子宫脱垂（Uterine prolapse）－狄文.ppt

2006-12-6 七年制 Uterine Prolapse Uterine Prolapse Definition The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but is usually classified as one of three degrees. Causes 1. The stretching of muscle and fibrous tissue 2. Increased intra-abdominal pressure 3. A constitutional predisposition to stretching of the ligaments as a response presumably to years in the erect position In recent years,the incidence of prolapse is greatly reduced. The more liberal use of caesarean section and the elimination of labours are probably the two most important factors. Symptoms Something coming down Backache Increased frequency of micturition A ‘bearing down’ sensation Stress incontinence Coital problems Difficulty in voiding urine Degrees of uterine prolapse First degree: cervix still inside vagina Degrees of uterine prolapse Second degree: the cervix appears outside the vulva. The cervical lips may become congested and ulcerated Degrees of uterine prolapse Third degree: complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia. Diagnosis A pelvic examination reveals protrusion of the cervix into the lower part of the vagina (mild prolapse), past the vaginal introitus/opening (moderate prolapse), or protrusion of the entire uterus past the vaginal introitus/opening (severe prolapse). Treatment Pessary treatment Indications:Patient prefers a pessary. Pelvic surgery unaviodable risks Prolapse amenable to pessary The patient is not fit for surgery Patient wishes to delay operation Surgery * Anterior colporrhaphy (and repair of cystocele) * Posterior colpoperineorrhaphy (including repair of rectocele) * Manchester repair * Vaginal hysterectomy * DI WEN M.D., Ph.D., Profess