妇产科学课件：子宫内膜异位症英文版

EndometriosisEMTDefinitionEndometriosisisadisorderinwhichabnormalgrowthsoftissue,histologicallyresemblingtheendometrium,arepresentinlocationsotherthantheuterinelining.

Thelesionsareusuallyfoundontheperitonealsurfacesofthereproductiveorgansandadjacentstructuresofthepelvis,buttheycanoccuranywhereinthebody.Itsexactprevalenceisunknownbecausesurgeryisrequiredforitsdiagnosis,butitisestimatedtobepresentin10%ofallreproductiveagewoman.ImplantationtheoryRetrogrademenstruationIatrogenicimplantLymphaticandvasculardisseminationMetaplasiatheoryofcoelomicepitheliumInductiontheoryEtiologyThesizeoftheindividuallesionsvariesfrommicroscopictolargeinvasivemassesthaterodeintounderlyingorgansandcauseextensiveadhesionsformation.PathologyOvarianendometriosisPeritonealendometriosisDeepinfiltratingendometriosispathologyOvarianEMTbilateralovariesinvolvedin50%casesmicrolesionsmacrolesions-----chocolatecyst(endometrioma)pathologyPeritonealEMTUterosacralligament,Cul-de-sacandposterialwalloftheuterusDeepinfiltratingEMTUterosacralligament,Cul-de-sac

pathologyMicroscopyendometrialglandendometrialstromaorhemosiderin-ladenmacrophagespathologyClinicalfindingsvarygreatlydependingonthenumber,size,andtheextentofthelesions.WomenwithEMTcanbecompletelyasymptomaticormaybecrippledbypelvicpainandinfertility.ClinicalpresentationChronicpelvicpainanddysmenorrhea:constantpelvicpainoralowsacralbackachepremenstruallyandsubsidesaftermensesbeginsDyspareuniaClinicalpresentationInfertilityAnatomicabnormalityofpelviccavityChangeofthemicroenvironmentofthepelviccavityAbnormalimmunefunctionOvariandysfunctionClinicalpresentationAbnormalmenstruation

-Menorrhagia-premenstrualspottingOtherlocalizationurinarytract:bloodyurinebowel:bloodystoolscar(episiotomyandcesareansectionincision)ClinicalpresentationPelvicexaminationtenderadnexalmassuterusfixedandretrovertedtendernodulesinuterosacralligament,cul-de-sacandposterialwalloftheuterusClinicalpresentationClinicalpresentationUltrasonicexaminationSerumCA125determinationlaparoscopydiagnosisPelvictumorsPelvicinflammatorydiseaseAdenomyosisDysmenorrheausuallythiswillrequireoperativeevaluationDifferentialdiagnosisTreatmentoptionsaredictatedbythepatient’sdesireforfuturefertility,hersymptoms,thestageofherdisease,andtosomeextentherage.Itmustbeemphasizedthattherapiesrequireoperativeinspectionofthelesionsforcorrectdiagnosis.treatmentObservationAnalgesictherapyMedicine:pseudopregnancypseudomenopausegestrinoneothertherapy:mifepristonesurgerytreatmentInasymptomaticpatients,thosewithmilddiscomfort,orinfertilewomenwithminimalormildendometriosis,expectantmanagementmaybeappropriate.treatmentobservationWhenthepatienthasmildpremenstrualpainfromminimalEMT,noabnormalitiesonpelvicexamination,andnodesireforimmediatefertilityProstaglandinsynthetaseinhibitingdrugstreatmentAnalgesictherapyPseudopregnancyBestreservedforpatientswithmilderformsofEMTwhodonotdesireimmediatefertilityandareunabletotakeothertreatments.Createconstanthighlevelsofprogestins,asseeninpregnancy,tothintheendometriumandcauseitsregressionwithpseudodecidualchanges.treatmentMedicinePseudopregnancyOralcontraceptionProgestin

Sideeffect:depression,bloating,weightgain,breakthroughbleedingtreatmentMedicinePseudomenopauseGn-RH(gonadotropinreleasinghormone)agonistsmedicallyoophorectomySideeffect:perimenopusesymdromeosteoporosis,hecticfeveradd-backtherapytreatmentMedicinePseudomenopauseDanazol:aweakandrogeninhibitGn-RHreleasingsexsteroidsbindtoandrogenreceptorsanddirectlyinhibitimplantgrowthSideeffect:acne,oilyskin,deepeningofthevoice,weightgain,edema,andadverseplasmalipoproteinchanges(androgenic)

treatmentMedicineOtherhormonaltherapiesGestrinoneItisananti-estrogen,anti-progesteronesteroidwitheffectssimilardanazol.Thedoseis2.5-5mgorallytwiceweekly.Followupliverfunction

treatmentMedicineIndicationmedicaltreatmentineffectiveovaryendometrioticcystlargerthan5cmdesireforfertilitytreatmentsurgeryPreservereproductiveability:conservativesurgery,exciseordestroyallendometriotictissue,removealladhesions,andrestorepelvicanatomyPreserveovarianfunction:doesnotdesirefuturechild-bearingtreatmentStyleofoperationradicalsurgery:totalhysterectomy,bilateralsalpingooophorectomy,andexcisionofremainingadhesionsorimplantationSurgerytorelievepain:presacralneurectomyoruterosacralligamenttreatmentStyleofoperationPreventretrogradeofmenstruationPa