中国医科大学妇产科学英文课件 myoma of uterus（二）.pptVIP

子宫肌瘤 ( Myoma of uterus ) 典 型 病 例 1. XX 47岁 ，月经周期缩短、月经血多二年，近半年每次月经期流血不止，均用止血药止血，此次因大流血11天、头迷、乏力、止血药不能止血而来我院就诊，诊断为子宫多发 肌瘤继发重度贫血而收入院，Hb 5.9g/L. 2. XX 27岁，婚后二年未孕，月经周期正常，但经期7-10天，经量较多，因不孕就诊发现为子宫多发肌瘤。 3. XX 42岁，体检发现子宫肌瘤二天 ，子宫亚新生儿头大小，月经无改变，劳累后腰骶部酸痛、有尿频症状。 4. XX 36岁，突然下腹痛1.5小时，疼痛为持续性、逐渐加重，内诊发现子宫右前方鹅卵大小实质肿物，表面光滑、触痛++， B超见右附件区实质肿物。 5. XX 32岁，月经血多2-3年，近2-3个月阴道分泌物多、伴有异味，就诊发现阴道有亚鸡卵大肿物，表面污秽，有蒂通过宫颈管，2-3个月前阵发性腹痛约7-8小时。 QUESTIONS 1. What’s the most common clinical situation of the uterus myoma？ In which kind of myoma?Why? 2. When will the myoma cause pain？ Why？ What’s the special feature of the pain? 3. To these women,what kind of treatment is suitable？ Etiology The exact etiology is uncertain. Clinical manifestation indicates the illness relates with estrogen. 1.Usually occur during sexual maturity 2When pregnant or using extrinsic estrogen,myoma grows rapidly. 3.Anti-estrogen therapy is effective. 4.Myoma stops growth or shrink in postmenopause. 5.The estrogen receptor(ER) in myoma is more than the normal uterus muscular tissue. Secondary Degeneration Myoma loses its typical structure 1.玻璃样变（hyaline degeneration） 2.囊性变（Cystic degeneration） 3.肉瘤变（Sarcomatous Changes) 发生率约0.5％左右。 4.红色变（Red degeneration） Classification According to the location 1).myoma of corporis 　about 96％ 2).myoma of cervical　 about 2.2％ Myoma of corporis and cervical coexistent 1.8% Relation with mural muscle: 1).Intramural myoma 60~70%; 2).subserous myoma 20%; 3).submucous myoma 10~15％. According to number 1).Single myoma 2).Multiple myoma （≥2） Clinical menifestation Common symptoms 1).menses