tugas kepaniteraan obgyn

8/20/2019 Tugas Kepaniteraan OBGYN

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2003-11-3 1

Myoma of UterusXu Hong


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Synonyms

leiomyoma of uterus

leiomyomas

fibromyomas

myofibromas

fibroids

fibromas

myomas


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Incidence

Most common solid pelvic tumors

Develop in 20～ 25% of women duringreproductive years

30～ 50 years old


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Correlative Factors

n estrogenic milieu may be necessary

!rogesterone function

"rowt# factor and t#eir receptor ：

epit#elial growt# factor （ $"） &nsulin-li'e growt# factor （ &"）

platelet-derived growt# factor

puberty

青春期

menopause

绝经期

estrogen

雌激素 progesterone

孕激素


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2003-11-3 5

Pathology


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2003-11-3 (

Gross Appearance

)are only a single， usually many e*ist

+ell-circumscribed， nonencapsulated

pseudocapsule is present,

#e consistency is usually firm or even #ard e*ceptw#en degeneration or #emorr#age #as occurred,

color ： lig#t gray or pin'is# w#ite

cut section： an intertwining pattern or

a w#orl-li'e arrangement； bulgy

pseudocapsule

假包膜


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2003-11-3 .

/moot# muscle tumors of t#e uterus are oftenmultiple, /een #ere are submucosal intramuraland subserosal leiomyomata of t#e uterus,


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2003-11-3

Microscopic

Appearanceomposition： smoot# muscle

connective tissue

#e nonstriated muscle fibers are arranged

in bundles of various sies t#at run in

multiple directions,


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Classication

1

ccording to growt# location ：

Myomas on t#e body of uterus（ 0%）

Myomas on t#e cervi* of uterus（ 10%）


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Classication

ccording to t#e relation to uterine muscle：

/ubmucous

（10～

15%）

&ntramural（ (0 ～ .0%）

/ubserosal（ 20%）

ew leiomyomas are actually of a single 6pure7 type,

8 #ybrids


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Clinical

Manifestation


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Symptoms

menorr#agia and prolonged menstrual period ：common

!elvic pain： occurs in pregnancy if undergoing degeneration ortorsion of a pedunculated myoma

!elvic pressure： urinary fre9uency

bowel difficulty（ constipation）/pontaneous abortion

&nfertility

menorr#agia

月经过多

pedunculated

有蒂的

spontaneous abortion

自然流产

infertility

不育症


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2003-11-3 13

Signs

palpable abdominal tumour

!elvic e*amination：

uterus 8 enlarged and irregular ；

#ard


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2003-11-3 14

!egeneration

:yaline degeneration

ystic degeneration

)ed degeneration

/arcomatous c#ange

#e ot#ers：

fat degeneration calcification

t#e secondary infection

)esult from t#e diminis#ed

vascularity of t#e

connective-tissue element


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"ed !egeneration

;ccasionally seen as a complication of pregnancy（ during pregnancy or immediate postpartum period）

#e pat#ogenesis is un'nown，may be t#e result of t#eaccumulation of blood in t#e tumour because of venous

obstruction,

#e cut surface resembles raw meat,

linical features： a cause of pain（ acute）

fever rapid growt#， tender

产期


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2003-11-3 1(

:ere is a very largeleiomyoma of t#e uterus

t#at #as undergone

degenerative c#ange and is

red , /uc# anappearance mig#t ma'e

you t#in' t#at it could be

malignant, )emember t#at

malignant tumors do notgenerally arise from benign

tumors,


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2003-11-3 1.

Sarcomatous Change

)are： 0,4%～ 0,%

More common at 40～ 50 years old

?sually occur in intramural fiboids

grow 9uic'ly

vaginal bleeding


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2003-11-3 1

!iagnosis

:istory

@imanual e*amination

?ltrasonograp#y （ @!ultrasound e*amination）

:ysteroscopy

Aaparoscopy

:ysterograp#y

#ysteroscopy

"#$%&

laparoscopy'($%&


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2003-11-3 1

!i#erential !iagnosis

!regnancy

;varian tumour

denomyosis

Malignant tumors of uterus

sarcoma of uterus

endometrial carcinoma

cervical cancer


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$reatment


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%&servation and Follo'Up

/mall， asymptomatic fibroids need not be

treated， especially near menopause,

&nterval： 3～ ( mont#s


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2003-11-3 22

Medical $reatment

ndrogenic agents： testosterone propionate

"n):-a： induce a #ypoestrogenic pseudomenopausalstate

not recommended for longer t#an ( mont#s 6add-bac'7 regimens

)*

+,-./0，12/0


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Surgery

$reatment 1 &ndications：

greater t#an 10 wee'sB gestational sie

menorr#agia， lead to anemia

#ave pressure symptoms

grows rapidlyfailure of medical treatment


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2003-11-3 24

Surgery

$reatment Met#od：

Myomectomy8conservative t#erapy

preserve fertility

significant ris' of recurrence

:ysterectomy8 radical t#erapy

/ubtotal #ysterectomy

#ysterectomy

"#345

myomectomy

67845

;nly true 6cure7

for leiomyomas

9:"#345


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Surgery

$reatment (

pproac#：

trans-abdominal

trans-vaginal

laparoscopic or #ysteroscopic


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&t is important to

individualie

t#e c#oice of

t#erapy,


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2003-11-3 2.

Uterine )eiomyomasComplicating Pregnancy

impact on pregnancy： abortion

impact on delivery： premature labour

fetal malpresentation

retained placenta

placenta previa

need for operative delivery

（ birt# canal obstruction）

postpartum #emorr#age

onservative treatment


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2003-11-3 2

Critical Points

May be related to superabundant estrogen,

+ell-circumscribed， nonencapsulated,

:ave a pseudocapsule,

an be classified into submucosal; intramural andsubserosal types,

Different types #ave different features,

Menorr#agia is common,

our degeneration types

&ndividualied treatment， includeobservation;medical treatment and surgical treatment,

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