扬州大学：《妇产科学》课程教学课件（PPT讲稿）37 子宫内膜异位症 Endometriosis

Endometriosis& Adenomyosis2003-11-3

2003-11-3 1 Endometriosis ＆ Adenomyosis

Endometriosis22003-11-3

2003-11-3 2 Endometriosis

Definition:Abnormal growth of endometrialtissue outside the uterine cavity32003-11-3

2003-11-3 3 Definition: Abnormal growth of endometrial tissue outside the uterine cavity

Incidence and Prevalence:. Increase significantly: Range from 1～ 50%General population: 1 ～ 2%Infertile women:30～ 50% Occurs primarily in women in 25～ 45s2003-11-34

2003-11-3 4 Incidence and Prevalence: • Increase significantly • Range from 1～ 50% General population:1～ 2% Infertile women:30～ 50% • Occurs primarily in women in 25～ 45s

Pathogenesis:: Implantation TheoryRetrograde Menustration TheorySampson， 1921: Lymphatic and Vascular Dissemination TheoryJavert, 1952. Coelomic TheoryMeyer· Genetic TheoryImmune System Dysfunction （immunologic theory）52003-11-3

2003-11-3 5 Pathogenesis: • Implantation Theory Retrograde Menustration Theory Sampson，1921 • Lymphatic and Vascular Dissemination Theory Javert，1952 • Coelomic Theory Meyer • Genetic Theory • Immune System Dysfunction（immunologic theory）

Genetic factors:.Familial clustering of endometriosis is a commonclinical observation.. In families with endometriosis, the disease isoften confined to the maternal line, and is 7 timesmore common in first-degree relatives than in thegeneral populationIn future studies, evaluation of DNApolymorphism may identify specific genesinvolved in the development of endometriosis2003-11-36

2003-11-3 6 Genetic factors： • Familial clustering of endometriosis is a common clinical observation. • In families with endometriosis，the disease is often confined to the maternal line，and is 7 times more common in first-degree relatives than in the general population. • In future studies，evaluation of DNA polymorphism may identify specific genes involved in the development of endometriosis

Immunologic Theory:Lose control of immunologic balanceBoth cellular immunity and humoral immunitychange.1)Macrophage↑ —release IL-1、IL-6、TNF、EGF、FGF etc."→ stimulate T、B lymphocyte proliferationand activation2)Activity ofkiller cell (NK cell and T cell) J3)Produce anti-endometrium antibody4)Abnormal expression of CAMs (cell adhesionmolecules)72003-11-3

2003-11-3 7 Immunologic Theory： • Lose control of immunologic balance • Both cellular immunity and humoral immunity change. 1) Macrophage↑ release IL–1、IL–6、TNF、EGF、 FGF etc. stimulate T、B lymphocyte proliferation and activation 2) Activity of killer cell（NK cell and T cell）↓ 3) Produce anti–endometrium antibody 4) Abnormal expression of CAMs（cell adhesion molecules）

. The pathogenesisis unclear.? multifactor82003-11-3

2003-11-3 8 • The pathogenesis is unclear. • multifactor

Pathologymacroscopic appearance (1) :The commonest sites:Ovary (chocolate cyst)T2. Peritoneum of the recto-vaginal cul-de-sac of the Pouch of Douglas3. Utero-sacral ligaments4. Sigmoid colon5. Broad ligament92003-11-3

2003-11-3 9 Pathology – macroscopic appearance（1）： • The commonest sites： 1. Ovary（chocolate cyst） 2. Peritoneum of the recto–vaginal cul–de– sac of the Pouch of Douglas 3. Utero–sacral ligaments 4. Sigmoid colon 5. Broad ligament

This is a section through an enlarnged 12 cm ovary todemonstrate a cystic cavity filled with old blood typical forendometriosis with formation of an endometriotic, or"chocolate", cyst.102003-11-3

2003-11-3 10 This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst