子宫肌瘤和动脉栓塞治疗讲课教案.ppt

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1、子宫肌瘤的动脉栓塞治疗(uterinearteryembolization,UAE)子宫肌瘤子宫平滑肌瘤（uterineleiomyoma）简称子宫肌瘤（uterinemyoma），由平滑肌细胞和不同数量的纤维结缔组织构成。生育年龄女性最常见的良性肿瘤，多见于30～50岁，41～50岁为高峰，占54.9％，20岁组和60岁以上组少见。资料统计，30岁以上女性发病率高达20％～30％，约占女性良性肿瘤的51.78％。10％～30％有症状。常见症状是月经过频、过多、经期延长，贫血发生率增加，体质下降。粘膜下肌瘤出血几率达100％，肌壁间和浆膜下肌瘤出血率为76％和36

2、％。2021/7/312UTERINEFIBROIDBenigntumorofuterinesmoothmuscleFibroidsarenotthoughttobepre-cancerousAlsoknownasmyomas（肌瘤）orleiomyomas（平滑肌瘤）Types:submucosal,intramural,andsubserosal2021/7/313LOCATIONOFUTERINEFIBROIDS2021/7/3142021/7/315SYMPTOMSOFUTERINEFIBROIDSMenorrhagia（Heavierandlongerm

3、enstrualbleeding）,sometimeswithpassageofbloodclots.AnemiacanoccurifbleedingisseverePain,pressure,orfeelingoffullnessintheabdomen,pelvisorlowerbackFrequenturinationorconstipation（便秘）PainandbleedingduringorafterintercourseInfertilityormiscarriage2021/7/316TREATMENTsurgerymicropunctureUA

4、EHIFURFmedicationChinesetraditionmedicine2021/7/317HYSTERECTOMYSurgicalremovalofuterusandfibroids,performedthroughabdominalincisionoroccasionallyvaginally,sometimeswithalaparoscopeAdvantages:100%Curative,Noriskoffuturecancer,WellestablishedprocedureDisadvantages:majorsurgerywithpotent

5、ialsurgicalcomplications:ureteralinjury,infection,adhesions(scarring),lossofchildbearingpotential:emotional?sexual?2021/7/318MYOMECTOMYIndividualfibroidsareresectedthroughanabdominalincisionorsometimeswithalaparoscopeorhysteroscopeAdvantages:Fertilitycanbepreserved,wellestablishedproc

6、edure,lessinvasiveiflaparoscopicorhysteroscopic2021/7/319MYOMECTOMYDISADVANTAGESPotentialsurgicalcomplicationsaswithhysterectomyOnlypartofuterusistreatedandrecurrencecanoccur15to25%needrepeatprocedureusuallyhysterectomyNotallfibroidsamenabletomyomectomyAdhesionscanleadtoinfertility202

7、1/7/3110术式选择目的：除去肌瘤、消除症状要求：最佳术式、最佳效果术式宜简单、创伤小，术后恢复快，不易产生并发症或后遗症，不影响远期生活质量。2021/7/3111术式优点缺点子宫全切术（包括经腹、经阴、腹腔镜）可以完整地切除病变子宫、无复发A:断扎附件容易影响卵巢血供，致卵巢功能早衰B:破坏了盆底的完整性C:缩短了阴道、影响性生活D:手术难度、易出血、损伤泌尿道子宫次全切除术手术操作相对简单，并发症少，可以避免全切术的大部分缺点A:存在子宫颈残端癌的可能性B:仍有影响卵巢功能的问题存在子宫筋膜内子宫切除术避免了子宫全切术和子宫次全切除术的缺点术后对卵巢功能

8、仍有影响子