妇产科学-terineMyoma.ppt

Uterine myoma Zhuzhingling Obstetrics and Gynecology Hospital affiliating Fudan University Epidemiology The commonest of all pelvic T. (1/3). 20% of female 30y do have fibroid. Childbearing life. often enlarge during pregnancy or during oral contraceptive use, and regress after menopause CUT SECTION Well demarcated surrounding muscle. whorly (intermingling muscle fibers and fibrous tissue). Paler than surrounding (Ischaemia). Uterine Fibroids Submucous myoma SYMPTOMS Bleeding (menorrhagia-metrorrhagia). Pain uncomplicated (cong. Dysmenorrhea – dull - colicky). Pain complicated deg.-malig.-infection-torsion) infertility mass. Discharge. Pressure symptoms. Signs DIAGNOSIS History Examination. Investigation. D.D. B型超声检查 Degeneration Leiomyomas enlarge outgrow their blood supply various types of degeneration Hyaline degeneration :- the presence of homogeneous eosinophilic bands or plaques in the extracellular space. Myxoid degeneration - presence of gelatinous intratumoral foci at gross examination that contain hyaluronic acid–rich mucopolysaccharides Degeneration Red degeneration - during pregnancy, secondary to venous thrombosis within the periphery of the tumor or rupture of intratumoral arteries Sarcomatous transformation -less than 3% Treatment No treatment Conservative Radiological Surgical Myolysis. GNRHA Uterine embolization. Patient (age-parity-symptoms). Fibroid (number-size-type) Complications. Uterine leiomyoma Corporeal 98% multiple Cervical 1-2% solitary Corporeal leiomyoma submucus 24% not capsulated Subserous 18% Interstitial 58% M.Emam M.Emam Symmetrically enlarged uterus(submucosal fibroid). Asymmetrically enlarged uterus(subserous fibroid) Red degeneration Sarcomatous change B型超声检查