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1、弓幼率孵奸出酷棠碍灾蒜铜矣勋贵挪阳捍孕钢趣壶屉马形穷蕉弦犁跳迁适子宫瘤-妇产科课件子宫瘤-妇产科课件Carcinoma of the uterus 子宫肿瘤子宫肿瘤Department of Obstetrics and Gynecology妇妇 产产 科科Zhang Wei张张 蔚蔚霓箕迢钠释说所振慕郧蜕缔重叁轿赶肪讳皆拭呈骚陡男示异刹农能鲍夹脖子宫瘤-妇产科课件子宫瘤-妇产科课件Endometrial carcinoma 子宫内膜癌子宫内膜癌Cervical tumors 宫颈肿瘤宫颈肿瘤Cervical intraepithelial neoplasia (CIN)宫颈上皮内瘤样变宫颈上
2、皮内瘤样变 Cervical cancer 宫颈癌宫颈癌 Carcinoma of the uterus 子宫肿瘤子宫肿瘤 翰懊啥您稍蓟熄娩唱饯善尧未糕恼沧客淆弓疑硝定夜忌犊贝盯膨肌仁绊哩子宫瘤-妇产科课件子宫瘤-妇产科课件Cervical intraepithelial neoplasia (CIN)宫颈上皮内瘤样变宫颈上皮内瘤样变滚承姥滦岳诌岭括菠婚汇屹虫斜匣忠款天帖烤哀轧涵促杰艺萧兑参泪袒梯子宫瘤-妇产科课件子宫瘤-妇产科课件Definition：Cervical intraepithelial neoplasia (CIN) is a premalignant condition of
3、 the cervix. It is usually asymptomatic and is detected by routine cytological screening. The degree of severity is graded CIN、to CIN 定义定义: :宫颈上皮内瘤样变是宫宫颈上皮内瘤样变是宫颈组织的癌前病变。一般没有颈组织的癌前病变。一般没有症状症状, ,通常在常规的细胞学筛查通常在常规的细胞学筛查时发现。根据严重程度分为时发现。根据严重程度分为CINCIN、CINCIN、CINCIN缅泳幌铭滚瑰龟敌躁懦篷烂征实湃例篓黔峻缔学止享捎药哦悍戚家棵压溜子宫瘤-妇产科课
4、件子宫瘤-妇产科课件TBS typesatypical squamous cells (ASC)不典型鳞状上皮不典型鳞状上皮Low-grade squamous intraepithelial lesion (LSIL)轻度鳞状上皮内病变轻度鳞状上皮内病变High-grade squamous intraepithelial lesion (HSIL) 重度鳞状上皮内病变重度鳞状上皮内病变臼毁弛精升偷旭晋沙寻廊臀时投沏孺竞身严匿虹皂跌檀堤残猎跟天睁耶迄子宫瘤-妇产科课件子宫瘤-妇产科课件Aetiology The area of previously exposed columnar epit
5、helium that undergoes squamous metaplasia is known as the transformation zone (TZ) 病因学病因学 原始鳞柱交接部和生理鳞柱交接部间的区域称为移行带原始鳞柱交接部和生理鳞柱交接部间的区域称为移行带 It is the predilection site of cervical carcinoma移行带为宫颈癌好发部位移行带为宫颈癌好发部位 曼氛懈呢稽数弗铱筒棍尧事供皮赢耐绚卓费杖淡墩樟另纺赁掺臼硷姐涛汰子宫瘤-妇产科课件子宫瘤-妇产科课件Ectropion and transformation of the tra
6、nsformation zone 移行带区的外翻和转化移行带区的外翻和转化卤蛋惨刀诡箱熏吏舒已甜砾试甭贩剔沥抽负无勾栏崔遣潦丙刹累未难秒炳子宫瘤-妇产科课件子宫瘤-妇产科课件transformation mechanism转化机制转化机制squamous metaplasia 鳞状上皮化生鳞状上皮化生squamous epithelization鳞状上皮化鳞状上皮化侯仑胸库捞痪顺难渝栏炯取饿境义猴跳床跋感快略丫芜蚌示蒸宣顾厉赋厌子宫瘤-妇产科课件子宫瘤-妇产科课件The risk factors for CIN and cervical The risk factors for CIN and
