子宫内膜癌终结版课件.pptVIP

子宫内膜癌 Endometrial carcinoma 湘雅医院妇产科 曹兰琴 副教授 目的要求 讲授重点 1、子宫内膜癌的发病情况和致病因素。 2、子宫内膜增生过长与子宫内膜癌的关系和 子宫内膜癌的临床分期。 3、子宫内膜癌的临床表现。 4、子宫内膜癌的诊断方法。特别是分段诊刮的重要性。 5、子宫内膜癌的治疗，特别是手术，化疗，激素治疗。 Overview概 述 Endometrial carcinoma is now the most common gynaecological cancer in china, accounting for 7% of the women’s malignant tumor and 20-30% of genital malignant tumor. The disease is highly curable if it presents in the early stages. Rencent years, the morbidity of endometrial carcinoma has a trend of rising. Etiology 病 因 长期持续雌激素刺激 无孕激素拮抗 Etiology 病 因 Pathology 病理 巨检： 原发病灶多位于宫底部或二宫角处。 1、弥漫型 2、局限型 Endometrial carcinoma original occur in corner of the bottom of the uterus . Pathology 病理 镜检： 1 、 Adenocarcinoma内膜样腺癌；占80%-90% 2、 Adenocarcinoma association with squamous 腺癌伴鳞化:腺角化癌，腺鳞癌。 3 、 Papillary serous adenocarcinoma浆液性腺 癌:恶性程度高，预后差，常见于老年患者。 4 、 Clear cell透明细胞癌:少见，恶性程度 高，易早期转移。 Dissemination of the disease转移途径 1、直接蔓延 Directly to the cervix and from fallopian tube to ovary. 向上沿宫角→输卵管 向下→宫颈管及阴道 穿透肌壁→浆肌层→盆腔腹膜、子宫直肠窝及大网膜 Endometrial carcinoma is usually not difficult to diagnose. The most common symptom is following: 1、vaginal bleeding 阴道流血 2、 vaginal watery 阴道排液 3、Pelvic pain, ascites, weight loss 疼痛及其他全身症状 signs 体征： The uterus is still normal or light large in size,but is more soft . Patients’ pelvic is as hard as ice when clinical stages is very late. Daignosis诊断 1、History病史:there are some high risk factors as following:old age, obesity, diabetes, hypertension. 2、Symptoms 症状：vaginal bleeding, vaginal watery and pelvic pain. 3、Signs体征：the uterus is larger than normal uterus. 4、Accessory examination 辅助检查 （1）B超：（ultrasound） 可了解子宫大小、宫腔形状、内膜厚度、宫腔内有无赘生物、肌层是否浸润及深度等。 (2)分段诊刮术fractional curettage: 是确诊宫内膜癌最常见最可靠的方法 八、Differential diagnosis鉴别诊断 更年期功血 老年性阴道炎 粘膜下肌瘤 内膜息肉 原发性输卵管癌 老年性子宫内膜炎、积脓 宫颈癌、子宫肉瘤 Treatment 治疗 1、surgery手术治疗：首选的治疗方法 ，腹水找癌细胞，全面探查。 Patients with endometria