子宫肿瘤-妇产科课件.ppt

Carcinoma of the uterus 子宫肿瘤 Department of Obstetrics and Gynecology 妇 产 科 Zhang Wei 张 蔚 Cervical tumors 宫颈肿瘤 Cervical intraepithelial neoplasia (CIN) 宫颈上皮内瘤样变 Cervical cancer 宫颈癌 Cervical intraepithelial neoplasia (CIN) 宫颈上皮内瘤样变 TBS types atypical squamous cells (ASC) 不典型鳞状上皮 Low-grade squamous intraepithelial lesion (LSIL) 轻度鳞状上皮内病变 High-grade squamous intraepithelial lesion (HSIL) 重度鳞状上皮内病变 transformation mechanism转化机制 squamous metaplasia 鳞状上皮化生 squamous epithelization 鳞状上皮化 Route of metastasis转移途径 Direct metastasis 直接蔓延 Lymphatic metastasis 淋巴转移 Hematogenous metastasis 血行转移 Route of metastasis转移途径 Direct metastasis 直接蔓延 Lymphatic metastasis 淋巴转移 Hematogenous metastasis 血行转移 Presentation 临床表现 Symptoms 症状 Signs 体征 Confined to cervix 局限于宫颈 At routine examination Postcoital bleeding 性交后出血 Cervix looks suspicious at time of smear 宫颈刮片时可疑 Postmenopausal bleeding Abnormal cells, indicative of invasive carcinoma on cytology 异常细胞，细胞学提示浸润癌 Intermenstrual bleeding 月经间期出血 绝经后出血 常规检查 Offensive, blood-stained vaginal discharge 血性白带 At colposcopy 阴道镜检查 Spread to adjacent structures 侵犯临近组织 Heavy, contact bleeding 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 irregular surface contour 表面轮廓不规则 Renal failure - bilateral ureteric obstruction 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、 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） Lower limb oedema - extensive pelvic side wall infiltration 骨盆侧壁广泛浸润－下肢水肿 Staging 分期 b 宫旁浸润，但未达盆壁 b Parametrial spread, but not as far as pelvic side wall a 侵犯阴道，无明显盆壁浸润 a Vaginal spread, but no obvious parametrial spread Ⅱ期 超越宫颈但未达盆壁，侵犯阴道，但未及下1/3 Stage 2: Spread beyond the cervix, but not to the pelvic side wall, with involvement of upper two-thirds of the vagina b2 肿瘤直径4 cm b2 Tumor diameter 4 cm b1 肿瘤直径≤4 cm b l Tumor diameter