《妇产科学》课程授课教案（讲义）子宫肌瘤 Uterine Leiomyoma

UterineLeiomyoma子宫肌瘤一、教学目的及重点：1．熟悉子宫肌瘤的类型。2．了解子宫肌瘤的变性。3．熟悉子宫肌瘤的临床表现。4．熟悉子宫肌瘤的处理。二、教学方法：紧密结合临床实际,提问式讲解教材并举例说明。三、教学重点和难点：子宫肌瘤的变性1.子宫肌瘤的类型。2．子宫肌瘤的临床表现。3．子宫肌瘤的处理。四、教学内容：Uterine Leiomyoma is the benign(良性)and most common tumor of the femalereproductive system.1.Etiologyfemalehormones女性激素(estrogen雌激素，progestin孕激素）Evidences() Occur in reproductive age (30-50)(2) No new formation in postmenopause(3) Increase in size during pregnancy

Uterine Leiomyoma 子宫肌瘤 一、教学目的及重点： 1. 熟悉子宫肌瘤的类型。 2. 了解子宫肌瘤的变性。 3. 熟悉子宫肌瘤的临床表现。 4. 熟悉子宫肌瘤的处理。 二、教学方法：紧密结合临床实际,提问式讲解教材并举例说明。 三、教学重点和难点: 子宫肌瘤的变性 1. 子宫肌瘤的类型。 2. 子宫肌瘤的临床表现。 3. 子宫肌瘤的处理。 四、教学内容: Uterine Leiomyoma is the benign(良性)and most common tumor of the female reproductive system. 1.Etiology female hormones 女性激素 (estrogen 雌激素, progestin 孕激素) Evidences (!) Occur in reproductive age (30-50) (2) No new formation in postmenopause (3) Increase in size during pregnancy

2.Clasifiation()Intramural myoma（肌壁间）60-70%increased menstrual loss(2)Subserous myoma（浆膜下）20%Torsion（扭转）may occur and cause painNoeffectonmenstrualbloodloss(3)Submucousmyoma（粘膜下）10-15%Irregular or heavy menstrual bleeding3.PathologyNaked eye appearance 肉眼观()whorled patem (漩涡状结构)(2) false capsule(假包膜)Microscopicalstructure smooth muscleDegeneration() Hyaline change(透明变性)homogeneous /transparent appearance（嗜酸性）massstructureless eosinophilic(2) Cystic change (囊性变)liquefaction(液化)ofthe areas ofhyaline change(3)Reddegeneration(红色变性)Venous thrombosis（i血栓）and congestion（充血）Interstitial hemorrhage（出血）(4) Sarcomatous change (肉瘤变)Malignant transformation（恶性变）rar 0.4%-0.8%Grow quickly in short period,Iregular vaginal bleed ing Incease in postmenopause

2.Classification (!)Intramural myoma（肌壁间）60-70% increased menstrual loss (2)Subserous myoma（浆膜下） 20% Torsion（扭转） may occur and cause pain No effect on menstrual blood loss (3)Submucous myoma（粘膜下） 10-15% Irregular or heavy menstrual bleeding 3.Pathology Naked eye appearance 肉眼观 (!) whorled pattern (漩涡状结构) (2) false capsule(假包膜) Microscopical structure :smooth muscle Degeneration (!) Hyaline change (透明变性) homogeneous /transparent appearance structureless eosinophilic （嗜酸性）mass (2) Cystic change (囊性变) liquefaction (液化)of the areas of hyaline change (3) Red degeneration (红色变性) Venous thrombosis (血栓）and congestion (充血） Interstitial hemorrhage （出血） (4) Sarcomatous change (肉瘤变） Malignant transformation（恶性变） rar 0.4%-0.8% Grow quickly in short period,Irregular vaginal bleeding ,Incease in postmenopause

