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子宫肌瘤小讲课PPT课件

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子宫 肌瘤 讲课 PPT 课件
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Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever v正常子宫解剖形态 v子宫肌瘤 病因 病理表现及分类 临床表现及辅助检查 诊断和鉴别诊断 治疗 相关护理 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 子宫的位置及功能 v子宫位于盆腔中央 坐骨棘水平之上 膀 胱与直肠之间 v子宫 产生月经 是 精子达到输卵管的通 道 是孕卵着床发育 的场所 分娩时提供 产力协助胎儿及附属 物娩出 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 子宫的形态和组织结构 形态 前后略扁 上大下小 倒置扁梨形 成年女性的子 宫平均的长 宽 厚分别为 7 5 3cm 重约50g 子宫 腔容量约5ml 子宫壁分三层 子宫内膜 粘膜层 功能层4 5 青 春期 卵巢激素 周期性脱落 月经 基底层1 5 子宫肌层 子宫外膜 浆膜层 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 概述 子宫肌瘤是女性生殖器中最常见的良性肿瘤 多见于育龄妇女 40岁 50岁 子宫肌瘤是卵巢激素依赖性肿瘤 一般认为其 发生和生长与雌激素长期刺激有关 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 病因病因 确切病因不明确切病因不明 v但临床资料表明 1 好发于生育期妇女 发病后继续生长和发展 绝经后停止生长 甚至萎缩 消失 2 拮抗孕激素药物治疗有效 这些均提示本病的发生可能与女性激素有关 尤 其E关系密切 是一种激素依赖性肿瘤 3 细胞遗传学研究显示25 50 子宫肌瘤存在 细胞遗传学的异常 染色体异常 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 病理 病理 v巨检 实性球形肿块 表面光 与肌壁有明显界限 假包膜 假包膜上有供应肌瘤的血管 呈放射状 管壁缺 乏外膜 受压后易引起血供障碍而发生变性 v镜检 肌瘤由皱纹状排列的平滑肌纤维与结缔组织相互 交织成漩涡状结构 细胞大小均匀 呈卵圆形或杆状 核染色较深 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 临床表现 v月经改变 v腹块 v白带增多 v压迫症状 v下腹疼痛 v不孕 20 30 v继发性贫血 主要和肌瘤的生 长部位有关 与肌瘤大小和个 数关系较少 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 临床表现 体征 v体征决定于肌瘤的大小 数目 位置以及有 无退行性变 合并症等 v肌瘤较大 子宫增大超过妊娠3 4个月子宫 大小时 可在腹部扪及 v妇科检查 子宫大 硬 形不整 浆膜下肌 瘤结节与子宫有蒂相连 活动 粘膜下肌瘤 如未托出 子宫多为均匀性增大 有时瘤结 节脱出阴道内 呈红色 实质性硬 表面光 滑 若伴有感染 有渗出液覆盖 排出液有 臭味 大的肌瘤有变性时 子宫可变软 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 三 辅助检查 1 B超 2 探针探测宫腔深度及方向 3 宫腔镜检查 4 腹腔镜 5 子宫输卵管碘油造影 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 诊断 鉴别诊断 v一 诊断 根据病史 体征 辅助检查 v二 鉴别诊断 1 增大子宫鉴别 1 妊娠子宫 2 子宫腺肌病 2 卵巢肿瘤鉴别 尤其是有蒂的浆膜下肌瘤 3 盆腔炎性包块 4 子宫畸形 双子宫 残角子宫 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 治疗 v原则 依据患者年龄 生育要求 症状及肌 瘤大小等全面考虑 治疗有两种方案 非手术治疗和手术 治疗 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 治疗 保守治疗 即非手术治疗 1 随访观察 患者肌瘤小无症状 尤其是近绝经年龄者 可每 3 6个月随访一次 在观察过程中 如发现肌瘤增 大或者症状明显再采取措施 2 药物治疗 凡肌瘤在两个月妊娠子宫大小以内 症状较轻 近绝经年龄或周身情况不能胜任手术 可给 予药物治疗 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever v雄激素 对抗雌激素 促使子宫内膜萎缩 直接 作用于平滑肌 使其收缩而减少出血 如 a 甲基睾酮 5mg 舌下含服 每日2次 每月用 药20日 b 丙酸睾酮注射液 25mg 肌注 每5日1次 每月总量不宜超过300mg 以免男性化 v抗雌激素制剂 三苯氧胺治疗月经明显增多者 每次10mg 每日口服2次 连续3 