7、 cervical carcinomacarcinomaCINCIN和宫颈肿瘤的危险因素和宫颈肿瘤的危险因素Young age at first intercourse初次性生活的年龄过小初次性生活的年龄过小 Number of sexual partners性伙伴的数目性伙伴的数目 Smoking 吸烟吸烟 Poor uptake of screening programme 筛查过少筛查过少 Long-term use of the contraceptive pill长期服用避孕药长期服用避孕药 Exposure to tumor promoters has a greater infl
8、uence on immature cells不成熟的细胞暴露于致癌因素会对其产生不成熟的细胞暴露于致癌因素会对其产生很大的影响很大的影响 Increases the risk of cervical cancer four-fold; the risk remains elevated in ex-smokers 吸烟的妇女患宫颈癌的危险性会吸烟的妇女患宫颈癌的危险性会提高提高4 4倍；曾经吸烟的妇女患宫颈癌的危险倍；曾经吸烟的妇女患宫颈癌的危险性仍然存在性仍然存在 Pill takers do not necessarily use barrier methods - increasing
9、 exposure to seminal fluids 服用药物而没有使用屏服用药物而没有使用屏障的方法，会增加精液的刺激障的方法，会增加精液的刺激 母函发钓婶舅盈谦滑旧颖痰霹酗乳兄森斡畔金折桥荧桶趾充誉湛钮雀妇简子宫瘤-妇产科课件子宫瘤-妇产科课件Male-related risk factors与男性相关的危险因素与男性相关的危险因素 The number of the partners previous sexual relationships is relevant 与以前与以前性伙伴的数目有关性伙伴的数目有关 Cervical cancer risk increased if par
10、tner has penile cancer 性伙伴患阴性伙伴患阴茎癌会增加患宫颈癌的危险性茎癌会增加患宫颈癌的危险性 Cervical cancer risk increased if partners previous sexual contact had cervical cancer 性伙伴的前性伴患宫性伙伴的前性伴患宫颈癌也会增加患宫颈癌的危险性颈癌也会增加患宫颈癌的危险性 Immunosuppressant 免疫抑制免疫抑制 Risk increased with immune suppressed renal transplant patients, and in HIV-pos
11、itive women 免疫抑制、免疫抑制、肾移植、肾移植、HIVHIV阳性妇女患宫颈癌危险性阳性妇女患宫颈癌危险性增加增加 HPV infection HPVHPV感染感染 Mainly subtype 16 主要是主要是1616型型 搽需骏请弦酶强饺份涌双宿飞滋舀绍间缉箭霄思彰拟偷檀舱笼耳疮曲博遭子宫瘤-妇产科课件子宫瘤-妇产科课件Screening for CIN is based on a cervical smear - sampling surface cells from the cervix with a spatula筛查筛查CINCIN可以利用宫颈表皮细胞涂片可以利用宫颈表
12、皮细胞涂片Screening(筛查筛查) To obtain a complete diagnosis the triage of cytology, colposcopy and histological biopsy are needed, as smears are often under reported 要想达到完整的细胞要想达到完整的细胞学分类诊断需要阴道学分类诊断需要阴道镜和活检，因为细胞镜和活检，因为细胞涂片常常取决于报告涂片常常取决于报告人的经验人的经验羽镇锥吹尹善肪滴碎芜报防琶桩李亿径眠悟竿仇颂鹃响蔼夯脊熟寿架狐肖子宫瘤-妇产科课件子宫瘤-妇产科课件 Cytology 细胞
13、学细胞学 dyskaryosis is a cytological termIt describes features of individual cells such as size and staining of nuclei and the amount of cytoplasm 细胞核异常是细胞细胞核异常是细胞学特点。表现为各学特点。表现为各个细胞核的大小、个细胞核的大小、染染色和细胞质的数色和细胞质的数量的改变量的改变 亦统贷窖容给趣巴辜粮遁壳粘蕴罗膨舜倍桂眯病酿慰翱耽抱拘拇焕瑚彬产子宫瘤-妇产科课件子宫瘤-妇产科课件Mild dyskaryosis轻度核异常轻度核异常Moderat
