子宮平滑肌瘤第一頁，共五十三頁，編輯于2023年，星期二Introduction

Uterineenlargementasaresultofleiomyomaiscommoninclinicalpractice.Myomaarethecommonestnewgrowthsoftheuterusandoneofthemostcommontumorsofthehumanbody.Theseoccurinapproximately,20%ofwomenover30,25%ofwomenover40.第二頁，共五十三頁，編輯于2023年，星期二AetiologicalfactorsFemaleHormonesEstrogensProgestronsGrowthFactorsBasicfibroblastgrowthfactor(BFGF).Insulinlikegrowthfactor(IGF)-I.Epidermalgrowthfactor(EGF).第三頁，共五十三頁，編輯于2023年，星期二Anatomyofuterus第四頁，共五十三頁，編輯于2023年，星期二Classification第五頁，共五十三頁，編輯于2023年，星期二ClassificationAccordingtolocationofuterinemyomatahavebeendividedinCorporealfibromyomata(90%)Cervicalmyomata(10%).第六頁，共五十三頁，編輯于2023年，星期二ClassificationAndcorporealmyomatahavebeendivided:Intramuralfibromymata60-70%Subserousfibromymata20%Submucousfibromymata10-15%第七頁，共五十三頁，編輯于2023年，星期二第八頁，共五十三頁，編輯于2023年，星期二ClassificationIntramuralfibromymata

withintramuralfibromyomataenlargementoftheuterinebodyusuallyoccurs,oftenwithelongationofitscavitysothatthereisincreasedmenstrualloss.第九頁，共五十三頁，編輯于2023年，星期二Classification

Subserousfibromymata

Size:fromsmallnodulestoenormousmassesof20kgormoreinweight.Pedunculatedmyoma:theytendtogrowupintotheabdomenandthebroadligament,Rarelytorsionmayoccur,resultingininterferencewiththebloodsupplytothetumor.第十頁，共五十三頁，編輯于2023年，星期二ClassificationSubmucousfibromyoma.Someintramuraltumorsareextrudedtowardstheuterinecavity.Theuteruscontractsinanattempttoexpelthetumoranditmaybeextrudeduntilitisonlyattachedtotheuterinewallbyastalkandisknownasafibro-myomatouspolyp第十一頁，共五十三頁，編輯于2023年，星期二PathologyNackedeyeappearance.onsectionthefibromyomaispaler,harderandmorefibrousthantheuterinewall.Oncomparinganintramuraltumorwiththesurroundingfalsecapsuleofuterinewallthedifferenceiswellmarked.第十二頁，共五十三頁，編輯于2023年，星期二Nackedeyeappearance第十三頁，共五十三頁，編輯于2023年，星期二Smoothmuscletumorsoftheuterusareoftenmultiple.Seenherearesubmucosal,intramural,andsubserosalleiomyomataoftheuterus.第十四頁，共五十三頁，編輯于2023年，星期二PathologyMicroscopicalstructure.Thesegrowthsarecomposedofunstripedmuscleandfibroustissue第十五頁，共五十三頁，編輯于2023年，星期二Hereisthemicroscopicappearanceofabenignleiomyoma.Normalmyometriumisattheleft,andtheneoplasmiswell-differentiatedsothattheleiomyomaattherighthardlyappearsdifferent.Bundlesofsmoothmuscleareinterlacinginthetumormass.第十六頁，共五十三頁，編輯于2023年，星期二DegenerationThesetumorsgrowslowly;insomecasestheremaybenoevidentchangeinsizeformanyyears.Inafewcasesgrowthismorerapidandsecondarychangesmayalsocauseswellingofthetumor.第十七頁，共五十三頁，編輯于2023年，星期二DegenerationHyalinedegenerationisthecommonestchangeseeninfibromyomata.Itiscausedbyagradualinadequacyofthebloodsupply.Cysticdegenerationisnotuncommon,especiallyafterthemenopause,andisduetoliquefactionoftheareasofhyalinechange.第十八頁，共五十三頁，編輯于2023年，星期二DegenerationReddegeneration.Inthisvarietyofdegenerationtheaffectedareaisstainedredandresemblesrawmeat.Itismostfreguentlyseenduringthepregnancyandinpostpartum.第十九頁，共五十三頁，編輯于2023年，星期二Degeneration

Malignantchange

In0.1to1%ofcases,malignancyasleiomyosarcomamaydevelop.Itismostlikelytobeseeninlargetumors.Malignancyismoretypicalinolderpatients,especiallypostmenopausalpatientsPresentionwithrapidlyenlarginguterinemassandpostmenopausalbleeding.Metastasisoccursrapidllyinthesecases.第二十頁，共五十三頁，編輯于2023年，星期二Thisisaleiomyosarcomaprotrudingfrommyometriumintotheendometrialcavityofthisuterusthathasbeenopenedlaterallysothatthehalvesofthecervixappearatrightandleft.Fallopiantubesandovariesprojectfromtopandbottom.Theirregularnatureofthismasssuggeststhatisnotjustanordinaryleiomyoma.第二十一頁，共五十三頁，編輯于2023年，星期二SymptomsBleedingisthemostcommonpresentingsymptominuterinefibroids.Menorrhagiaisfreguentreasonforpatientstoseekadvice.Theperiodsincreaseinamountandduration.第二十二頁，共五十三頁，編輯于2023年，星期二SymptomsBleeding

Submucousfibromyomatamenorrhagiaisnearlyalwayspresent,andquitesmalltumorscanleadtosevereanaemia.IntramuraltumorsmayincreasethelossSubserousgrowthsdonotaffectthemenstrualloss.第二十三頁，共五十三頁，編輯于2023年，星期二SymptomsBleeding