6个月 副反 应出现围绝经期综合征的症状如潮热 急躁 出 汗 阴道干燥等 v促性腺激素释放激素激动剂 GnRHa 通过 一直垂体 卵巢功能 降低体内雌激素水平 达 到治疗目的 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 治疗 手术治疗 最常用的治疗手段 其适应征为 1 有明显的症状 2 肌瘤超过两个半月大小 3 肌瘤生长迅速 有恶性变之可能 4 粘膜下肌瘤有蒂 特别是突出宫颈口者 5 宫颈肌瘤 6 肌瘤有蒂扭转或发生感染时 但需先控制炎症 7 青年妇女尚未生育为避免影响生育 可及早行肌瘤 摘除术 8 诊断不明确 有卵巢瘤可能者 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 手术方式 1 肌瘤摘除术 保留子宫 指征 未婚或已婚要求保留生育 功能 方法 1 经腹或腹腔镜下切除 2 经阴道或宫腔镜切除 2 子宫切除术 指征 无生育要求 疑有恶变 方法 1 次全子宫切除术 2 全子宫切除术 年龄在50以下 卵巢无恶变 应保留双侧或一侧 卵巢 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 护理措施 1 提供信息 增强信心 详细评估病人所具备的子宫肌瘤相关知识及 错误概念 通过连续性护理活动与病人建立 良好的护患关系 讲解有关疾病知识 纠正 错误认识 使病人确信子宫肌瘤属于良性肿 瘤 并非恶性肿瘤的先兆 通常不会出现其 他问题 消除其不必要的顾虑 增强康复信 心 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 2 观察病情 认真护理 a 出血多需住院治疗者 应严密观察并记录其生命体征变 化情况 协助医师完成血常规及凝血功能检查外 需测血 型 交叉配血 评估出血量 按医嘱给予止血药和子宫收 缩剂 b 巨大肌瘤患者出现局部压迫导致尿 便不畅时 应予导 尿 或用缓泻剂软化粪便 或番泻叶2 4g冲饮 以缓解 尿潴留 便秘症状 c 需接受手术治疗者 按腹部及阴道手术护理 肌瘤脱出 阴道内者 应保持局部清洁 防止感染 d 合并妊娠者应定期接受产前检查 多能自然分娩 不需 急于干预 但要预防产后出血 若肌瘤阻碍胎先露下降 或致产程异常发生难产时 应按医嘱做好剖宫术前准备及 术后护理 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 3 提供随访及出院指导 a 使保守治疗者明确随访的时间 目的及联系方式 按时接受随访指导 以便根据病情需要修正治疗 方案 b 向接受药物治疗者讲明药物名称 用药目的 剂 量 方法 可能出现的副反应及应对措施 c 使术后病人了解术后一个月返院检查的内容 具 体时间 地点及联系人等 d 病人的性生活 日常生活恢复均需通过术后复查 全面评估身心状况后确定 e 任何时候出现不适或异常症状 需及时随诊 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 宫内孕16周 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 左侧卵巢肿瘤示意 图 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 肌壁间肌瘤 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 浆膜下肌瘤 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 黏膜下肌瘤 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 月经改变 月经改变 腹块 腹块 A 经量增多 经期延长 周期缩短是典型症状 B 浆膜下肌瘤及壁间小 肌瘤月经无改变 C 月经改变和肌瘤大小 不成正比 A 多位于下腹正中 B 清晨膀胱充盈时易扪 及 C 质地坚硬 形态不规 则 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 白带增多白带增多 压迫症状压迫症状 v壁间肌瘤较大使宫腔面 积增大时 内膜腺体分 泌增多 并伴有盆腔充 血时致使白带增多 粘 膜下肌瘤 尤其是脱出 子宫口或阴道口的有蒂 肌瘤 因表面粘膜溃疡 和坏死 可产生大量血 性或有臭味的白带 v肿瘤增大 可压迫附近 器官而产生各种症状 如子宫前壁和宫颈肌瘤 可压迫膀胱 发生尿频 排尿障碍 尿潴留等 后壁肌瘤可压迫直肠 引起大便困难 Happy times always go by quickly and today s story game is coming to an end Today this happy day will remain in our memory forever 下腹疼痛 v浆膜下肌瘤蒂扭转 急性腹痛 v肌瘤红色变性 腹痛剧烈 伴发热 v粘膜下肌瘤排出宫腔时 因子宫收缩引起痉 挛性疼痛 v肌瘤较大压迫周围组织 产生坠痛
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上传时间: 2020-05-23

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