4.Clinical Findingsdepending on the size, position and number of the tumors(1),SymptomsAbnormal uterine beedingAbdominal massPainPressure ffectsEffects on childbearinga. Abnormal uterine bleed ingMenrhagia (月经量过多)(经期延长)Menses prolongedCycledeceased（周期缩短）irregular vaginal bleeding(不规则阴道流血)intramuralmyomas submucous myomasb. Abdominal Masshard lumplocal discomfortc. PainComplications: red degeneration, torsiond. Pressure Effects（尿频)frequency of urination（排尿困难）difficulty in micturition

4.Clinical Findings depending on the size, position and number of the tumors (1).Symptoms Abnormal uterine bleeding Abdominal mass Pain Pressure effects Effects on childbearing a. Abnormal uterine bleeding Menorrhagia (月经量过多) Menses prolonged (经期延长) Cycle deceased (周期缩短) irregular vaginal bleeding(不规则阴道流血) intramural myomas submucous myomas b. Abdominal Mass hard lump local discomfort c. Pain Complications: red degeneration, torsion d. Pressure Effects frequency of urination （尿频） difficulty in micturition （排尿困难）

retention ofurine（尿储留）constipation（便秘）e. Effects on Childbearinginfertility不孕abortion流产( submucous, intramural )obstruct labour阻碍产程(2)Physical signsEnlargement of the uterus5.DiagnosisSymptomsPhysical signsUltrasound scanningdisordered（肌层内不均质回homogenousmyometrial echoesare声)Differential diagnosisa. Dysfunctional bleeding(功血)b.EndometrialCarcinoma(子宫内膜癌)c. Adenomyomad. Ovarian tumorse. Pregnancyamenorrhoea（闭经，停经）HCGsoftandelasticuterus（子宫软，有弹性）ultrasound find ing

retention of urine （尿储留） constipation （便秘） e. Effects on Childbearing infertility 不孕 abortion 流产 ( submucous, intramural ) obstruct labour 阻碍产程 (2)Physical signs Enlargement of the uterus 5.Diagnosis Symptoms Physical signs Ultrasound scanning homogenous myometrial echoes are disordered （肌层内不均质回 声） Differential diagnosis a. Dysfunctional bleeding(功血) b. Endometrial Carcinoma (子宫内膜癌) c. Adenomyoma d. Ovarian tumors e. Pregnancy amenorrhoea (闭经，停经) HCG soft and elastic uterus（子宫软，有弹性） ultrasound finding

6.Treatmentdepends upon symptoms,size and location,state of preservation,age, parity,pregnancy status, general health(I) Observation or Follow-upSmall tumors with no symptomclose to menopause(绝经)(2) Medial reatment pretreatment for surgerycontraindicated for surgerya.Gonadotropin-releasing hormone analogs (GnRH-a)(促性腺激素释放激素类似物)inducea profoundhypoestrogenismb.Mifepristone（米非司酮）antagonist against progesteronec. Surgical treatment(1) heavy or prolonged bleeding(2) possible malignant change(3) symptoms from large tumor or degeneration(4) myomas which interfere with fertility and labora.Myomectomy（肌瘤摘除术）whenever the patient choosesb.Hysterectomy（子宫切除术）subtotal h~(次全子宫切除)total h(全子宫切除术)五、复习思考题子宫肌瘤的临床表现与肌瘤类型的关系以及治疗方案？

6.Treatment depends upon symptoms,size and location,state of preservation,age, parity,pregnancy status, general health (1) Observation or Follow-up Small tumors with no symptom close to menopause(绝经) (2) Medical treatment pretreatment for surgery contraindicated for surgery a.Gonadotropin-releasing hormone analogs (GnRH-a) (促性腺激素释放激素类似物)induce a profound hypoestrogenism b.Mifepristone （米非司酮） antagonist against progesterone c. Surgical treatment (1) heavy or prolonged bleeding (2) possible malignant change (3) symptoms from large tumor or degeneration (4) myomas which interfere with fertility and labor a. Myomectomy (肌瘤摘除术） whenever the patient chooses b.Hysterectomy （子宫切除术） subtotal h~ (次全子宫切除） total h~ (全子宫切除术) 五、复习思考题 子宫肌瘤的临床表现与肌瘤类型的关系以及治疗方案?