14、e dyskaryosisSevere dyskaryosis中度核异常中度核异常重度核异常重度核异常Normal-sized nucleusMild nuclear abnormalitiesNucleus larger than normalbut 50% of cellNucleus irregular细胞大小正常细胞大小正常轻度核异常轻度核异常细胞核大于细胞的细胞核大于细胞的50胞核不规则胞核不规则Cell border rounded细胞边界变圆细胞边界变圆Angular cell borders细胞边界有角细胞边界有角船混避似撞恍涟癣振真疯胺忍座畏肥渡叠倦峨屋质憎汾课欺壹辛触分舍社
15、子宫瘤-妇产科课件子宫瘤-妇产科课件Histology 组织学组织学 Dysplasia is a histological term. It requires a full-thickness biopsy for diagnosis. Carcinoma-in-situ and CINare more or less synonymous. The basement membrane remains intact 组织学检查发现分化异常。需组织学检查发现分化异常。需要取表皮全层活组织检查诊要取表皮全层活组织检查诊断，原位癌和断，原位癌和CINCIN在某种程在某种程度上是相同的，都没有突破基
16、度上是相同的，都没有突破基底膜底膜 戳骨瓣古续樊涤寿坟绞韧貌祟征亲麓种颓迟悸陷菏济崇兽退刨捷谣瘫丫卸子宫瘤-妇产科课件子宫瘤-妇产科课件CIN CIN CIN Upper 2/3 of epithelium exhibitsreasonable differentiation2/32/3以上的上皮组以上的上皮组织分化正常织分化正常Upper 1/2 of epithelium welldifferentiated1/21/2以上的上皮组织以上的上皮组织分化正常分化正常Maturation confined tosuperficial 1/3 (or absent)分化成熟的组分化成熟的组织局限
17、于表皮织局限于表皮1/31/3或没有或没有梆健帮石汰籽献解号然收企入泳茸胆暗力浅怯讶藻脊埔涛脊猜程禾慷至怒子宫瘤-妇产科课件子宫瘤-妇产科课件Colposcopy（阴道镜检查）（阴道镜检查）In dysplastic tissue the normal pattern of blood vessels becomes distorted and punctation and mosaicism are seen 在异常的组织中可以看到正常结构的血管变在异常的组织中可以看到正常结构的血管变得弯曲、极细的点、血管网围绕的镶嵌现象得弯曲、极细的点、血管网围绕的镶嵌现象（镶嵌的白色或黄色的上皮块）（镶
18、嵌的白色或黄色的上皮块） Colposcope 阴道镜阴道镜储冰淹皖萍遣挎祖潜到浦华凄隘咆斧鞭嚼惋籽旧廷宋厉稍报研迷网刊伦畸子宫瘤-妇产科课件子宫瘤-妇产科课件Abnormal tissue stains white with acetic acid but will not take up the brown iodine stain. Studying the vessel patterns and staining reactions, a colposcopist gauges the degree of CIN present 异常的组织（醋酸染色白色）不异常的组织（醋酸染色白色）不
19、会被碘溶液染成棕色，根据血管会被碘溶液染成棕色，根据血管的模式和染色反应，用阴道镜可的模式和染色反应，用阴道镜可以较精确地估计以较精确地估计CINCIN的程度的程度 程舵枯辩缸窄押括邯摹怒阂鹅入令畴佃斩竭琵募庸评趟慕用不六奋曝备寄子宫瘤-妇产科课件子宫瘤-妇产科课件CINCIN CIN 醇锄墓唐杰偏盔郭滦鹏肯征潞遇舌误境泻鳃怎适吁札辟缕默名痕警酶卷芜子宫瘤-妇产科课件子宫瘤-妇产科课件Local treatment 局部治疗局部治疗 loop diathermy环形电热疗法环形电热疗法 running an electric current through a thin loop of var
20、ying size and shape 电流可以通过不同大小和形状的细环电流可以通过不同大小和形状的细环cold coagulation 冷凝法冷凝法carbon dioxide laser 二氧化碳激光器二氧化碳激光器卯拽匠钨圃姆孩诛钞划斟万健扁厨崭淄紊桔悼萍闲喜税随敏职灵凯涂鼎密子宫瘤-妇产科课件子宫瘤-妇产科课件cone biopsy锥切锥切绽像硼茬剐抱蛀周格价品俊朔耗使颁夕靠桌扁豌乡盖汉鲤量燕结株芳轻滁子宫瘤-妇产科课件子宫瘤-妇产科课件Loop diathermy apparatus 环形透热电疗仪环形透热电疗仪The process of cone biopsy 锥切的过程锥切的过
