妇科12周英文Uterine-Leiomyoma2011.ppt

Prevalence/incidence 25% - 50% reproductive women Increased incidence with age Age incidence 20-30yr 4 % 30-40yr 11-18% 40-50yr 33 % Etiology/Epidemiology Etiology unknown Increased risk factors 40 years or older Family history of uterine fibroid Nulliparity Obesity Black race Associated Factors Female Hormones ---Estrogen (雌激素)/ Progestron (孕激素) Clinical evidences: Reproducutive patients No cases before puberty No new cases after menopause(停经) Increased during pregnancy Estrogen receptor (ER-α) high concentration in black women Classification I Intramural ~(60%--70%) 肌壁间 Subserous(20%) 浆膜下 Submucous ~(10%) 粘膜下 Cervical ~ -2% ClassificationII Single Pathology ---gross structure Frequently multiple Firm, vary in size Spherical or irregularly lobulated False capsule (假包膜) Whorled appearance (漩涡状结构) Pathology ---microscopic structure Hyaline ? 玻璃样变性yellow, soft gelatinous areas Cystic ?囊性变liquefaction follows extreme hyalinization Red (carneous) degeneration 红色变性 Edema hypertrophy ?impede blood supply ?aseptic degenration infarction with venous thrombosis hemorrhage Other changes calcification 钙化 hemorrhage 出血 necrosis 坏死 Depend on location, size, changes pregnancy status Abnormal uterine bleeding most common 30% Heavy / prolonged bleeding (menorrhagia月经过多 ) ----submucous/large intramural myoma pre post-menstrual spotting (月经前后淋漓出血 ) ----submucous myoma intermenstrtual bleeding (月经间期出血 ) ---- Pedunculated submucous myoma Pain/discomfort Heaviness fullness in the