单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,Uterine myoma,1 Uterine myoma,2,Definition and Introduction,Myoma,fibroid,fibromyoma,One of the most commonest tumors,present in 20-25%of reproductive-age women,Benign uterine neoplasms,composed primarily of smooth muscle,2Definition and IntroductionMy,3,3,4,4,5,Pathogenesis,Not clear,Estrogen and its receptors in higher concentrations,Progesterone maybe accelerate the mitosis of cells,Heredity,(25%-50%):12,1,4,7 chromosome correlated with myoma,5Pathogenesis Not clear,6,Pathology,Grossly:,buff-colored,rounded,smooth,firm,6Pathology Grossly:,7,Pathology,Microscope:,Individual cells are spindleshaped,（梭形）,have elongated nulcei,and are quite uniform in size,Fibre are intermixed with the smooth muscle bundles,7Pathology Microscope:,8,Classification,according to the situation,Corpus:90%,Cervical:10%,according to the relationship between myoma and uterine wall,Submucous:,10%-15%,Intramural:,60%-70%,Subserous:,20%,8Classification according to t,9,Degeneration,The myoma lose the typical structure(the spiral shape),Benign degeneration,1,、,hyaline,2,、,cystic,3,、,red,4,、,calcification,Malignant transformation:,sarcomatous change(0.4-0.8%),9DegenerationThe myoma lose th,10,Clinical symptom,Symptoms:present in 35-50%patients,Symptoms depend on the location,size,degeneration and whether or not the patient i,s pregnant,10Clinical symptom,11,Abnormal uterine bleeding,Pain,Pressure symptoms,Infertility,Spontaneous abortion,Mass,Clinical symptom,11Abnormal uterine bleedingCli,12,Clinical symptom,Signs,Abdominal exam:,Speculum exam:,cervical myoma,Bimanual exam:,The diagosis is obvious when the normal uterine contour is distorted by one or more smooth,spherical,firm masses,but often it is difficult to be absolutely certain that such masses are part of the uterus,12Clinical symptomSigns,13,Clinical symptom,Laboratory and special examinations,Ultrasound,Lab exam:anemia(menorrhagia),Hysteroscopy:identification,removal submucous,Laparoscopy:the precise origin of myoma,myomectomy,13Clinical symptom Laboratory,14,Diagnosis,History,Symptoms and signs,Special exam:especially the outcomes of ultrasound,14DiagnosisHistory,15,Differential diagnosis,Ovarian carcinoma,Hyperplasia and enlarged fallopian tubes,Tubo-ovarian abscess,Endometriosis,Pregnant uterus,polyps,Malformation of uterus,15Differential diagnosisOvaria,16,Treatment,16Treatment,17,Principle of treatment,Depends on the patient,s age,pregnancy status,desire for future pregnancies,general health,and symptoms,T,he size,location,and state of preservation of the myomas,17Principle of treatment,18,Emergency measure,Severe Anemia:Blood transfusion,Indicate of emergency surgery:,infected myoma(submucous),acute torsion,intestinal obstruction,usually caused by a pedunculated myoma,18Emergency measureSevere Anem,19,Medicine measures,Do not require surgery,Rule out the other causes,Examined every 6 months after diagnosis to monitoring growth of the myoma,whether it grows quickly,19Medicine measuresDo not requ,20,N,o definitive medicine therapy is currently available for myoma,T,he gonadotropin-releasing hormone agonists(GnRH-a)may be effective in limiting growth or causing a temporary decrease in tumor size.,20No definitive medicine thera,21,GnRH-a mechanisms:,induce hypogonadism,through pituitary desensitization,downregulation of receptors,inhibition of gonadatropins,21GnRH-a mechanisms:,22,Judgment must be individualized,Uterine Size,：,beyond 10 weeks pregnancy,Anemia,；,oppressing symptom,；,infertility,；,habitual abortion,；,quickly growth and so on,Surgical measure,22Judgment must be individuali,23,Myomectomy,（肌瘤挖出术）,symptomatic patient who wish to preserve fertility or conserve the uterus,hysterosco,pe:,submucous myoma,laparo,scope:,subserous myoma,23Myomectomy（肌瘤挖出术）,24,D&C,hysterosco,pe,24D&Chysteroscope,25,25,26,Hysterectomy,by,vaginal,hysterectomy:,vaginal relaxation demands repair of cystocele,（膀胱膨出）,rectocele,（直肠膨出）,enterocele,（肠疝）,by,abdominal,hysterectomy,26Hysterectomy,27,Surgical methods,Laparotomy（剖腹手术）,Laparoscope,（腹腔镜）,Hysteroscope,（宫腔镜）,myomectomy,hysterectomy,27Surgical methodsLaparotomy（剖,28,Advancement of treatment,Arterial embolism,HIFU,(high intensity focus ultrasound),28Advancement of treatment,29,Thanks!,29Thanks!,Submucous myoma,Submucous myoma,Intramural myoma,Intramural myoma,Subserous myoma,Subserous myoma,33,Hyaline degeneration,Mature or“old”myoma are white but contain yellow,soft,and often gelatinous,（胶状）,areas of hyaline change.,These tumors are usually asymptomatic,*,33Hyaline degeneration*,34,34,35,Cystic degeneration,Liquefaction follows extreme hyalinization,the liquid in the cavity and the myoma becomes soft,*,35Cystic degeneration*,36,36,37,Red degeneration,Venous thrombosis and congestion with interstitial hemorrhage are responsible for the color of a myoma undergoing red degeneration.Usually occurs in pregnancy or puperium,the,vortex,myoma structure disappea