七年制医学课件 妇产科 24Uterine Leiomyoma.ppt

Uterine Leiomyoma子宫平滑肌瘤 (Fibromyoma, Myoma) 肌纤维瘤 肌瘤 Age 30-50 The benign （良性） and the most common tumor of the female reproductive system Etiology female hormones 女性激素 (estrogen, progestin) 雌激素 孕激素 1. Occur in reproductive age (30-50) 2. No new formation in postmenopause 3. Increase in size during pregnancy Classification 1. Intramural myoma （肌壁间）60-70% 2. Subserous myoma （浆膜下） 20% 3. Submucous myoma （粘膜下） 10-15% Intramural myoma increased menstrual loss Subserous myoma Torsion（扭转） may occur and cause pain Submucous myoma Irregular or heavy menstrual bleeding Pathology Naked eye appearance 1. whorled pattern (漩涡状结构） 2. false capsule (假包膜) Microscopical structure Degeneration (变性) homogeneous /transparent appearance structureless eosinophilic （嗜酸性）mass liquefaction (液化）of the areas of hyaline change Red degeneration (红色变性） Incidence 0.4%-0.8% Grow quickly in short period Irregular vaginal bleeding Increase in postmenopause Clinical Findings depending on the size, position and number of the tumors A. Symptoms Abnormal uterine bleeding Abdominal mass Pain Pressure effects Effects on childbearing a. Abnormal uterine bleeding Menorrhagia (月经量过多) Menses prolonged (经期延长) Cycle decreased (周期缩短) irregular vaginal bleeding (不规则阴道流血) intramural myomas submucous myomas hard lump local discomfort Complications: red degeneration torsion frequency of urination （尿频） difficulty in micturition （排尿困难） retention of urine （尿储留） constipation （便秘） infertility 不孕 abortion 流产 ( submucous, intramural ) obstruct labour 阻碍产程 B. Physical signs Enlargement of the uterus asymmetrical~ 不对称增大 Diagnosis Symptoms Physical signs Ultrasound scanning homogenous myometrial echoes are disordered （肌层内不均质回声） [ Differential dia