、装 Department of obstetrics and gynecology, CUM
Department of Obstetrics and Gynecology, CUM
Case(Part D Age: 40 years GP Complaint Menstrual pain for 3 years Present history: Three years ago, she started to feel pain in lower abdomen and lumbosacral (H AL area during menstruation.The pain has been worsening progressively. In addition, she has heavy menses(月经) Past history: She gave birth to healthy male baby 15 years ago. Five . years ago she had an artificial abortion, and an IUD was placed then
Case (Part I) Age: 40 years G2P1 Complaint: Menstrual pain for 3 years Present history: Three years ago, she started to feel pain in lower abdomen and lumbosacral (腰骶)area during menstruation. The pain has been worsening progressively. In addition, she has heavy menses (月经). Past history: She gave birth to healthy male baby 15 years ago. Five years ago she had an artificial abortion, and an IUD was placed then
What condition was she having
What condition was she having?
Endometriosis (子宫内膜异位症
Endometriosis (子宫内膜异位症）
Learning objectives Definition of endometriosis Pathology and clinical features Diagnosis Principles of treatment
• Definition of endometriosis • Pathology and clinical features • Diagnosis • Principles of treatment Learning Objectives
Introduction What is endometriosis? Definition: Presence of functioning endometrial glands and stroma(E] ii)outside their usual location in the uterine cavity Pathological features a benign condition with clinically malignant biological behavior(invasion and metastasis) Sex hormones dependent
What is endometriosis? Definition: Presence of functioning endometrial glands and stroma (间质) outside their usual location in the uterine cavity. Pathological features: • A benign condition with clinically ‘malignant’ biological behavior (invasion and metastasis) • Sex hormones dependent Introduction
Introduction How common is the disease? About 3%0-10%o in women of reproductive age 5%0-15% women who are having an abdominal surgery are diagnosed with the condition 25%0-35% in women with infertility 20%0-90% in women with chronic pelvic pain 40%0-60% in women with menstrual pain
• About 3%-10% in women of reproductive age • 5%-15% women who are having an abdominal surgery are diagnosed with the condition • 25%-35% in women with infertility • 20%-90% in women with chronic pelvic pain • 40%-60% in women with menstrual pain. Introduction How common is the disease?
Introduction Why does endometriosis happen?
Introduction Why does endometriosis happen?
athogenesis Ectopic transplantation theory(异位种植学说) Irect Implantation) 70-90% women have retrograde menstruation(经血逆流 Viable endometrial cells exist in the peritoneal fluid in more than 50% woman during menstruation Implantation of menstrual tissue has been demonstrated experimentally( in the monkeys) and iatrogenic(医源性的) implantation occurs(e.g. endometriosis in the scar of abdominal wall after an abdominal cesarean section) Often pelvic deposits of endometriosis occur close to the ends of the fallopian tubes
Pathogenesis Ectopic transplantation theory (异位种植学说） (Direct Implantation) • 70-90% women have retrograde menstruation (经血逆流). • Viable endometrial cells exist in the peritoneal fluid in more than 50% woman during menstruation. • Implantation of menstrual tissue has been demonstrated experimentally (in the monkeys) and iatrogenic (医源性的) implantation occurs (e.g. endometriosis in the scar of abdominal wall after an abdominal cesarean section). • Often pelvic deposits of endometriosis occur close to the ends of the fallopian tubes
Pathogenesis Sites of endometriosis
Sites of endometriosis Pathogenesis