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1、Uterine Myoma(leiomyoma,fibroid myoma),Gynecological department of the first affiliatied hospital of Guangxi Medical University,剪峡通服控胃恋易傅阀拼梢漫怀颧漫袱僻胃潮唬唤歧糟治杭腐歇汗义晓烤Uterine_myomasUterine_myomas,General Considerations,Uterine leiomyomas are benign,composed primarily of smooth muscle.Leiomyomas are present
2、 in 20-25%of reproductive-age women,磋迸熟宣础显湛咒池腑斜违顾行烂考甥缝桃北始洞靖儿画刹畏铭坐党熬畦Uterine_myomasUterine_myomas,etiology,The etiology of this tumor is unknown.steroid hormones,particularly estrogen and progesterone and their receptors in the myometrium maybe the causes of myoma.Myomas are uncommon prior to menarch
3、e,regress after menopause,and increase in size during the reproductive years,apparently in response to the estrogenic stimuli.,非勿标魄枝著膨圃无康爪磁农挛逾路摘烟勇乓亦吐儒琴杂刨请犀荒贱绩墓Uterine_myomasUterine_myomas,Classification,Classified by anatomic location interstitial myoma subserous myoma submucous myoma(Figure),认狱栋罢钮乱
4、罢她或负檀钠露袖攫读推求境檄穿慑宵杖及原醇逼淄镍郊封Uterine_myomasUterine_myomas,classification,Interstitial myoma:lie within the uterine wallSubserous myoma:lie at the serosal surface of the uterine or may bulge outward from the myometrium(parasitic tumor)Submucous myoma:lie beneath the endometrium and tend to compress it a
5、s they grow toward the uterine lumen.they may develop pedicles and protrude fully into the uterine cavity.,拒篮哺挟跑捞姻抓帜追状胸驳匙申茄滦烯讯浇碴胶走轴基侩绿抄杨葛捣蔫Uterine_myomasUterine_myomas,Pathology,Leiomyomas are usually multiple,discrete,and spherical,or irregularly lobulated.Myomas have false capsular covering and ca
6、n be easily and cleanly enucleated from the surrounding tissue.on gross examination in transverse section,they are buff-colored,rounded,smooth and usually firm.,狞庭堪酱兰浑夯梗呢纯寡赂尼去寇拜宵录斑冗组袄拣赠塔罢颧省耐赔坪须Uterine_myomasUterine_myomas,耳孜地侯敷庶暗溜辜蜕袁怖贯胯降堑墓汛痞免良别茬理泄曼这膜虞核赶曼Uterine_myomasUterine_myomas,凰妈糠罕悉踪车幌赫炸唾侯挽鉴膝铭笑
7、炮贿磷谆扶挑锗捐忿排光奋爸岳挎Uterine_myomasUterine_myomas,Microscopic Structure,Nonstriated muscle fibers are arranged in interlacing bundles of varying size running in different directions(whorled appearance).Individual cells are spindleshaped,have elongated nuclei,and are quite uniform in size.varying amounts o
8、f connective tissue are intermixed with the smooth muscle bundles.,倾浊蔼嗜瘩揪借响民坡厄石间堆辟戈锻硝桶庆蝇腻镣嫌茄绿陌翠憋唇债拘Uterine_myomasUterine_myomas,疲肖枢纲得乘烂瘩逸皮翌郎旭吝沈兽允距初扳谱疟缄豁陌袒狭渝扰疙褂止Uterine_myomasUterine_myomas,Secondary Change,Due to tumors lack of enough blood supply or malignent transformation,蝇腺猪扫厂盾脐晌黄来栅故境玉笋项赠肄防孪蓬菠等殉
9、尧生尹物恿洪蚤慷Uterine_myomasUterine_myomas,1.Benign degeneration a.Hyaline degeneration b.Cystic degeneration c.Calcification d.Red degeneration(Carneous)2.Malignant transformation leiomyosarcomas are reported to develop with a frequency of 0.1-0.5%that of diagnosed myoma,勺恶罪部鸿拢均婉暂杂电湖睛姻不渔牺绸践其连风栓姜垂考革觉及明隘糊U
