新 疆医科大学第一临床医学院妇产科学课件 子宫内膜异位症.pptVIP

子宫内膜异位症Endometriosis Gynecological department of the first affiliated hospital of Xinjiang medical university 教学目的要求 熟悉子宫内膜异位症的临床特点诊断方法及治疗原则 定义 Definition 具有生长功能的子宫内膜组织出现在子宫以外身体其他部位时称子宫内膜异位症. Presence of endometrial tissue outside the lining of the uterine cavity Age: common in reproductive period True Incidence Unknown: ? 1-5% 30 – 50 % infertility. Does NOT Discriminate by Race. Herdietary (↑↑ among sisters). Pelvic 宫骶韧带及卵巢 - Extra pelvic Umbilicus. Scars (Lap.). Lungs Uterine= Adenomyosis (50%). Extraut: - Ovary 30% - Pelvic peritoneum 10%. - F. tube. - Vagina. -Bladder rectum. - Ligaments. 体腔上皮化生学说 遗传因素 病理 Symptoms (history). Signs (Exam). Investigations. Symptoms症状 疼痛: 继发性渐进性加重的痛经 不孕 月经失调 性交痛 卵巢子宫内膜异位囊肿破裂 盆腔以外异位症的临床表现 异位症引起不孕的原因 盆腔结构异常：卵巢、输卵管粘连----机械性障碍，影响排卵、受精和生殖细胞游走。 盆腔内微循环改变：补体系统、细胞因子 卵巢功能异常：未破裂卵泡黄素化综合征（luteinized unruptured follice syndrome,LUFS) 1. Pelvic tenderness. 2. Fixed retroverted uterus. 3. Nodularity of the Douglas pouch and uterosacral ligaments. 4. Ovaries may be enlarged and tender . Ovarian cyst may be detected. 1. Laparoscopy .腹腔镜------金标准 2. Imaging. B超 3. Serum CA - 125. 4. ? IL-8 CEA. Laparoscopy Value: It permits a “see and treat” approach, although its effectiveness may be limited by the nature of the disease and the surgeons skill. Laparoscopy cont…. Appearance: Endometriosis May Appear Brown Black (“Powderburn”) Clear (“Atypical”) 1.Ovarian cysts.卵巢恶性肿瘤 2. Pelvic inflammatory disease . 盆腔炎性包块 3. Asymmetrical enlarged uterus. Ovarian Endometriosis Formed by invagination of the ovarian cortex after accumulation of menstrual debris from bleeding of endometriotic implants. 临床分期 Staging Revised AFS System: Most Often Used. Ranges from Stage I (Minimal) to Stage IV (Severe). Staging Involves Location and Depth of Disease, Extent of Adhesions. Revised AFS 1985 Stage I (minimal) 1 – 5. Stage II (mild) 6 – 15. Stage III (moderate) 16 – 40. Stage IV (severe