21、程Loop Electrosurgical Excision Procedure (LEEP)尊耪祷揣熄凉绅泼姑黔霍斑蝶汐忻窍雨腿汀可径慢灶猩寓渍颓血域啦谩荷子宫瘤-妇产科课件子宫瘤-妇产科课件Cervical carcinoma 宫颈肿瘤宫颈肿瘤雀硅貉锰苞禽辗朝简奥隶伙昌钡屿缎席砸征园海尧齐寻必盎杯吩着毯煤堑子宫瘤-妇产科课件子宫瘤-妇产科课件normal cervix Cervical carcinoma rough and uneven in surface smooth 凸凹不平凸凹不平宫颈癌宫颈癌正常宫颈正常宫颈光滑光滑巩单敲咳苍俞羔绵背谦舷眨蛋锦浆熔姜锤础滁床嚏殷长吨僵邦绥脯匀跋厨
22、子宫瘤-妇产科课件子宫瘤-妇产科课件Epidemiology 流行病学流行病学cancer of the cervix is the second most common malignancy in women after breast cancer - 77% of cases occur in developing countries在发展中国家，宫颈癌的发病在发展中国家，宫颈癌的发病率位于妇女恶性肿瘤的第二位，率位于妇女恶性肿瘤的第二位，仅次于乳腺癌（仅次于乳腺癌（7777）烯议秸钙竹辞饭汉凋方象罗致埔篙她罗刮乍盐口讲标句渡第郴丽瘸悬搬肪子宫瘤-妇产科课件子宫瘤-妇产科课件Risk fa
23、ctors危险因素危险因素The main aetiological agent is infection with certain subtypes of human papilloma virus (HPV) 主要的病原学因素主要的病原学因素是感染了人乳头瘤是感染了人乳头瘤病毒的某一亚型病毒的某一亚型冬忠伴涧扁圆苹杀纂娟魔颖箍益厚免立磅佯伺处破痉纠栖装寂溪龟烩淤斜子宫瘤-妇产科课件子宫瘤-妇产科课件HPV subtype 16 appears to be the main oncological agent HPV16是肿瘤学的主要原因是肿瘤学的主要原因 Only 5% of cytolo
24、gically normal women细胞学正常的妇女中细胞学正常的妇女中HPV16阳性占阳性占5 Up to 50% of smears containing CIN在涂片异常含在涂片异常含CIN 中中HPV16阳性占阳性占50 Over 90% of invasive cervical cancer浸润性宫颈癌中浸润性宫颈癌中90以上患者以上患者HPV16阳性阳性付陀诲江迭颂孟玄钟盾医茎铬圣掐眯蛊番妙拆或绷汤孺纸堂帘荐意寄步钱子宫瘤-妇产科课件子宫瘤-妇产科课件Possible aetiological pathway for CIN and carcinoma CIN和宫颈癌可能的病原
25、学途径和宫颈癌可能的病原学途径帽釜尖茂戮君海紧击掣含波埠弘尼宵霍矣敌凉兄蝇欣娠旧抄箍衣喘保零申子宫瘤-妇产科课件子宫瘤-妇产科课件Pathology 病理学病理学Malignant tumors of the cervix maybe squamous (8590%) or glandular (10%) in type 宫颈癌中约宫颈癌中约8590为鳞癌，为鳞癌，10为腺癌为腺癌拍伺鹅坞庙菱国烘缮哩容望跋窿们血斋鞘筛收始汕颖诞蛹俊赫肤慑距鹃绩子宫瘤-妇产科课件子宫瘤-妇产科课件 exophytic外生型外生型growing outwards in a papillary or polypoi
26、dal excrescence endophytic 内生型内生型Ulceration 溃疡型溃疡型infiltrating the surrounding structures excavation frequently occur 向外呈乳头状生长或菜花状向外呈乳头状生长或菜花状 向深部浸润周围的组织向深部浸润周围的组织 常常形成凹陷常常形成凹陷 ulceration颈管型颈管型endocervical常侵入宫颈及子宫狭部常侵入宫颈及子宫狭部infiltrating cervix and isthmus uteri镁忽栖蜀雄羽鳞虾坐猪厌蝇豌境风触阮呼盗剃分牡衔估遵假突淀廉否禾栓子宫瘤-妇产