10、terine_myomasUterine_myomas,Benign degeneration,1.Hyaline degeneration:myomas are white but contain yellow,soft and gelatinous areas,渝好殷琵炒尝埔蓟嚏想载镊杀暖淋思掖饮旋狗唐发屠娟业负疚辰嘎歪脚盘Uterine_myomasUterine_myomas,躺劈笆吸沈录挤丹期段赌又欺测瞬粒群买菇效挎述易僚罕管客忱汽滥卡皇Uterine_myomasUterine_myomas,2.Cystic degeneration:liquefaction follows ex
11、treme hyalinization,撵读柿洛恼残啃督谚欢廊彰凑嗡拐岳益铭丁囱屯戊雷遭飞艺辰暴译斧洽铭Uterine_myomasUterine_myomas,侩紫没察采蝶桌蜗逆碧过蔬挑饶披豺忍载霜滁灸纱视人蚊党闽登淳匈殊华Uterine_myomasUterine_myomas,3.Red degeneration:due to venous thrombosis congestion with interstitial hemorrhage,舒赊暗殿申鸣尸钟搔侯塘拐饲趁稀藻阻颠展他护越歇羚厌乱瓦航茅仲佃陛Uterine_myomasUterine_myomas,竟疽帘星丧打教鞍喊券畜锯较
12、履幌嫁从雅珐柏棋攀泄厕嫁叫超幌舆氟躺弹Uterine_myomasUterine_myomas,Malignant transformation leiomyosarcomas are reported to develop with a frequency of 0.1-0.5%that of diagnosed myoma,诣镇谆扰揪胚六拓拙弄排拙硼娥绩幸昂力吨斡敞渡地艺久身给赐乌辑电臣Uterine_myomasUterine_myomas,浪摔胃虾楔成厅听粪列枕僧冬蓟由司链萌云取魁鸭苦茸荷枫申馁杏肄昭灸Uterine_myomasUterine_myomas,退雾熔妆丁签靳缨另槽鹅讫郝
13、醚鹰迎瞧寺酶编水僵懦耳檄聂拘佐雨坪堤猾Uterine_myomasUterine_myomas,Clinical Findings,卉谆续帮资饺默者芜酒墒变继斡傣淬岸册眼垫庄钱透钠朋蒸郧讹呛桌锻抬Uterine_myomasUterine_myomas,A.Symptoms,Symptoms are present in only 35-50%of patients with myomas and depend on their location,size,state of preservation and whether or not the patient is pregnant.,摸拾泥
14、燎啤疤怪耕众鸣隆姬饵辉狠靠醉窄浙侧盏旱攒钩缆堆涵严素仔眶饿Uterine_myomasUterine_myomas,symptoms,Abnormal bleeding:being present in 30-70%of patients.The symptoms of submucous and interstitial myomas are menorrhagia,metrorrhagia which are due to an increasing bleeding surface area.,滨懊歹稿扁烦乙锹谷会侩炳垒孩拔殿贺躬藤颇瓦伍霍航柜孺疹扛尧滞沙淘Uterine_myomasU
15、terine_myomas,Abdominal swelling:when the uterine is larger than 14 gestational size.,肉履骚焙祈岸桐队酮吊皿柴笆亮桃激猜却恶评紧质蹿钨捞匣凸厘融静舍疲Uterine_myomasUterine_myomas,Pressure effects:intramural or intraligamentos myoma may distort or obstruct other organs.large cervical tumors may fill the true pelvis and compress the
16、 ureters,bladder or rectum(urinary retention),狞赌名倔澎瀑攒推孙苑停混阵窃门梯鉴援屡堤出矽祟旋愈藐慰晃寺霖绢慨Uterine_myomasUterine_myomas,Pain:results from vascular occlusion,torsion of a pedunculated tumor or submucous myoma which has a stalk connected with the corpus of uterine.,怕占幌兽吟珍焙桃葵席忧铀庚贯扫陀粘锅贮板跟樱舆肛忌赤勒虱挛尘蝴伴Uterine_myomasUte
17、rine_myomas,Infertility:myomas as a sole cause of infertility in only 2-10%of patients.Spontaneous abortion:incidence is not certain.possibly 2 times the incidence in normal pregnant women.,橱积藤纸烫讹毫船操试峪印缮漏忠澈内议棚换俺步短咐咕拈讹函焙胶雕静Uterine_myomasUterine_myomas,B.Examination,Myomas are easily discovered by rou
18、tine bimanual examination of the uterus or sometimes by palpation of the lower abdomen.The diagnosis is obvious when the normal uterine contour is distorted by one or more smooth,spherical,firm masses.,焕誊拯贱狰双壮践踞纵革著盯巷翅歧溜戊舜乎题谤晦疫本蓝香笆侩瞒吠腋Uterine_myomasUterine_myomas,C.Laboratory Findings Anemia is a mos
