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1、Uterine Leiomyoma 子宫平滑肌瘤 (myoma ， fibroid),Hua Linghu 令狐华 Department of Obs/Gyn,Prevalence/incidence,25% - 50% reproductive womenIncreased incidence with ageAge incidence20-30yr 4 %30-40yr 11-18%40-50yr 33 %,Lurie S, Piper I, Woliovitch I, Glezerman M. Age-related prevalence of sonographically confi
2、rmed uterine myomas. J Obstet Gynaecol. 2005;25:424,Etiology/Epidemiology,Etiology unknown Increased risk factors40 years or olderFamily history of uterine fibroid NulliparityObesity Black race,Associated Factors,Female Hormones-Estrogen (雌激素)/ Progestron (孕激素)Clinical evidences: Reproducutive patie
3、nts No cases before pubertyNo new cases after menopause(停经)Increased during pregnancyEstrogen receptor (ER-)high concentration in black women,Intramural (60%-70%)肌壁间 Subserous(20%)浆膜下 Submucous (10%)粘膜下Cervical -2%,Classification I,ClassificationII,Single,Multiple,Pathology -gross structure,Frequent
4、ly multipleFirm, vary in size Spherical or irregularly lobulatedFalse capsule (假包膜) Whorled appearance (漩涡状结构),Pathology -microscopic structure,Hyaline 玻璃样变性yellow, soft gelatinous areas Cystic 囊性变liquefaction follows extreme hyalinizationRed (carneous) degeneration 红色变性Edema & hypertrophy impede bl
5、ood supply aseptic degenration & infarction with venous thrombosis & hemorrhage Other changes calcification 钙化hemorrhage 出血necrosis 坏死,SECONDARY CHANGES/ DEGENERATION,Hyaline /Cystic Degeneration,Red (carneous) degeneration,Usually occurs during pregnancy,Malignant Transformation rare 0.1-0.5%,leiom
6、yoma,leiomyosarcoma,Increased cell number Pathological nuclear fission病理性核分裂,Depend on location, size, changes & pregnancy status,Clinical Findings,Abnormal uterine bleeding most common 30% Heavy / prolonged bleeding (menorrhagia月经过多 ) -submucous/large intramural myoma pre & post-menstrual spotting
7、(月经前后淋漓出血 )-submucous myoma intermenstrtual bleeding (月经间期出血 )- Pedunculated submucous myoma,Clinical Findings-Symptoms,Pain/discomfort Heaviness fullness in the pelvic area(large fibroid ) back pain Dysparunea (性交痛 ) Pressure Effects Acute pain -Torsion, Red degenrationVascular occlusionMyometrial
8、contractions,Clinical Findings-Symptoms,Clinical Findings-Symptoms,Infertilityuncertain relationship multiple fibroids 20-40%Endocavitary 70%Spontaneous Abortion incidence before myomectomy 40%after myomectomy 20% intracavitary tumors,Enlarged uterus ( regular / irregular )or Normal uterus ( small )
9、or Midline mass contiguous with cervix,Clinical Findings-Signs,Complications in Pregnancy,Infertility 2/3 of women with fibroids & unexplained infertility conceive after myomectomy Red Degeneration During Labor Malpresentation 胎先露异常Obstruction of the birth canalCervical or isthmeic myoma necessitate
10、 CS,Symptoms Physical signs Ultrasonographic scanning Hysteroscopy 宫腔镜检查 MRI,Diagnosis,Diagnosisultrasonographic scanning,TAS,TVS,Diagnosis -MRI,leiomyoma,leiomyosarcoma,leiomyoma cystic change,Diagnosis -hysteroscopy宫腔镜检查,Stalk, pedicle,pregnancy other pelvic massesovarian tumor卵巢肿瘤, Tubo-ovarian a
11、bscess输卵管卵巢脓肿 other causes of uterine enlargementAdenomyosis 子宫腺肌症 other causes of abnormal bleedingEndometrial hyperplasia 子宫内膜增生Endometrial Ca 子宫内膜癌,Differential Diagnosis,Treatment,Individulization,Depends on Age Parity Pregnancy status Desire for future pregnancy General health Symptoms Size Loc
12、ation,Treatment,Choices of Management Follow-up Medication Focused Ultrasound ( high intensity focused ultrasound , HIFU ) Uterine artery embolization Surgery MyomectomyHysterectomy,Expectant management small lesion, perimenopausal pt. Medication (herbal medicine ,GnRH-a )suppress tumor preoperative
13、ly Focused Ultrasound ( high intensity focused ultrasound , HIFU )sonographic ablation 海扶公司 Uterine artery embolizationblock blood supply,Treatment,Model JC focused ultrasound tumor therapeutic system manufactured by Chongqing Haifu Technology Co., Ltd. (Chongqing, China),ablation focus,Uterine artery embolization,Surgery myomectomy 肌瘤摘除术Transabdominal 经腹手术Transvaginal 经阴道手术Laparoscopic 腹腔镜手术Hysteroscopic 阴道镜手术hysterectomy 子宫切除术 Transabdominal， Tranvaginal, Laparoscopic,Laparoscopic myomectomy,Transabdominal myomectomy,Thanks,