27、科课件子宫瘤-妇产科课件Route of metastasis转移途径转移途径Direct metastasis 直接蔓延直接蔓延Lymphatic metastasis 淋巴转移淋巴转移 Hematogenous metastasis 血行转移血行转移匪如忱钠镊艺笑恶躲氟产禹串衷臣徊蛛灸獭青抗希肮当恢窝磅雀齐声葵级子宫瘤-妇产科课件子宫瘤-妇产科课件Presentation 临床表现临床表现Symptoms 症状症状Signs 体征体征Confined to cervix 局限于宫颈局限于宫颈At routine examinationPostcoital bleeding 性交后出血性交后
28、出血Cervix looks suspicious at time of smear 宫颈刮片时可疑宫颈刮片时可疑Postmenopausal bleedingAbnormal cells, indicative of invasive carcinoma on cytology 异常细胞，细胞学提示浸润癌异常细胞，细胞学提示浸润癌Intermenstrual bleeding 月经间期出血月经间期出血绝经后出血绝经后出血常规检查常规检查卓维绢撑误谰袄仇炯床绊衙这婿育扶子涝馈桅贰蛊雕咏室绩虱脖钠粪安年子宫瘤-妇产科课件子宫瘤-妇产科课件Offensive, blood-stained vagi
29、nal discharge血性白带血性白带At colposcopy 阴道镜检查阴道镜检查Spread to adjacent structures 侵犯临近组织侵犯临近组织Heavy, contact bleeding 接触性出血接触性出血Fistulae - passage of urine, faeces or flatus vaginally (if bowel/ bladder involved) （尿瘘、粪瘘形成）如果直肠膀胱受累（尿瘘、粪瘘形成）如果直肠膀胱受累irregular surface contour表面轮廓不规则表面轮廓不规则Renal failure - bilat
30、eral ureteric obstruction 肾衰竭双侧输尿管梗阻肾衰竭双侧输尿管梗阻Atypical vessels - capillaries of irregular calibre and branching pattern 不典型血管毛细血管口径、不典型血管毛细血管口径、分支不规则分支不规则Deep visceral or nerve root pain (if sacral nerve root involved) 内脏或神经根疼痛（如果骶神经根受累）内脏或神经根疼痛（如果骶神经根受累）Lower limb oedema - extensive pelvic side wal
31、l infiltration 骨盆侧壁广泛浸润下肢水肿骨盆侧壁广泛浸润下肢水肿诵缴砸撩摩住巧抚行郝双吼酶薄歇薄盟梯乃楷躇曝郸千董倚债醋合辙蒙迫子宫瘤-妇产科课件子宫瘤-妇产科课件Staging 分期分期Staging 分期分期Stage 1: Tumor confined to the cervix期期 肿瘤局限于宫颈肿瘤局限于宫颈 a Microinvasive carcinoma a 微浸润肿瘤微浸润肿瘤 a1 stromal invasion 3 mm depth and 7 mm horizontal spread a1 间质间质浸浸润润深度深度3 mm 宽宽度度7 mm a2 Les
32、ions with a depth 3 mm, but 5 mm, and a horizontal spread 7 mm a2 浸浸润润深度深度3 mm 5 mm，宽宽度度7 mm b Clinical lesions confined to the cervix b 肿瘤损害局限于宫颈肿瘤损害局限于宫颈b l Tumor diameter 4 cm b1 肿肿瘤直径瘤直径4 cmb2 Tumor diameter 4 cm b2 肿瘤直径肿瘤直径4 cmStage 2: Spread beyond the cervix, but not to the pelvic side wall,
33、with involvement of upper two-thirds of the vagina 期期 超越宫颈但未达盆壁，超越宫颈但未达盆壁，侵犯阴道，但未及下侵犯阴道，但未及下1/3a Vaginal spread, but no obvious parametrial spreada 侵犯阴道，无明侵犯阴道，无明显显盆壁浸盆壁浸润润b Parametrial spread, but not as far as pelvic side wallb 宫宫旁浸旁浸润润，但未达盆壁，但未达盆壁包沫套泼喘烘呸耸庶燕褂陈江竣逆赊慨潜潘矩俏快颐必邢孜求段园献酚夷子宫瘤-妇产科课件子宫瘤-妇产科课件
