UterineLeiomyoma子宮平滑肌瘤

2021/10/10星期日12021/10/10星期日2Etiology/EpidemiologyEtiologyunknownIncreasedriskfactors

40yearsorolderFamilyhistoryofuterinefibroidNulliparityObesityBlackrace2021/10/10星期日3AssociatedFactorsFemaleHormones---Estrogen(雌激素)/Progestron(孕激素)Clinicalevidences:ReproducutivepatientsNocasesbeforepubertyNonewcasesaftermenopause(停經(jīng))Increasedduringpregnancy

Estrogenreceptor(ER-α)highconcentrationinblackwomen2021/10/10星期日4Intramural~(60%--70%)

肌壁間Subserous(20%)

漿膜下Submucous~(10%)

粘膜下

Cervical~-2%

ClassificationI2021/10/10星期日5ClassificationIISingleMultiple2021/10/10星期日6Pathology

---grossstructureFrequentlymultipleFirm,varyinsizeSphericalorirregularlylobulatedFalsecapsule(假包膜)Whorledappearance(漩渦狀結(jié)構(gòu))2021/10/10星期日7Pathology

---microscopicstructure2021/10/10星期日8Hyaline

玻璃樣變性yellow,softgelatinousareasCystic

囊性變liquefactionfollowsextremehyalinizationRed(carneous)degeneration紅色變性

Edema&hypertrophyimpedebloodsupplyasepticdegenration&infarctionwithvenousthrombosis&hemorrhageOtherchanges

calcification鈣化hemorrhage出血necrosis壞死

SECONDARYCHANGES/DEGENERATION2021/10/10星期日9Hyaline/Cystic

Degeneration2021/10/10星期日10Red(carneous)degenerationUsuallyoccursduringpregnancy2021/10/10星期日11MalignantTransformationrare

0.1-0.5%

leiomyomaleiomyosarcomaIncreasedcellnumberPathologicalnuclearfission病理性核分裂2021/10/10星期日12Dependon

location,size,changes&pregnancystatusClinicalFindings2021/10/10星期日13Abnormaluterinebleeding

mostcommon30%Heavy/prolongedbleeding(menorrhagia月經(jīng)過多

)----submucous/largeintramuralmyomapre&post-menstrualspotting(月經(jīng)前后淋漓出血

)----submucous

myomaintermenstrtualbleeding(月經(jīng)間期出血

)----Pedunculatedsubmucous

myoma

ClinicalFindings---Symptoms2021/10/10星期日14Pain/discomfortHeavinessfullnessinthepelvicarea(largefibroid

)backpainDysparunea(性交痛

)PressureEffectsAcutepain---Torsion,Reddegenration

Vascularocclusion

MyometrialcontractionsClinicalFindings---Symptoms2021/10/10星期日15ClinicalFindings---Symptoms

Infertility

uncertainrelationshipmultiplefibroids20-40%Endocavitary70%SpontaneousAbortionincidencebeforemyomectomy40%aftermyomectomy20%intracavitarytumors2021/10/10星期日16Enlargeduterus(regular/irregular)orNormaluterus(small～)

orMidlinemasscontiguouswithcervix

ClinicalFindings---Signs2021/10/10星期日17ComplicationsinPregnancyInfertility

≥

2/3ofwomenwithfibroids&unexplainedinfertilityconceiveaftermyomectomyRedDegenerationDuringLabor

Malpresentation胎先露異常

ObstructionofthebirthcanalCervicaloristhmeicmyomanecessitateCS2021/10/10星期日18SymptomsPhysicalsignsUltrasonographicscanningHysteroscopy宮腔鏡檢查MRIDiagnosis2021/10/10星期日19Diagnosis—ultrasonographicscanningTASTVS2021/10/10星期日20Diagnosis

---MRIleiomyomaleiomyosarcomaleiomyomacysticchange2021/10/10星期日21Diagnosis

--hysteroscopy宮腔鏡檢查Stalk,pedicle2021/10/10星期日22pregnancyotherpelvicmasses

ovariantumor卵巢腫瘤,Tubo-ovarianabscess輸卵管卵巢膿腫

othercausesofuterineenlargement

Adenomyosis子宮腺肌癥

othercausesofabnormalbleeding

Endometrialhyperplasia子宮內(nèi)膜增生EndometrialCa子宮內(nèi)膜癌DifferentialDiagnosis2021/10/10星期日23Treatment

IndividulizationDependsonAgeParityPregnancystatusDesireforfuturepregnancyGeneralhealthSymptomsSizeLocation2021/10/10星期日24TreatmentChoicesofManagementFollow-upMedication

FocusedUltrasound(highintensityfocusedultrasound,HIFU)UterinearteryembolizationSurgeryMyomectomyHysterectomy2021/10/10星期日25Expectantmanagement

smalllesion,perimenopausalpt.Medication

(herbalmedicine,GnRH-a)suppresstumorpreoperativelyFocusedUltrasound(highintensityfocusedultrasound,HIFU

)

sonographicablation海扶公司Uterinearteryembolization

blockbloodsupply

Treatment2021/10/10星期日26ModelJCfocusedultrasoundtumortherapeuticsystemmanufacturedbyChongqingHaifuTechnologyCo.,Ltd.(Chongqing,China)

ablationfocus2021/10/10星期日27Uterinearteryembolization2021/10/10星期日28

Surgery

myomectomy

肌瘤摘除術(shù)

Transabdominal經(jīng)腹手術(shù)

Transvaginal經(jīng)陰道手術(shù)

Laparoscopic

腹腔鏡手術(shù)

Hysteroscopic

陰道鏡手術(shù)