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1、第一节 子 宫 肌 瘤 Myoma of uterus,武汉大学第一临床学院 妇产科Department of Obstetrics and Gynecology张 蔚 教 授Zhang Wei,Most common benign tumor of female reproductive system. And the most common benign tumor in human body 是女性生殖系统最常见的良性肿瘤, 并且是人体最常见的良性肿瘤Present in 20-25% of reproductive-age women 发生于20-25%的生育年龄妇女,病 因 Aeti
2、ology,High concentrations of both estrogen and progesterone receptors 肌瘤组织中含有高浓度的雌、孕激 素受体,分类Classification,According to the location,Myoma is divided into:Uterine body myoma (90%) Cervical myoma (10%),依据肌瘤的位置分类:子宫体肌瘤(90%) 子宫颈肌瘤(10%),分 类 Types,各型子宫肌瘤示意图,肌 壁 间 肌 瘤(intramural myoma),Within the uterine
3、wall 肌瘤位于子宫肌壁内，周围均被肌层包围。占6070,浆 膜 下 肌 瘤(subserous myoma),Deforming the external serosa肌瘤向子宫浆膜面生长，突起在子宫表面，约占20%,浆 膜 下 肌 瘤,Extend between the 2 peritoneal layers of the broad ligament若肌瘤位于宫体侧壁向宫旁生长，突阔韧带两叶之间称阔韧带肌瘤,阔韧带肌瘤Broad ligament myoma,阔韧带肌瘤Broad ligament myoma,粘 膜 下 肌 瘤 (submucous myoma),Deforming
4、 the uterine cavity 肌瘤向子宫粘膜方向生长,突出于宫腔,仅由粘膜层覆盖,占10-15%,粘 膜 下 肌 瘤,多发性子宫肌瘤(multiple myomata ) 子宫肌瘤常为多个性,各种类型的肌瘤可发生在同一子宫，称多发性子宫肌瘤,多 发 性 子 宫 肌 瘤,white-colored, round, smooth, and usually firm, pseudocapsule 呈白色的,圆形的,光滑的,并且常是 坚硬的,有假包膜,病 理Pathology,漩涡状whorled appearance 纤维结缔组织Fibrous connective tissue,sarc
5、omatous change肉瘤变,Degeneration肌瘤变性,cystic degeneration囊性变,red degeneration红色变,Hyaline degeneration玻璃样变,with calcification钙 化,透明样变Hyaline degeneration,The most common degeneration最普遍的变性Its whorled structure disappears and is replacedby clear substance, white color螺旋状结构消失,由透明结构代替,呈白色Under microscope,
6、the cells in the degeneration area disappear镜下观,变性区域细胞消失,囊性变Cystic degeneration,Secondary change following hyaline degeneration紧随透明样变性的次级变化Tissue necrosis and liquefaction and forms multiplecysts有组织坏死、液化和形成多发囊性结构,红色变Red degeneration,Whorled structure disappears and has bad smell螺旋结构消失和有恶臭 Most commo
7、n during pregnancy and puerperium最常见于妊娠期和产褥期It is a special type necrosis which cause is not clear为一种特殊类型的坏死,原因不明Accompanied by pain and fever and rapidly enlarged myoma伴随有疼痛,发热和肌瘤迅速增大,肉瘤变Sarcomatous change,Malignant transformation of leiomyoma子宫肌瘤的恶性转变The frequency is 0.4-0.8%,often occurs in old w
8、omen发病率为0.4-0.8%,多见于老年妇女The myoma enlarges rapidly in short term with irregular vaginal bleeding肌瘤短期迅速增大并伴有不规则阴道流血,钙化Degeneration with calcification,Majority occur in the myomas with thinpedecle or after menopause多发生于蒂小或绝经后肌瘤Causes precipitation of calcium carbonate and phosphate 引起碳酸钙和磷酸盐的沉积 Often
9、secondary to the fatty degeneration常发生于脂肪变之后,脂 肪 样 变,临 床 表 现,症 状 SymptomsDepend on their location, the speed of growth and degenerations取决于肌瘤部位、生长速度及肌瘤变性It is not associate with the size and the number of myomas与肌瘤大小、数目无关,AbnormalMenstrualbleeding,体 征 Signs Relate to myoma size 、location 、number 、de
10、generation与肌瘤大小、位置、数目以及有无变性有关,Diagnosis according to typical symptoms and signs 、 Ultrasound 、Hysteroscopy and Laparoscop,诊 断根据典型的症状和体征、超声、宫腔镜及腹腔镜,治 疗Treatment,Depends on the patients age 、parity 、 symptoms 、myoma size根据患者年龄、产次、症状、肌瘤大小等情况全面考虑Follow up every 3 to 6 months 每36个月随访一次,药 物 治 疗 androgenic
11、 hormone 雄激素 GnRH 促性腺激素释放激素类似物,手 术 治 疗 surgery Myomectomy 肌瘤切除术 Hysterectomy 子宫切除术,子 宫 肌 瘤 合 并 妊 娠Myomas during pregnancy,Produce uterine inertia, fetal malpresentation, or obstruction of the birth canal产生子宫无力,胎先露异常,或者产道阻塞May necessitate cesarean delivery有可能进行剖宫产Interfere with effective uterine cont
12、raction after delivery干扰分娩后子宫的有效收缩The possibility of postpartum hemorrhage 有产后出血的可能,课 堂 讨 论Questions,What are the operation indication of uterus myoma? Why? What are the Signs and Symptoms of uterus myoma? How to treat the disease of uterus myoma?,主要参考文献Main References,Joan P,Alison B.P,Brian A.M,et al,Obstetrics and GynaecologyM.Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto,2019;134-139丰有吉,沈铿,马丁,妇产科学M.人民卫生出版社,2019,316-328,谢 谢,