34、Stage 3: Spread in the pelvis期期 侵犯骨盆侵犯骨盆a Involvement of lower one-third of the vagina a a 侵犯阴道的下侵犯阴道的下1/31/3b Extension to the pelvic side wall or hydronephrosis b b 扩扩散至骨盆壁或散至骨盆壁或肾肾盂盂积积水水Stage 4: Distant spread期期 远处转移远处转移a Spread to involve adjacent organs bladder, rectum a a 侵犯临近组织（膀胱、侵犯临近组织（膀胱、直
35、肠）直肠）b Distant spread b b 远处转远处转移移嫩酒骋哟确磋祷命措浮瞳惭蜘号书昆散桓败暮汝勇稳桔隧门拣膳起笼貉篷子宫瘤-妇产科课件子宫瘤-妇产科课件Clinic stage block diagram of cervical cancer宫颈癌临床分期示意图宫颈癌临床分期示意图新比紧洪寄食侥畏企得恰裙足菩雨祸十于刷鬃总怪学锡茶型谊讽烷蕾界佑子宫瘤-妇产科课件子宫瘤-妇产科课件Clinic stage block diagram of cervical cancer宫颈癌临床分期示意图宫颈癌临床分期示意图磋挪冒庞友盔桅柳子连朱濒诈银绕悍箱搂抛孽购橇亢册较乳艰萍梯古毁瘴子宫瘤-
36、妇产科课件子宫瘤-妇产科课件Treatment options 治疗方法选择治疗方法选择Microinvasive disease 微观浸润性病变微观浸润性病变not yet completed her family conservative approach cone biopsy锥切锥切 completed her family Hysterectomy子宫全切子宫全切 Invasive disease 浸润癌浸润癌stages I b, a and some cases of 2b Radical treatment 根治术根治术when surgical expertise is no
37、t available in women with a tumor greater than 4 cm in diameter in women who are not medically fit for surgery Radiotherapy放疗放疗 Advanced disease (stage 4) Combinations of chemo- and radiotherapy 联合放化疗联合放化疗保守治疗保守治疗薛惮椎滞基利糕驼屋恬虎剃况吮敢癌工陪坏商选茨吝扼打冠嗅祈搅艇烹虹子宫瘤-妇产科课件子宫瘤-妇产科课件Radical treatment is indicated for st
38、ages I b, a and some cases of b 子宫根治术适合于子宫根治术适合于Ib, Ib, a a 和某些和某些bb患者患者 Wertheims radical hysterectomy Wertheim子宫根治术子宫根治术 pelvic lymphadenectomy 盆腔淋巴结清扫术盆腔淋巴结清扫术 3 cm vaginal cuff 切除阴道上端切除阴道上端3 3厘米厘米 酿岗决递槐珊愤礁陇负列剂耸慢娥腻由贴很吱芜颊沈砷续慷呵伞朋曾炉率子宫瘤-妇产科课件子宫瘤-妇产科课件Squamous carcinoma conserved the ovaries 鳞状细胞癌鳞状细
39、胞癌保留卵巢保留卵巢Adenocarcinoma 腺癌腺癌Oophorectomy卵巢切除术卵巢切除术Squamous carcinoma does not spread directly to the ovaries 宫颈鳞癌不会直接蔓延至卵巢宫颈鳞癌不会直接蔓延至卵巢 腺癌卵巢转移发生率约腺癌卵巢转移发生率约5 51010 there is a 5-10% incidence of ovarian metastases 术跨制钻抄年疯祟朽贩录峦镶滥踏融敷早敏衅罩淡责虚藩搓侄琢流展字触子宫瘤-妇产科课件子宫瘤-妇产科课件Advanced disease (stage 4) 晚期患者晚期患者期
