子宫内膜异位症艾星子endometriosisEndometriosis

体腔上皮化生学说子宫内膜种植学说淋巴静脉播散学说continue遗传因素Motorras等报道有异位症家族史者的发病率为46%免疫学说自身免疫性疾病2008年前攻破创妇科史上的奥林匹克http:/www.endozone.orgOXEGENE-国际合作项目国际合作项目卵巢异位症宫骶韧带宫骶韧带,直肠子宫陷凹直肠子宫陷凹子宫后壁下段异位症子宫后壁下段异位症输卵管及宫颈异位症输卵管及宫颈异位症盆腔腹膜异位症盆腔腹膜异位症巨检巨检 continue镜镜检检子宫内膜腺体子宫内膜腺体子宫内膜间质子宫内膜间质纤纤 维维 素素出出 血血继发性渐进性加重的痛经盆腔结构异常：卵巢、输卵管粘连-机械性障碍，影响排卵、受精和生殖细胞游走。盆腔内微循环改变：补体系统、细胞因子卵巢功能异常：未破裂卵泡黄素化综合征（luteinized unruptured follice syndrome,LUFS)1.Pelvic tenderness.2.Fixed retroverted uterus.3.Nodularity of the Douglas pouch and uterosacral ligaments.4.Ovaries may be enlarged and tender.Ovarian cyst may be detected.Signs 体征体征 辅辅 助助 检检 查查cont.1.Ovarian cysts.卵巢恶性肿瘤卵巢恶性肿瘤2.Pelvic inflammatory disease.盆腔炎性包块盆腔炎性包块3.Asymmetrical enlarged uterus.Revised AFS System:Most Often Used.Ranges from Stage I(Minimal)to Stage IV(Severe).Staging Involves Location and Depth of Disease,Extent of Adhesions.Stage I(minimal)1 5.Stage II(mild)6 15.Stage III(moderate)16 40.Stage IV(severe)40.Young,asymptomatic infertile patient with mild endometriosis.If pregnancy does not achieved within 12-18 months of observation:The presence of endometriosis does not generally impair the results of IVF but it increases the risk of infection.It is preferable not to cauterize ovarian endometrioma if IVF or ICSI is indicated for fear of destruction of ovarian tissues.1.达那唑达那唑 danazol2.孕三烯酮孕三烯酮3.米非司酮米非司酮4.促性腺激素释放激素激动剂促性腺激素释放激素激动剂 GnRH-a5.假孕疗法假孕疗法 大剂量雌大剂量雌/孕激素，连服孕激素，连服 9个月个月保留生育功能的手术保留生育功能的手术保留卵巢功能的手术根 治 性 手 术附件包块盆腔疼痛不孕药 物 手 术药物腹腔镜确诊腹腔镜确诊+手术手术+药物药物金标准金标准治疗治疗什么是子宫内膜异位(endometriosis)?子宫内膜异位症典型症状是什么内异症引起不孕的原因是什么制制 作作 简简 介介E