Irregular masses of wh
26、ite tumor are seen over the surface of this uterus that has been opened anteriorly.The cervix is at the bottom of the picture.This enlarged uterus was no doubt palpable on physical examination.第39页，共53页，编辑于2022年，星期五Abnormality of uterus第40页，共53页，编辑于2022年，星期五TreatmentvFollow up vhormonal treatment vf
27、ibroid embolisation vSurgical management 1.hysterectomy 2.myomectomyvmyolysis第41页，共53页，编辑于2022年，星期五TreatmentvFollow up:the majority of patients with uterine myomas do not require surgical treatment.vSmall tumors and not causing symptomsvPatients in the late reproductive or perimenopausal years.vMana
28、gement:repeat pelvic exminations and assisted by serial pelvic ultrasound measurements vEvery 3-6 months.第42页，共53页，编辑于2022年，星期五TreatmentvDrug therapy:bleeding is not heavy enough to cause anemia and small myoma.vMechanisms:vPharmacologic inhibition of estrogen secretionvAn attempt may be made to min
29、imize uterine bleeding vThis treatment is commonly used for 3 to 6 months.第43页，共53页，编辑于2022年，星期五TreatmentvDrugsvandrogen vGnRH-a supplementation.vGestrinonevMifepristonevChinese medicine第44页，共53页，编辑于2022年，星期五TreatmentSurgical treatment is indicated in cases with:1.Heavy or prolonged bleeding2.Tumors
30、 of large size over 2.5 gestation months,even if these are not causing symptoms.3.Possible malignant change,such as a tumor which grows after the menopause.4.Pressure symptoms,pressure against bladder,bowel,and pelvic floor.5.Tumors which have undergone torsion第45页，共53页，编辑于2022年，星期五TreatmentvSurgica
31、l forms:vMyomectomy is occasionally warranted in younger patients whose fertility is compromised by the presence of myomas.vHysterectomy:although hysterectomy is commonly performed for uterine myomas,it should be considered as definitive treatment only in symptomatic women who have completed childbearing.第46页，共53页，编辑于2022年，星期五第47页，共53页，编辑于2022年，星期五第48页，共53页，编辑于2022年，星期五第49页，共53页，编辑于2022年，星期五Uterine Fibroid Embolization(Uterine Artery Embolization)第50页，共53页，编辑于2022年，星期五Uterine Fibroid Embolization(Uterine Artery Embolization)第51页，共53页，编辑于2022年，星期五第52页，共53页，编辑于2022年，星期五第53页，共53页，编辑于2022年，星期五