子宫肿瘤-妇产科课件PPT.ppt

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 Staging 分期 Stage 1: Tumor confined to the cervix Ⅰ期 肿瘤局限于宫颈 a Microinvasive carcinoma a 微浸润肿瘤 a1 stromal invasion ≤ 3 mm depth and ≤ 7 mm horizontal spread a1 间质浸润深度≤3 mm 宽度≤7 mm a2 Lesions with a depth 3 mm, but ≤ 5 mm, and a horizontal spread ≤ 7 mm a2 浸润深度3 mm ≤ 5 mm，宽度≤7 mm b Clinical lesions confined to the cervix b 肿瘤损害局限于宫颈 b l Tumor diameter ≤ 4 cm b1 肿瘤直径≤4 cm b2 Tumor diameter 4 cm b2 肿瘤直径4 cm Stage 2: Spread beyond the cervix, but not to the pelvic side wall, with involvement of upper two-thirds of the vagina Ⅱ期 超越宫颈但未达盆壁，侵犯阴道，但未及下1/3 a Vaginal spread, but no obvious parametrial spread a 侵犯阴道，无明显盆壁浸润 b Parametrial spread, but not as far as pelvic side wall b 宫旁浸润，但未达盆壁 Stage 3: Spread in the pelvis Ⅲ期 侵犯骨盆 a Involvement of lower one-third of the vagina a 侵犯阴道的下1/3 b Extension to the pelvic side wall or hydronephrosis b 扩散至骨盆壁或肾盂积水 Stage 4: Distant spread Ⅳ期 远处转移 a Spread to involve adjacent organs [bladder, rectum] a 侵犯临近组织（膀胱、直肠） b Distant spread b 远处转移 Clinic stage block diagram of cervical cancer