武漢大學第一臨床學院婦產科DepartmentofObstetricsandGynecology張蔚教授ZhangWeiMostcommonbenigntumoroffemalereproductivesystem.Andthemostcommonbenigntumorinhumanbody

是女性生殖系統最常見的良性腫瘤,并且是人體最常見的良性腫瘤Presentin20-25%ofreproductive-agewomen發生于20-25%的生育年齡婦女病因

AetiologyHighconcentrationsofbothestrogenandprogesteronereceptors

肌瘤組織中含有高濃度的雌、孕激素受體分類

ClassificationAccordingtothelocation,Myomaisdividedinto:Uterinebodymyoma(90%)Cervicalmyoma(10%)分類

TypesMyomaofuterus子宮肌瘤Intramuralmyoma肌壁間肌瘤Subserousmyoma漿膜下肌瘤Submucousmyoma粘膜下肌瘤肌壁間肌瘤

(intramuralmyoma)漿膜下肌瘤

(subserousmyoma)漿膜下肌瘤闊韌帶肌瘤

Broadligament

myoma闊韌帶肌瘤

Broadligamentmyoma

粘膜下肌瘤

(submucousmyoma)粘膜下肌瘤white-colored,round,smooth,andusuallyfirm,pseudocapsule

呈白色的,圓形的,光滑的,并且常是堅硬的,有假包膜病理

Pathology漩渦狀whorledappearance纖維結締組織Fibrousconnectivetissuesarcomatouschange肉瘤變Degeneration肌瘤變性cysticdegeneration囊性變reddegeneration紅色變Hyalinedegeneration玻璃樣變withcalcification鈣化透明樣變

HyalinedegenerationThemostcommondegeneration最普遍的變性Itswhorledstructuredisappearsandisreplacedbyclearsubstance,whitecolor螺旋狀結構消失,由透明結構代替,呈白色Undermicroscope,thecellsinthedegenerationareadisappear鏡下觀,變性區域細胞消失囊性變

CysticdegenerationSecondarychangefollowinghyalinedegeneration緊隨透明樣變性的次級變化Tissuenecrosisandliquefactionandformsmultiplecysts有組織壞死、液化和形成多發囊性結構紅色變

ReddegenerationWhorledstructuredisappearsandhasbadsmell螺旋結構消失和有惡臭

Mostcommonduringpregnancyandpuerperium最常見于妊娠期和產褥期Itisaspecialtypenecrosiswhichcauseisnotclear為一種特殊類型的壞死,原因不明Accompaniedbypainandfeverandrapidlyenlargedmyoma伴隨有疼痛,發熱和肌瘤迅速增大肉瘤變

Sarcomatouschange鈣化

DegenerationwithcalcificationMajorityoccurinthemyomaswiththinpedecleoraftermenopause多發生于蒂小或絕經后肌瘤Causesprecipitationofcalciumcarbonateandphosphate引起碳酸鈣和磷酸鹽的沉積

Oftensecondarytothefattydegeneration常發生于脂肪變之后脂肪樣變臨床表現癥狀SymptomsDependontheirlocation,thespeedofgrowthanddegenerations取決于肌瘤部位、生長速度及肌瘤變性Itisnotassociatewiththesizeandthenumberofmyomas與肌瘤大小、數目無關

abdominalmass腹塊

leucorrhea白帶增多

Abdominalpain腹痛、腰酸、下腹墜脹compresssymptom壓迫癥狀anemia繼發性貧血infertility不孕月經改變Symptoms癥狀AbnormalMenstrualbleeding

體征

Signs

Relatetomyomasize、location、number、degeneration與肌瘤大小、位置、數目以及有無變性有關Diagnosis

accordingtotypicalsymptomsandsigns、Ultrasound、HysteroscopyandLaparoscopAntidiastole鑒別診斷Graviduterus妊娠子宮Tumoroftheovary卵巢腫瘤Adenomyosis子宮腺肌病Pelvicinflammatorytumor盆腔炎性腫塊Uterinemalformation子宮畸形Adenomyoma腺肌瘤治療

TreatmentDependsonthepatient’sage、parity、symptoms、myomasize根據患者年齡、產次、癥狀、肌瘤大小等情況全面考慮Followupevery3to6months每3~6個月隨訪一次

藥物治療

androgenichormone

雄激素GnRHα促性腺激素釋放激素類似物Latestadvancement最新進展Interventionaltherapy介入治療Hysteromyomaablation消融術Hysteroscope宮腔鏡技術Laparoscopicoperation腹腔鏡手術微創手段的聯合應用課堂討論

QuestionsWhataretheoperationindicationofuterusmyoma?Why?WhataretheSignsandSymptomsofuterusmyoma?Howtotreatthediseaseofuterusmyoma?

主要參考文獻

MainReferencesJoanP,AlisonB.P,Br