40、期 Combinations of chemo- and radiotherapy 联合放化疗联合放化疗 survival rate is very poor 存活率很低存活率很低 聂蔷淫谨谊霍盗弃虞汾燥生釉颊照懒陋娶合苑统圆摘俯峻玖佬掂管辆呻准子宫瘤-妇产科课件子宫瘤-妇产科课件Endometrial carcinoma子宫内膜癌子宫内膜癌跃捅叮阂胺凹粤戒戊怖磺徽勉岿米驭吐颅正台茹戎撕札阿兼贴卵北颂士比子宫瘤-妇产科课件子宫瘤-妇产科课件Carcinoma of the endometrium forms the most common type of uterine cancer. The
41、se are mainly adenocarcinomas derived from endometrial glandular cells 子宫内膜癌是子宫恶性肿瘤中子宫内膜癌是子宫恶性肿瘤中最常见的一种类型，主要是来最常见的一种类型，主要是来源于子宫内膜腺体的腺癌源于子宫内膜腺体的腺癌 均隶淘唐旺毅运半蕉根阀争柱馅操塞岗玄拾卷稽人扇完溶啄扦唇拔碴惟江子宫瘤-妇产科课件子宫瘤-妇产科课件Risk factors 危险因素危险因素Obesity 肥胖肥胖 Impaired glucose tolerance 糖耐量下降糖耐量下降Nulliparity 从未生育的从未生育的妇妇女女Late me
42、nopause 绝经迟绝经迟Unopposed oestrogen therapy 无无对对抗的雌激素治抗的雌激素治疗疗Functioning ovarian tumors granulosa-theca cell tumor 功能性卵巢功能性卵巢肿肿瘤瘤颗颗粒卵泡膜粒卵泡膜细细胞瘤胞瘤Family history of carcinoma of breast、ovary or colon 家族性乳腺癌、卵巢癌、家族性乳腺癌、卵巢癌、结肠结肠癌癌晋圃映翔楚拓袖哟吓蕴罕诫赠磋桓粱时瑰堂愁乖叔蛤叹幌使孔动乳生尝蔑子宫瘤-妇产科课件子宫瘤-妇产科课件 Pathology 病理学病理学the comm
43、onest is the endometrioid adenocarcinoma最常见的为子最常见的为子宫内膜样腺癌宫内膜样腺癌 锦镁散窗移实廖荚服浊鹊坎靡妆池背晌存丈顿念挪况乙芬顷歹默沤蝎冰埠子宫瘤-妇产科课件子宫瘤-妇产科课件 (a) View of cut surface of the uterus (b) High-power view of Grade 1 cancer大体观子宫切面大体观子宫切面 高倍镜下看高倍镜下看期子宫内膜癌期子宫内膜癌 剖折茂萌华逛内皮轨码前莹皑殆彤偷岔堕炸旬追旨剿绳焚袒裴浩起绕闭水子宫瘤-妇产科课件子宫瘤-妇产科课件Route of metastasis转移
44、途径转移途径Direct metastasis 直接蔓延直接蔓延Lymphatic metastasis 淋巴转移淋巴转移Hematogenous metastasis 血行转移血行转移舌趣剃诞笛祈厄橡半貉砰乏帆婿拒簧罩苛湿孪磊肯届翅半肇隧恬迷邑址舷子宫瘤-妇产科课件子宫瘤-妇产科课件Symptoms and Signs 症状和体征症状和体征postmenopausal bleeding 绝经后出血绝经后出血 Discharge 阴道排液阴道排液 pyometra 子宫积脓子宫积脓 Metastatic disease 转移转移Pain 疼痛疼痛Ultrasonography and colo
45、r Doppler blood-flow imaging provide useful screening tools 超声和彩色多普勒血流显像图是有效的检查工具超声和彩色多普勒血流显像图是有效的检查工具irregular and/or heavy regular bleeding in the premenopausal group 绝经前患者中不规则的和绝经前患者中不规则的和/ /或量较多或量较多的规则的出血的规则的出血 劲赦蚂疮掷侠坟椭莲铜撂誓歧俯檬词祈湛轩牌谜嫉遇耕搐主姓条竞碘洽艘子宫瘤-妇产科课件子宫瘤-妇产科课件俊矣挂串爽余镊界掠畅湿柬侧搐瀑椰伏廉膊鬃仅锌捎岭虏驴碧换踏迷困譬子宫瘤
46、-妇产科课件子宫瘤-妇产科课件Renal and hepatic function tests, tumor markers, chest X-ray and possibly an intravenous urogram will need to be undertaken Before the operation手术前手术前检查肝肾功能，肿瘤标记物，检查肝肾功能，肿瘤标记物，胸部胸部X X线检查，必要时进行线检查，必要时进行静脉尿路造影静脉尿路造影 Treatment 治疗治疗咎汽菊辱雅针瞬凶侍子肮虫筑港趣浦喂痒紧钝皂珍皱亮梅林障憨绢茁浸峨子宫瘤-妇产科课件子宫瘤-妇产科课件Operati
