1、Endometriosis EMTEndometriosis EMTDefinition Endometriosis is a disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining. Definition Endometriosis is a The lesions are usually found on the peritoneal surfaces of t

2、he reproductive organs and adjacent structures of the pelvis, but they can occur anywhere in the body.The lesions are usually found 婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)Its exact prevalence is unknown because surgery is required for its diagnosis, but it is estimated to be present in 10% of all reproductive age woman

3、.Its exact prevalence is unknowImplantation theory Retrograde menstruation Iatrogenic implant Lymphatic and vascular disseminationMetaplasia theory of coelomic epithelium Induction theoryEtiology Implantation theory The size of the individual lesions varies from microscopic to large invasive masses

4、that erode into underlying organs and cause extensive adhesions formation.Pathology The size of the individual lesOvarian endometriosisPeritoneal endometriosisDeep infiltrating endometriosispathology Ovarian endometriosispathologyOvarian EMT bilateral ovaries involved in 50% cases micro lesions macr

5、o lesions-chocolate cyst (endometrioma)pathology Ovarian EMTpathology 婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)Peritoneal EMT Uterosacral ligament, Cul-de-sac and posterial wall of the uterus Deep infiltrating EMT Uterosacral ligament, Cul-de-sac pathology Peritoneal EMTpathology 婦產(chǎn)科

6、學(xué)課件：子宮內(nèi)膜異位癥(英文版)Microscopy endometrial gland endometrial stroma or hemosiderin-laden macrophagespathology Microscopy pathology 婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)Clinical findings vary greatly depending on the number, size , and the extent of the lesions.Women with EMT can be completely asymptomatic or may be cripp

7、led by pelvic pain and infertility.Clinical presentationClinical findings vary greatlyChronic pelvic pain and dysmenorrhea: constant pelvic pain or a low sacral backache premenstrually and subsides after menses beginsDyspareuniaClinical presentationChronic pelvic pain and dysmenInfertility Anatomic

8、abnormality of pelvic cavityChange of the microenvironment of the pelvic cavityAbnormal immune function Ovarian dysfunctionClinical presentationInfertility Clinical presentatAbnormal menstruation - Menorrhagia - premenstrual spotting Other localization urinary tract: bloody urine bowel: bloody stool

9、 scar (episiotomy and cesarean section incision) Clinical presentationAbnormal menstruation ClinicalPelvic examination tender adnexal mass uterus fixed and retroverted tender nodules in uterosacral ligament, cul-de-sac and posterial wall of the uterusClinical presentationPelvic examination Clinical

10、pClinical presentationUltrasonic examinationSerum CA125 determinationlaparoscopydiagnosisClinical presentationdiagnosis婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)Pelvic tumorsPelvic inflammatory diseaseAdenomyosisDysmenorrhea usually this will require operative evaluationDifferential diagnosisPelvic tumo

11、rsDifferential diagTreatment options are dictated by the patients desire for future fertility, her symptoms, the stage of her disease, and to some extent her age.It must be emphasized that therapies require operative inspection of the lesions for correct diagnosis.treatmentTreatment options are dict

12、atedObservation Analgesic therapyMedicine: pseudopregnancy pseudomenopause gestrinone other therapy: mifepristone surgerytreatmentObservation treatmentIn asymptomatic patients, those with mild discomfort, or infertile women with minimal or mild endometriosis, expectant management may be appropriate.

13、treatmentobservationIn asymptomatic patients, thosWhen the patient has mild premenstrual pain from minimal EMT, no abnormalities on pelvic examination, and no desire for immediate fertilityProstaglandin synthetase inhibiting drugstreatmentAnalgesic therapyWhen the patient has mild premPseudopregnanc

14、y Best reserved for patients with milder forms of EMT who do not desire immediate fertility and are unable to take other treatments. Create constant high levels of progestins, as seen in pregnancy, to thin the endometrium and cause its regression with pseudodecidual changes.treatmentMedicinePseudopr

15、egnancy treatmentMedicPseudopregnancy Oral contraception Progestin Side effect: depression, bloating, weight gain, breakthrough bleedingtreatmentMedicinePseudopregnancy treatmentMedicPseudomenopause Gn-RH(gonadotropin releasing hormone) agonists medically oophorectomySide effect: perimenopuse symdro

16、me osteoporosis , hectic fever add-back therapytreatmentMedicinePseudomenopause treatmentMedicPseudomenopause Danazol: a weak androgen inhibit Gn-RH releasing sex steroids bind to androgen receptors and directly inhibit implant growthSide effect: acne, oily skin, deepening of the voice ,weight gain,

17、 edema, and adverse plasma lipoprotein changes (androgenic) treatmentMedicinePseudomenopause treatmentMedicOther hormonal therapiesGestrinone It is an anti-estrogen, anti-progesterone steroid with effects similar danazol. The dose is 2.5 - 5 mg orally twice weekly .Follow up liver function treatment

18、MedicineOther hormonal therapiestreatmIndication medical treatment ineffective ovary endometriotic cyst larger than 5cm desire for fertilitytreatmentsurgeryIndicationtreatmentsurgeryPreserve reproductive ability: conservative surgery, excise or destroy all endometriotic tissue, remove all adhesions,

19、 and restore pelvic anatomyPreserve ovarian function: does not desire future child-bearingtreatmentStyle of operationPreserve reproductive ability:radical surgery: total hysterectomy, bilateral salpingooophorectomy, and excision of remaining adhesions or implantation Surgery to relieve pain: presacral neurectomy or uterosacral ligamenttreatmentStyle of operationradical surgery: total hystere婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)婦產(chǎn)科學(xué)課件：子宮內(nèi)膜異位癥(英文版)Prevent retrograde of menstruationPay attention to the operation causespreventionPrevent retrograde of menstruaEndometriosis still stand as one of the most-investiga