Mechanismsforincreasedbleeding:AlterationofnormalmyometrialcontractilefunctionInabilityoftheoverlyingendometriumtorespondtothenormalE/Pmenstrualphases.Pressurenecrosisoftheoverlyingendometrialbed.第二十四頁，共五十三頁，編輯于2023年，星期二SymptomsAnabdominaltumourissometimesthefirstthingthatthepatientnotices.Thetumorisnottenderandrarelygivesrisetopain.Dischargeisrarelyaprominentsymptomexceptduringtheextrusionoffibromyomatospolypthroughthecervicalcanal.第二十五頁，共五十三頁，編輯于2023年，星期二SymptomsPainisnotacommonsymptom.whenitoccuritisgenerallyanindicationthatthereisassociatedendometriosisorpelvicinflammatorydisease,orsomecomplicationofthetumorsuchasreddegenerationortorsion.第二十六頁，共五十三頁，編輯于2023年，星期二SymptomsPelvicpressure:pressureonthebladderleadingtofrequencyandretentionofurine.第二十七頁，共五十三頁，編輯于2023年，星期二PhysicalsignsThephysicalsignsvarywiththesize,positionandnumberofthetumors.Asymmetricalenlargementoftheuterusisfoundwithasubmucosgrowth.Moreoftentheenlargementisasymmetrical;itisoftennodularonthesurfacebecausetherearemultipletumor.Subseroustumorswithlittlemyometrialcoveringoftenfellparticularlyhard.第二十八頁，共五十三頁，編輯于2023年，星期二PhysicalsignsOnpelvicexaminationthecervixmaybefoundtobepusheddownordisplacedtooneside.Ifitisexpandedbyanintracervicaltumor,oritmaybedilatedwiththelowerpoleofatumorleftwithinit.第二十九頁，共五十三頁，編輯于2023年，星期二DiagnosisThediagnosisofthesetumorsisusuallymadebyclinicalexamination,includeabdominalandbimanualpalpation,orimagingstudies.Inaddition,irregularitiesoftheuterinecavitycanbedetectedatthetimeofendometrialcurrettage.第三十頁，共五十三頁，編輯于2023年，星期二DiagnosisPelvicultrasoundisthemostcommonlyusedforconfirmationofuterinemyomas.Dilationandcurettagemayproviderelevantinformation,becauselargertissuespecimens,includingsmallsubmucousmyomas,maybeobtained.第三十一頁，共五十三頁，編輯于2023年，星期二Pelvicultrasound第三十二頁，共五十三頁，編輯于2023年，星期二Pelvicultrasound第三十三頁，共五十三頁，編輯于2023年，星期二HysteroscopyHysteroscopymayalsobeusedtoevaluatetheenlargeduterusbydirectlyvisualizingtheendometrialcavity.第三十四頁，共五十三頁，編輯于2023年，星期二DifferentialdiagnosisOtherconditionswhichcausemenorrhagiaDysfunctionaluterinebleedingCarcinomaoftheuterusEndometrialpolypofuterusOtherconditionswhichgiverisetoaswellinginthepelvisAdenomyoma,ovariantumors,inflammatoryswellinginthepelvis,pregnancy第三十五頁，共五十三頁，編輯于2023年，星期二Thisuterushasbeenopenedanteriorlythroughcervixandintotheendometrialcavity.Highinthefundusandprojectingintotheendometrialcavityisasmallendometrialpolyp.Suchbenignpolypsmaycauseuterinebleeding.第三十六頁，共五十三頁，編輯于2023年，星期二Thethickenedandspongyappearingmyometrialwallofthissectioneduterusistypicalofadenomyosis.Thereisalsoasmallwhiteleiomyomaatthelowerleft.第三十七頁，共五十三頁，編輯于2023年，星期二第三十八頁，共五十三頁，編輯于2023年，星期二Thisadenocarcinomaoftheendometriumismoreobvious.Irregularmassesofwhitetumorareseenoverthesurfaceofthisuterusthathasbeenopenedanteriorly.Thecervixisatthebottomofthepicture.Thisenlargeduteruswasnodoubtpalpableonphysicalexamination.第三十九頁，共五十三頁，編輯于2023年，星期二Abnormalityofuterus第四十頁，共五十三頁，編輯于2023年，星期二TreatmentFollowuphormonaltreatmentfibroidembolisationSurgicalmanagementhysterectomymyomectomymyolysis第四十一頁，共五十三頁，編輯于2023年，星期二TreatmentFollowup:themajorityofpatientswithuterinemyomasdonotrequiresurgicaltreatment.SmalltumorsandnotcausingsymptomsPatientsinthelatereproductiveorperimenopausalyears.Management:repeatpelvicexminationsandassistedbyserialpelvicultrasoundmeasurementsEvery3-6months.第四十二頁，共五十三頁，編輯于2023年，星期二TreatmentDrugtherapy:bleedingisnotheavyenoughtocauseanemiaandsmallmyoma.Mechanisms:PharmacologicinhibitionofestrogensecretionAnattemptmaybemadetominimizeuterinebleedingThistreatmentiscommonlyusedfor3to6months.第四十三頁，共五十三頁，編輯于2023年，星期二TreatmentDrugsandrogenGnRH-asupplementation.GestrinoneMifepristoneChinesemedicine第四十四頁，共五十三頁，編輯于2023年，星期二TreatmentSurgicaltreatmentisindi