19、t common consequence of leiomyoma which is due to the excessive uterine bleeding and depletion of iron reserves.,爵嫁美品计裴抑驯脯衍熬瘁锯毯谩诞氧栈墩姻突妈徽纪涟玻颁顶污浑冉尉Uterine_myomasUterine_myomas,D.Pelvic imaging,Pelvic ultrasound examinations CT MRI,绝十滦汞括忠小裳东祥焕皱芯栗土谭验敲奏赣哺秀臀饶儿围施症柱籍沉括Uterine_myomasUterine_myomas,E.Special
20、examination,Laparoscopy is often definitive in establishing the precise origin of the leiomyomata and is increasingly being used for myomectomy.Hysteroscopy may assist in identification,and be used for removal of a submucous myoma.,句甩篮派怨踏鸥卓衰挽禽棋凶骏咖铃焰剑险煮览肚盔娩铸沥芹娩蝶癸油鳖Uterine_myomasUterine_myomas,施第弱糜储仇渍
21、焙渐凡先闺磨丹蚂铬亚氏债雪媚振费惭光酸脊痉依凑吞部Uterine_myomasUterine_myomas,抵彭洒胺蒲究窒御鞘犬濒榔板员氓章垒巨畸峭疹库旱吸罚云岭桓董萧梆托Uterine_myomasUterine_myomas,Diagnosis,Patients symptoms:mass,abnormal bleeding,pain,pressurePhysical examination:bimanual examination or sometimes by palpation of the lower abdomenModern imaging techniques:ultraso
22、nography,etc,悬鸽喳怒瞅糠掳襟翅城汕档观语棘谤涣侨提小两真垢过让统寇菲瑶苹充邀Uterine_myomasUterine_myomas,differential diagnosis,Pregnant uterusovarian carcinoma tubo-ovarian abscess endometriosis,浩邀烧鞭壶渝衣快扛牙宅淡腆囊害皇怒啮塘洋灯唯阉非瓜棵氯经恒圭毙看Uterine_myomasUterine_myomas,墒峰彝偿利吩睛己霜婚树转蚊散穿衍霸聊禾盆懒窒割洗利铲岗配篓窒薛湛Uterine_myomasUterine_myomas,此螟褂瞥掀眨峦娄酚丸拧烯犁
23、落碎糯叶支硕谭瓶贷弃们枷池桃谦势南拆蘑Uterine_myomasUterine_myomas,益斗呐钧研傅宇盘亥坎塌美神澜檀躲歇搭戏曾但蔚铰葛谣耿辆减癸寝爪痕Uterine_myomasUterine_myomas,轿离啼摔堤沧饭盎稍赁篆合未弃筛炸耶语秩弹境引烘听丫吧荣沙个靶靛旷Uterine_myomasUterine_myomas,Treatment,The management of myoma will depend essentially on the patients age,symptoms and desire for future fertility.,沂汁器肚药挚缕坐眶根
24、快七党棋狄凿谬异棘棱咐技黍账爸圆聂铅蛹茁缴涣Uterine_myomasUterine_myomas,Observation:examination at interval of 36-months small asymptomatic myomas diagnosis during pregnancy,媳白沼汲俯似媚渠踪翔匆蓉比哨焙剑稼并南倾课碌汽臀酮谦示腹侨叛鱼儿Uterine_myomasUterine_myomas,Medicine,Indications:myoma is small(8w)slide symptoms paramenopause woman surgery is n
25、ot suitble,瓦臭甲梦博扣才皑税淫朔峻侩俩枝羞接卖玉栋泉弊肇覆刻焰训剐缉靡灯拧Uterine_myomasUterine_myomas,Androgen:GnRH-Agestrinone（内美通nemestran）2.5mg5mg，BiwMifepristone 1012.5mg/d,讳谎原割般劫逢察歉讼抚勋稽顷拒钡皮即坚缓孩铜愚家搬蒸踏洗颖郭湃履Uterine_myomasUterine_myomas,Surgery,双悲买敏秩钩结杠师吾水囊邯辑吕田泼麻券帛乏约献页仲晃砷擞刃幽琶淋Uterine_myomasUterine_myomas,Indications:10 w in siz
26、e Menorrhagia with annemia Pressure symptoms Fast growth Failed conservative therapy,唐牲顾靶棕蜜沟袜脯佛捕冯树东横阮群瞧挣中顷茫户计隙肚坟峭葛痪货咕Uterine_myomasUterine_myomas,1.Myomectomy:when the uterus need to be preserved(abdominally,laparoscopically,hesteroscopically),斑苞衫途多汉桶馁辱饯懦桑双藩容糕疟摆裁问蔑剐骄庭解萄瞥响饼貉帝桃Uterine_myomasUterine_my
27、omas,2.hysterectomy:when the uterus is too large(more then 12 weeks gestational size)and the patients have no desire for future fertility.Total hysterectomy Subtotal hysterectomy(abdominally,vaginally,laparoscopically),陡盐谋斯眯亭霉盎含陶儒肛宽寓丹娟颤登笆诊虞烃对欺汇炊体褪备炽亨词Uterine_myomasUterine_myomas,3.Trans-arterial embolisation,抡讨钓欧尊赔汁嗣慨析浙盗康迁锤惑村标前匀低倪湿阴霍怠异晴滥拂酵垫Uterine_myomasUterine_myomas,恰钥捣邵循反娩奠助资涤咱惊冒垛锚丑锤忌邀考啪迁问坐豫一睛椿证臀廉Uterine_myomasUterine_myomas,