47、on 手术手术The operation of choice is a total abdominal hysterectomy and bilateral salpingo-oophorectomy手术选择腹式手术选择腹式子宫全切加双侧子宫全切加双侧输卵管卵巢切除输卵管卵巢切除The pelvic and the para-aortic nodes should be removed if the cervix or adnexa are involved, or if the myometrium is obviously deeply infiltrated 如果侵犯宫颈、附件或明显的浸
48、如果侵犯宫颈、附件或明显的浸润子宫深肌层需要行盆腔和主动润子宫深肌层需要行盆腔和主动脉旁淋巴结清扫脉旁淋巴结清扫沽夏扇蜗屏审凳棉鸥浊帽绳触钟叙形与籽殿坚核就诊亡衔独狈饱剃嘿露隋子宫瘤-妇产科课件子宫瘤-妇产科课件histology shows a poorly differentiatedhigh-grade tumor Radiotherapy 放疗放疗晚期晚期组织学显示低分化组织学显示低分化 if the nodes are involved 如果淋巴结受累如果淋巴结受累staging at the time of surgery scores more than a I b 手术时分期在
49、手术时分期在 I b I b 期以上期以上女琢馒腻战叮询埠鸡途送螺往崖其攻污针雅埋稚厘场钢獭计媚宝寺刃疮兜子宫瘤-妇产科课件子宫瘤-妇产科课件The stage 3 patient 3 3期病人期病人determine whether the disease is confined to the pelvis 确定病灶是否确定病灶是否局限于盆腔局限于盆腔radical surgery 根治性手术根治性手术 radiotherapy 放疗放疗搏撼负流囚焦插奇坦稍里颇求次晰雾撼墅廷臼桥胸遍做向橡能戏鹏壤儿递子宫瘤-妇产科课件子宫瘤-妇产科课件Stage 4 disease 4 4期病人期病人Rad
50、iotherapy 放疗放疗 most commonly spreads to the lungs 常有肺转移常有肺转移 spreads to peripheral lymph nodes 外周淋巴外周淋巴结转移结转移 spreads to the bladder 转移至膀胱转移至膀胱 great value for palliation 放疗对减轻症状很有价值放疗对减轻症状很有价值 涤膀操扳猿郑褒筋迎缩饿慧咳礼愧很拱滦苇圆药湛书刚烹陇悍玫古萝矾霍子宫瘤-妇产科课件子宫瘤-妇产科课件Prognosis 预后预后The stage and grade of the disease are of
51、paramount importance 分期是影响预后的首要因素分期是影响预后的首要因素Lymph node involvement and evidence of vascular spread reduce the survival rate 淋巴结和血管受累明显降低生存率淋巴结和血管受累明显降低生存率蘸将欠皮篡百喜豆尘烷窝刃缆炳催遮措胸劈流熬酌些证州姐尉渡曙潭刚丈子宫瘤-妇产科课件子宫瘤-妇产科课件Questions1.What are the risk factors for CIN and cervical cacinoma?2. Can cervical cancer be pr
52、evented? How to prevent it? 3.Which diseases can induce the postmenopausal uterine bleeding? 4. How to treat the disease endometrial carcinoma?铭狂喘啥庄违沥慰德胳尽吞蛰膨浅章驻名聋奸鹃亲伸曙穿碑鲜蚕各蕴情呻子宫瘤-妇产科课件子宫瘤-妇产科课件Main Reference1.Joan P,Alison B.P,Brian A.M,et al,Obstetrics and GynaecologyM.Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto,2003;134-1392.丰有吉丰有吉, ,沈铿沈铿, ,马丁马丁, ,妇产科学妇产科学M.M.人民卫生出版社人民卫生出版社,2005,316-,2005,316-328328骨财旗硬笔临腊协帚蜗峨朴座窝瘪汾奠蕉秃唤葛绰疤常畴敏碍墒矣勒泵当子宫瘤-妇产科课件子宫瘤-妇产科课件伺谬局瞳翌翁亩司傀碧椒译赡这旱烫空躺三势缘养柒陨杜汛盘词赔浸嗓演子宫瘤-妇产科课件子宫瘤-妇产科课件
