子宫脱垂（Uterine prolapse）－狄文.ppt
Uterine Prolapse,DI WEN M.D.,Ph.D.,Professor&Chairman Department Of Obstetrics&Gynecology Renji Hospital Affiliated to SJTU School of Medicine,Uterine Prolapse,2,The uterus gradually descends in the axis of the vagina taking the vaginal wall with it.It may present clinically at any level,but is usually classified as one of three degrees.,Definition,Uterine Prolapse,3,Uterine Prolapse,4,Uterine Prolapse,5,Uterine Prolapse,6,Uterine Prolapse,7,Causes,1.The stretching of muscle and fibrous tissue2.Increased intra-abdominal pressure3.A constitutional predisposition to stretching of the ligaments as a response presumably to years in the erect position,Uterine Prolapse,8,Uterine Prolapse,9,Uterine Prolapse,10,In recent years,the incidence of prolapse is greatly reduced.The more liberal use of caesarean section and the elimination of labours are probably the two most important factors.,Uterine Prolapse,11,Symptoms,Something coming downBackacheIncreased frequency of micturitionA bearing down sensationStress incontinenceCoital problemsDifficulty in voiding urine,Uterine Prolapse,12,Uterine Prolapse,13,Uterine Prolapse,14,Uterine Prolapse,15,Uterine Prolapse,16,Uterine Prolapse,17,Uterine Prolapse,18,Degrees of uterine prolapse,First degree:cervix still inside vagina,Uterine Prolapse,19,Degrees of uterine prolapse,Second degree:the cervix appears outside the vulva.The cervical lips may become congested and ulcerated,Uterine Prolapse,20,Degrees of uterine prolapse,Third degree:complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.,Uterine Prolapse,21,Diagnosis,A pelvic examination reveals protrusion of the cervix into the lower part of the vagina(mild prolapse),past the vaginal introitus/opening(moderate prolapse),or protrusion of the entire uterus past the vaginal introitus/opening(severe prolapse).,Uterine Prolapse,22,Treatment,Pessary treatment Indications:Patient prefers a pessary.Pelvic surgery unaviodable risks Prolapse amenable to pessary The patient is not fit for surgery Patient wishes to delay operation,Uterine Prolapse,23,Uterine Prolapse,24,Uterine Prolapse,25,Uterine Prolapse,26,Uterine Prolapse,27,*Anterior colporrhaphy(and repair of cystocele)*Posterior colpoperineorrhaphy(including repair of rectocele)*Manchester repair*Vaginal hysterectomy,Surgery,Uterine Prolapse,28,Uterine Prolapse,29,Uterine Prolapse,30,Uterine Prolapse,31,Uterine Prolapse,32,Uterine Prolapse,33,DI WEN M.D.,Ph.D.Professor&Chairman Department of Obstetrics&Gynecology Renji Hospital Affiliated to SJTU School of Medicine,Thanks for Your Attention,DI WEN M.D.,Ph.D.Professor&Chairman Department of Obstetrics&Gynecology Renji Hospital Affiliated to SJTU School of Medicine,Thanks for Your Attention,
