婦產科學教學課件：13-1 MYOMA OF UTERUS

1MYOMAOFUTERUS2NewwordsIntramuralmyoma肌壁間肌瘤Subserousmyoma漿膜下肌瘤Submucousmyoma黏膜下肌瘤falsecapsule假包膜Hyalinedegeneration玻璃樣變形Cysticdegeneration囊形變Calcification鈣化

3In1840,AFrenchman

CreatedtheuterinemyomaresectionABritisher

BunnyGuinnessWorldRecords:Excavate258uterinemyomainonepatient

UterineMyoma4uterusovarycervixfallopiantube5

Teachingcontent:UterineMyomaFocusRelationshipbetweenthetypesofuterinemyomaandclinicalmanifestationsDifficultsTreatmentPrincipleandSurgicalIndicationsofUterinemyoma6OverviewEtiology,pathology,classificationClinicalmanifestations:symptomsandsignsDiagnosisTreatmentprinciplesMaincontent7AbenigntumorformedbytheproliferationofuterinesmoothmusclecellsMorethan20%ofallwomenoverage30havemyoma.Commoninwomenaged30-50yearsMostcaseshavenosymptomOverview8

EtiologyNotclearMyomagrowfasterduringpregnancyMoreER(estrogenreceptor)arefoundinmyomaFemalehormones(Hormone-dependentdisease)

9Accordingtosite:MyomainuterinebodyIntramuralmyomaSubserousmyomaSubmucousmyomaCervicalmyomaandBroadligamentmyoma

Classification10sizevaries:FromverysmallnoduleToenormousmasswhichoccupiesnearlythewholeabdomen.Pathology11composedofsmoothmuscleandconnectivetissuebloodsupplyareprovidedfromthevesselsinthesurroundingfalsecapsule.fewvesselsarefoundwithinmyoma.LeadtolackofbloodsupplyMicroscopicalstructure

12DegenerationHyalinedegenerationmostcommonCysticdegenerationSecondarytoHyalinedegenerationReddegeneration(Infarction)GenerallyoccursduringpregnancySarcomatouschangeIncreasedrapidly,malignantCalcification13Hyalinedegenerationmostcommonhomogeneous/transparentappearance,absenceofwhorledpattern,absenceofmusclecells

14liquefactionoftheareasofhyalinechange,capsularspacecontainingclearfluidCysticdegeneration15ReddegenerationGenerallyoccursduringpregnancyabdominalpainFeveruterusenlargedwithtenderness

16Increasedrapidlymalignant0.4%～0.8%Malignanttransformation17ClinicalmanifestationSymptomsPhysicalsignsSpecialexaminations18Symptoms

Symptomsarepresent

35%-50%AbnormalmenstruationAbdominalmassPressureeffectsEffectsonchildbearing,e.g.abortion19Where:largeintramuralmyomasubmucousmyomaWhy:EndometriumsurfaceincreasesMorebloodsurfaceInfluenceuterinecontractionAbnormaluterinebleeding20Uterusgrowsbiggerthan3-month-gestationHardmassRarelyleadstopainAbdominalMass

21cervicalmyomaurinationfrequencyandurgencyofurinationdifficultyinurinationretentionofurineconstipationPressureeffects22

submucous,intramuralinfertility(inabilitytoconceive)abortionobstructbirthcanal,difficultlaborEffectsonpregnancyandchildbearing23PhysicalsignsEnlargeduterussymmetricalenlargementsubmucousmyomasmallormedium

intramuralmyoma

Asymmetricalenlargement:morecommonnoduleonthesurface

24Specialexaminations

Ultrasound:lowecho-level

Usefulandcheap膀胱子宮肌瘤子宮25Specialexaminations

Hysteroscopy:submucousmyomaExamandtreat26DiagnosisSymptomsPhysicalsignsUltrasoundscanningSpecialexaminations:Hysteroscopy

27Differentialdiagnosis

A.Abnormalbleedinga.Disfunctional

uterine

bleedingultrasoundandhormoneb.Carcinomaoftheendometriumbiopsy28B.Pelvicmassa.

Adenomyomadysmenorrheaslightenlargementoftheuterusfinaldiagnosisdependsonpathologicalexam

Differentialdiagnosis

29

b.Ovariantumors

KeypointistodeterminetherelationoftumorwithuterusTheonlyuterinetumorswhichareseparateandmovableapartfromuterinebodyandcervixarepedunculatedsubserousmyomaDifferentialdiagnosis

30C.Pregnancy

Uterinemyomanevercauseamenorrhea.pregnantuterusissoftmyomaofuterusisharderandirregular.HCGultrasoundDifferentialdiagnosis

31TreatmentChoiceoftreatmentdependsupon:symptomssizelocationofthetumorsagepregnancystatus/desiregeneralhealthpatient’swish32TreatmentObservationorFollow-upevery3～6monthssmallmyomawithnosymptomclosetomenopauseMedicaltreatmentpretreatmentforsurgerycontraindicatedforsurgerySurgicaltreatment33Indication:HeavyorprolongedbleedingBigmyoma,evenwiyhoutsymptomsPossiblemalignanttendency,e.g.tumorgrowstoofastorgrowsaftermenopause

MyomawhichobstructlaborMyomawhichhaveundergonetorsionSurgicaltreatment

34NewmethodsformyomaMirena(曼月樂),aspecialIUDcontainingcontraceptivewhichcanbereleaseinaminordosageperday

35Newmethodsformyoma

Interventionaltreatment

36NewmethodsformyomaHIFUUltrasou