妇产科学- Endometriosis.pptVIP

Endometriosis Obstetrical Gynecological Hospital Fudan University Xie Kang-Yun, MD cndrxie@ Schematic diagram of female internal genitals Preface Basic Concepts Definition of Endometriosis: Presence of functioning endometrial glands and stroma outside the uterine cavity. Basic Concepts A common disease of reproductive age in women. First described by von Rokitansky, a German pathologist, in 1860. Clinical manifestation is multifarious. Benign in histology, malignant in behavior. Its growth depends on estrogen. Endometriosis vs Adenomyosis Different disease Commonness Ectopic endometrium Difference Pathogenesis Histogenesis Clinical manifestation Epidemiology Common disease in women (10％-15％). More in reproductive age (especially in 25-45 yr-old). Occurred also in adolescent or menopausal women using HRT. 20％-90％ in pelvic pain or infertile women. 3％-43％ in asymptomatic women. Risk factors Lesser bearing Postpone bearing Short cycle length (≤27 days) Heavier menstruation Longer flow duration (≥7 days) Pathogenesis Pathogenesis Not clear. 3 theories proposed: Ectopic transplantation of endometrial tissue Coelomic metaplasia The induction theory No single theory can account for the location of endometriosis in all cases. Pathogenesis: Ectopic Transplantation Proposed by Sampson in 1921. Transplantation paths： Retrograde menstruation (Sampson, 1921) Lymphatic and Vascular Dissemination (Halban and Sampson, 1925) Iatrogenic implantation Pathogenesis: Coelomic Metaplasia Proposed by Robert Meyer in 19 century. Diseased sites are homologous Transformed to endometrial tissue under stimulations Lack of clinical and laboratory bases in the past Genetic induction successed recently Pathogenesis: The Induction Theory Propose by Levander and Normann in 1955 An extension of the coelomic metaplasia theory Induction by undetermined endogenous biochemical factors Undifferentiated peritoneal cell developed to endometrial tissue Pathogenesis: Affecting Factors Genetic At least p