资源描述
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,*,*,*,Endometriosis,Womens Hospital, School of Medicine Zhejiang University,Prof. Lin Jun,Definition,Endometriosis,is usually defined as the presence of endometrial-like tissue, that is, glands and stroma, outside the endometrium,in uterine cavity and myometrium.,Common sites of endometriosis,The most common sites,：,uterosacral ligament,rectouterine pouch,ovary,Others,：,uterine serosa,fallopian tube,sigmoid colon (,乙状结肠,),outside of the pelvis,:,Umbilicus(,脐,) , bladder, kidney,Prevalence,present in 10%-15% of women in reproductive age group, especially from age 25 to 45,normally not seen before age 15 or after menopause,early and more childbearing,latest study: more frequent menses (cycle length 27 days ) and prolonged menstrual flow ( 1 week) 2 times risk,Pathogenesis,Theories of sources of ectopic endometrium,Endometrial implanting theory,(,种植学说,),Sampson 1921,endometrium,transfer implant grow,retrograde menstruation (,经血逆流,) theory,transport by lymph and vein,iatrogenic,(,医源性的,),implantation,Pathogenesis,Theories of source of ectopic endometrium,metaplasia theory(,化生学说,),inducement theory,（诱导学说）,Pathogenesis,Factors related with endometriosis,Genetic Abnormalities,：,high risk in first-degree relatives,Immunologic Factors :,increased concentrations of white blood cells, cytokines, and growth factors, IL-6,、,IL-8,、,TNF-,、,MCP-1,inflammation:,EMs lesions chronic pelvic inflammation,Pathology,ectopic endometrium,hemorrhage,proliferation of fibrous tissue,adhesions,dark blue or dark brown spots,scarring nodules or cysts,Gross appearance :,ovarian endometriosis,red, blue, or brown spots,endometriomas chocolate cysts,Gross appearance :,peritoneal endometriosis,common sites,：,uterosacral ligament,、,rectouterine pouch,purple,spots,dark brown spots,red lesions,white lesions,peritoneum lack,peritoneal endometriosis,peritoneal endometriosis,cervix,umbilicus,(,脐,),The microscopic findings,：,endometrial glands,endometrial stroma,fibrin,red blood cells and hemosiderin,（含铁血黄素）,2 findings to be diagnosed,Clinical Findings,symptoms,：,dysmenorrhoea,（痛经）,and,chronic pelvic pain,the most typical symptom,：,secondary dysmenorrhea that worsens over time,dyspareunia,（性交痛）,abnormal uterine bleeding,heavy menses, prolonged menstruation or premenstrual spotting,infertility,：,40% of patients,acute abdomen:,inter-cyst hemorrhage(,囊内出血,), or rupture,Clinical Findings,symptoms,：,others,：,diarrhoea,（腹泻）,constipation,（便秘）,bloody stool,painful urination,bloody urine,backache,Causes of infertility,1) Mechanical reason,2) Environmental change in the peritoneal cavity,3) Abnormal immune function,4) Abnormal ovarian function,(anovulation,LPD, Lufs),5) Increase in spontaneous abortion,Clinical Findings,P,elvic Examination,：,fixed retroverted uterine,tender nodules on uterosacral ligament or rectouterine pouch,tender and fixed adnexal masses,Diagnosis,history,pelvic examination,laparoscopy golden diagnosis standard,diagnosis, classification,treatment,ultrasound, (,CT and MRI, expensive),serum CA125 ,but usually,100IU/ml,anti-endometrium antibody,Diagnosis,Clinical classification,Revised American Fertility Society (r-AFS), 1985,Useful for:,Assessment of severity,Selection of therapeutic regimen,Comparison,Prognosis,r-AFS,Differential Diagnosis,Ovarian tumor,ascites,（腹水）, solid or mixed, B ultrasound image, CA-125100 IU/ml,Abdominal inflammatory mass,history of infection, fever, not cyclic, treatment with antibiotics effectively,Adenomyosis,(,子宫腺肌病,),medial, severe pain, uterus slightly enlarged,Treatment,Principles of treatment,：,Treatment should be individualized according to the age, severity of the condition and desire for childbearing.,With mild symptom:,expectant therapy,With childbearing desire:,mild-condition:,medication,severe-condition:,fertility preservation surgery,No childbearing desire :,Surgical treatment: ovary preservation or radical surgery,Treatment,Expectant Therapy,Follow-up,symptoms management,：,NSAIDs,（非甾体类抗炎药）,Treatment,Medication,Objective:,cause atrophic changes in the ectopic endometrium,（使异位内膜萎缩）,Medication,Pseudopregnancy therapy, oral contraceptives,：,a pill once daily for 6-12 m,progestins,：,medroxyprogesterone,（醋酸甲孕酮）,30mg daily,megestrol,（甲地孕酮）,40mg daily,norethindrone,（炔诺酮）,5mg daily,Side effects:,Intermittent breakthrough bleeding, nausea, breast tenderness, fluid retention, weight gain,Medication,Pseudomenopause therapy,GnRH-a,Mechanism:,Medical hypophysectomy (,药物性垂体切除,),/ Medical oophorectomy (,药物性卵巢切除,),leuprorelin,（亮丙瑞林，抑那通）,goserelin,（戈舍瑞林，诺雷德）,tryptorelin,（曲普瑞林，达菲林）,m / H, 1 inj/q28d, start d1,Medication,GnRH-a,Side effects:,(1) Menopausal symptoms :,hot flashes, dryness in vagina, loss of libido(,性欲,),(2) Osteoporosis,Medication,Pseudomenopause therapy,Danazol,A derivative of 17-ethinyltestosterone,（,17-,乙炔睾酮衍生物）,Mechanism:,Directly suppressing ovarian steroidogenesis,（甾体激素生成）,Direct inhibiting the growth of endometrium,400-600 mg/d for 6 months,Medication,Danazol,Side effects:,acne, deepening of the voice, oily skin, headache, hot flashes, loss of libido, weight gain,Medication,others,：,gestrinone,（孕三烯酮）,mifepristone,（米非司酮）,Surgical treatment,Purposes,：, diagnosis and classification, excise or destroy all endometriotic tissue, remove all adhesions, restore pelvic anatomy, enhance fecundity, relieve pain,Surgical treatment,laparoscopy + medicine,golden standard of treatment,Surgical treatment,Modes of surgical operation:,(1) Fertility preservation,(2) Ovarian function preservation,(3) Radical surgery,(4) Surgery for pain relief,Treatment,Combination of medication and surgery,surgery + medication,medication + surgery + medication,Treatment for patients with infertility,Prevention,Prevent retrograde flow of menses,Contraception with medicine,Avoid iatrogenic (,医源性,) implantation of the ectopic endometrium,Adenomyosis,Definition,Adenomyosis is defined by the presence of endometrial glands and stroma within the myometrium. It is associated with myometrial hypertrophy and proliferation.,Endometriosis,Adenomyosis,Pathogenesis,histological confirmation,Sites of lesions,Clinical findings,Adenomyosis is thought to be unrelated to endometriosis,.,Clinical findings,Multiparas,（,40,y,）,were most commonly affected.,Symptoms,：,prolonged and heavy menses,Dysmenorrhea,that worsens over time,Pelvic exam,：,enlargement of uterus,tenderness,Diagnosis,Typical symptoms and signs,Histopathologic examination, standard of the diagnosis,B ultrasound would suggest the disease.,Treatment,1. Medication,：,GnRH-a,2. Surgical treatment :,total hysterectomy,Thank you !,
展开阅读全文