子宫内膜异位症林安平.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,子宫内膜异位症,Endometriosis,重庆医科大学第二临床学院,妇产科 林安平,1,2021/3/20,Summary,Definition,Pathogenesis,Pathology,Clinical presentation,Diagnosis,Differential diagnosis,Treatment,Prevention,2,2021/3/20,一,、概念,（,DEFINITION,）,子宫内膜异位症,（,Endometriosis,EM,）,1,、,子宫内膜组织,(,腺体和间质,),2,、,子宫体,以外部位,3,2021/3/20,异位,子宫内膜,出现的部位,4,2021/3/20,二、,发病机制,（,PATHOGENESIS,）,1,种植,学说,Endometrial implantation Theory,a,经血倒流（,Retrograde menstruation,）,b,淋巴及静脉播散,(,Hematogenous or lymphatogenous transport),2,体腔上皮化生,学说,Coelomic metaplasia Theory,3,诱导,学说,Induction Theory,异位子宫内膜的来源,:,5,2021/3/20,二、,发病机制,（,PATHOGENESIS,）,1,遗传因素,Genetic factors,发病相关因素,：,2,免疫,学说,Immunologic abnormalities,6,2021/3/20,三、,病理,（,PATHOLOGY,）,1,、,基本病理变化,(Basal pathological changes),纤维组织,增生,(,Fibrosis,),和,粘连,(,Adhesions,),red,clear,7,2021/3/20,2,、巨检,(,pathological anatomy,),(1),、,卵巢,最多见,卵巢子宫内膜异位囊肿,(,Endometriomas,),卵巢巧克力样囊肿,(,Chocolate Cyst,),。,8,2021/3/20,三、,病理,卵巢巧克力样囊肿,(,Chocolate Cyst,),9,2021/3/20,2,、巨检,（,2,）、,宫骶韧带、,Douglas,陷凹,和,子宫后壁下段腹膜,是,好发部位,早期,异位内膜病变,晚期,异位内膜病变,10,2021/3/20,2,、巨检,阑尾,异位内膜病变,横隔,异位内膜病变,11,2021/3/20,腹腔镜下,早期,异位内膜病灶,2,、巨检,12,2021/3/20,（,1,）、,子宫,内膜上皮,（,Endometrial epithelium,）,、,内膜,腺体,（,glands,）,、,内膜,间质,(,stroma,),及出血。,3,、镜下特征,(,Histologic features,),（,2,）、少量,内膜间质细胞,即可确诊。或发现红细胞或含铁血黄素的,巨噬细胞,(,Hemosiderin laden macrophages,),等。,13,2021/3/20,镜下特征,(,Histologic features,),14,2021/3/20,临床表现：症状,痛经及慢性盆腔痛,性交痛,月经异常,不孕,急性腹痛,其他症状,15,2021/3/20,16,2021/3/20,17,2021/3/20,18,2021/3/20,19,2021/3/20,20,2021/3/20,21,2021/3/20,22,2021/3/20,23,2021/3/20,24,2021/3/20,25,2021/3/20,26,2021/3/20,27,2021/3/20,28,2021/3/20,29,2021/3/20,30,2021/3/20,B,型超声,检查,31,2021/3/20,六、鉴别诊断,(DIFFERENTIAL DIAGNOSIS),卵巢恶性肿瘤,：一般情况差，发展迅速，腹痛、腹胀为持续性。常发现有腹水。,B,超显示包块以实性或混合性居多,盆腔炎性包块,：以往多有急性盆腔感染和反复感染发作史，疼痛不仅限于经期。,子宫腺肌病,32,2021/3/20,33,2021/3/20,34,2021/3/20,35,2021/3/20,36,2021/3/20,37,2021/3/20,38,2021/3/20,39,2021/3/20,40,2021/3/20,41,2021/3/20,42,2021/3/20,43,2021/3/20,44,2021/3/20,45,2021/3/20,46,2021/3/20,47,2021/3/20,48,2021/3/20,49,2021/3/20,50,2021/3/20,51,2021/3/20,52,2021/3/20,53,2021/3/20,八、,预防,（,PREVENTION,）,防止经血逆流,避免,手术操作,所引起的子宫内膜异位,药物避孕,54,2021/3/20,Summary,Definition,Pathogenesis,Pathology,Clinical presentation,Diagnosis,Differential diagnosis,Treatment,Prevention,55,2021/3/20,子宫腺肌病（,Adenomyosis,）,曾称,内在性子宫内膜异位症,病因：多次,妊娠和分娩,时子宫壁的创伤和慢性子宫内膜炎,病理：巨检：子宫多呈均匀增大，病灶有弥漫型及局限型两种，偶见子宫腺肌瘤,(,adenomyoma,),。镜下：肌层内有呈岛状分布的,子宫内膜腺体与间质,。,56,2021/3/20,子宫腺肌病（,Adenomyosis,）,临床表现及诊断,：,30,岁以上的经产妇，出现经量增多、经期延长以及逐年加剧的进行性痛经，子宫呈均匀性增大或有局限性结节隆起，质硬而有压痛，经期压痛尤为显著。,保守治疗,：已近绝经期,全子宫切除术,57,2021/3/20,