妇产科学-Ademomyosis.ppt

Adenomyosis Obstetrical Gynecological Hospital Fudan University Xie Kang-Yun, MD cndrxie@ Schematic diagram of female internal genitals Preface Basic Concepts Definition of Adenomyosis: Presence of functioning endometrial glands and stroma in the myometrium. Myometrial cells around become hypertrophy and hyperplasia compensatively Epidemiology Common in pluripara of 30-50 year-old, and often complicated by myoma. Incidence of chronic pelvic pain is 15% in American women, reported by Scialli(1999), mainly of them are patients of adenomyosis and endometriosis Adenomyosis was account for 7.8% in 2669 gynecological operation patients during more than 10 years (1961-1974), collected by Beijing Union Hospital. Epidemiology Adenomyosis was account for 24.9% in 1334 removed uterine specimen, reported by Vercellini (1995). General incidence of adenomyosis is 5%-70％, reported by literatures. Pathogenesis Pathogenesis The pathogenesis is not known. Propose by Cullen in 1908, the theory of direct growth of the basal layer of endometrium into the myometrium is widely accepted. Pathogenesis Estrogen has been implicated as a stimulus to the development of adenomyosis. The symptomatic improvement that occurs with the onset of menopause supports this concept. Pathogenesis Induction Factors Inheritance Trauma (curettage / cesarean section ) Hyperestrogenemia Virus infection Pathology Pathology Macroanatomy Uterus enlarges uniformly, like a ball. Usually not bigger than 12 weeks of gestation. Thick muscle fiber and micro vesicle seen in myomerium. Occasionally, old blood in the vesicle. Some grew like myoma, called adenomyoma. Pathology Microscopic examination Endometrial glands and stroma in the myometrium, scattered like islands. Ectopic glands usually in proliferate phase. Local secretory changes seen occasionally. Clinical manifestations Clinical manifestations: Symptoms Common in pluripara of over 40 year-old. No symptoms in 35％ of patients. Menstrual amount increased, fl