8例不典型葡萄胎的诊疗分析

目的分析8例孕12周前不典型葡萄胎的诊疗体会,提示不良妊娠后病理检查的重要性。方法对2008年1月～2009年1月以稽留流产及不全流产收住院后经病理检查诊断为完全性葡萄胎患者5例,部分性葡萄胎患者3例进行分析。结果稽留流产及不全流产清宫术后肉眼均未见水泡样结构,不能排除早期葡萄胎可能,不典型葡萄胎易被误诊为稽留流产而导致漏诊。结论对不良妊娠患者于清宫术后常规病理检查及完善血HCG可减少葡萄胎的漏诊及误诊。     

超声检查早期诊断体外受精-胚胎移植术后复合妊娠

目的探讨超声检查早期诊断体外受精-胚胎移植术(IVF-ET)后复合妊娠(HP)的价值。方法回顾性分析81例IVF-ET后临床确诊为复合妊娠患者的超声和手术情况,并随访宫内妊娠结局。结果超声诊断HP的时间为IVFET后20~49天,平均(29.08±5.74)天。81例中,术前超声诊断为宫内合并输卵管妊娠70例,宫内合并宫角妊娠8例,宫内合并宫颈妊娠、宫内合并肌壁间妊娠、单侧输卵管妊娠各1例;术前超声误诊3例,漏诊1例;超声诊断符合率为95.06%(77/81)。对77例宫内妊娠情况进行随访,其中60例已分娩或继续妊娠,6例术后宫内胚胎停育而接受清宫术,1例因21-三体高风险而接受引产,10例失访。结论超声检查可早期诊断IVF-ET后HP,指导临床及时治疗。     

27例宫内妊娠合并输卵管妊娠临床分析

目的通过分析宫内妊娠合并输卵管妊娠的临床特点以提高临床医生诊断和治疗水平。方法回顾分析2005年1月至2016年12月我院收治的27例经手术病理确诊为宫内妊娠合并输卵管妊娠的患者,分析患者的受孕方式、诊断孕周、临床表现、超声表现和异位妊娠位点、双侧输卵管情况等方面资料。结果受孕方式:1例为促排卵人工授精,其余26例均为体外受精-胚胎移植。从移植或者授精到诊断宫内妊娠合并输卵管妊娠的平均时间间隔为35d,最早20d,最迟54d。最常见的临床表现为阴道出血或者腹痛,其中10例患者仅为常规超声检查发现。1例因内出血导致失血性休克而表现为胃肠道症状。超声下表现为盆腔包块26例,宫角妊娠1例;16例患者既往有至少1次异位妊娠病史,11例患者合并不同程度的输卵管病变而行相应手术处理。结论辅助生殖技术显著增加宫内妊娠合并输卵管妊娠风险,尤其是既往有异位妊娠病史的患者,临床医生应提高警惕;高危患者出现腹痛及阴道出血表现时,不应简单地视为宫内妊娠先兆流产而予以积极的保胎治疗,需要仔细寻找宫内妊娠证据并排除异位妊娠的发生;对高危患者在无临床症状时,首次确认宫内妊娠后间隔2周重复超声检查有助于排除同时合并输卵管妊娠的发生并改善临床结局。     

妊娠合并卵巢肿瘤的临床特点及诊治体会

目的探讨妊娠合并卵巢肿瘤的临床特点及诊治方法。方法回顾性分析80例妊娠合并卵巢肿瘤患者的临床诊治资料。结果本组超声诊断率为62.5%。76例良性肿瘤(95.0%)中以良性畸胎瘤和浆液性囊腺瘤最为常见,4例非良性肿瘤(5.0%)中有1例黏液性囊腺癌、3例交界性肿瘤。3例早产,无流产发生。结论超声检查是妊娠合并卵巢肿瘤的重要诊断方法,适时手术不会对妊娠结局产生较大影响。     

妊娠合并胰腺炎7例报告

摘要：回顾性分析7例妊娠合并急性胰腺炎（AP）的临床资料。经B超、血淀粉酶、血脂检查各6例， 其中3例合并胆道结石，6例有高脂血症，4例血淀粉酶增高。及时诊断6例，延误诊断1例。非手术治疗5例并继续妊娠，母婴均存活。手术治疗2例，同时终止妊娠，2例患者及1例胎儿存活，1例胎儿死亡。提示胆道结石和高脂血症是妊娠合并AP的重要诱因。酶学及影像学检查是重要的诊断方法。治疗应遵循“个体化”原则。     

妊娠期高血压疾病合并心力衰竭10例临床分析

目的:探讨妊娠期高血压疾病合并心力衰竭的原因、诊断、处理及预防措施.方法:回顾分析我院2003年1月至2009年12月收治妊娠期高血压合并心力衰竭患者的临床资料.结果:10例患者经早期诊断,积极强心、利尿、扩张血管,控制心力衰竭后及时终止妊娠治疗,母婴结局良好.妊娠期高血压疾病是高危妊娠,并发症较多,孕期需加强监护、补充营养、注毒血容量变化、严格掌握用药指征,早期发现异常,避免心力衰竭发生.     

宫角妊娠合并中隔子宫1例并文献复习

宫角妊娠是比较少见的异位妊娠类型,宫角妊娠合并中隔子宫更为少见。血B．hCG和超声检查是主要的诊断方法,但误诊及漏诊率较高。宫角妊娠及中隔子宫的传统治疗以剖腹手术为主,随着腔镜及超声技术的发展,其微创治疗成为可能。2012年,我们采用宫、腹腔镜联合吸宫术治疗宫角妊娠合并中隔子宫1例,报道如下。     

妊娠合并卵巢肿瘤32例临床分析

回顾性分析1997年1月至2002年1月收治的32例妊娠合并卵巢肿瘤的患，均予以手术治疗，肿瘤标本送病检，并追踪随访母婴。妊娠合并卵巢肿瘤呈上升趋势，绝大部分为良性肿瘤，手术疗效满意。妊娠合并卵巢肿瘤可通过孕早期妇检、B超检查及剖宫产术中对附件探查等早期诊断，予适时手术治疗，预后良好。     

妊娠合并急性阑尾炎的早期诊断和外科治疗（附26例报告）

目的总结妊娠合并急性阑尾炎的临床特点及手术效果。方法妊娠合并急性阑尾炎26例,平均发病时间28.2（4-72）h。术前明确诊断23例,术前疑诊3例。均行阑尾切除术,入院至手术平均时间4.7（1.8-44）h。结果术后2例切口感染,1例应患者要求行药物流产,余无流产、早产、胎儿宫内窘迫及死胎发生。所有病例均获随访,平均10.5（9-12）个月,1例术后4月发生轻度粘连性肠梗阻,保守治愈。结论妊娠合并急性阑尾炎临床特点不典型,但根据病史、体检,结合B超检查作出早期诊断亦不困难,一旦确诊应尽早手术,以保证母婴安全。     

妊娠合并血小板减少64例临床分析

妊娠合并血小板减少可由多种内科合并症和妊娠并发症引起．患者由于血小板减少或不良导致出血．尤其在分娩、手术、麻醉过程中易发生严重出血而危及母婴生命。回顾分析本院1995～2004年的64例妊娠合并血小板减少的临床处理情况．现报道如下．     

Partial hydatidiform mole with a coexistent live full-term fetus. A case report

A patient with a partial hydatidiform mole, who had a coexistent normal fetus, is described. The pregnancy proceeded to term and ended in the spontaneous, vaginal delivery of a normal baby. The placenta showed areas of macroscopic cystic degeneration with the histological features of hydatidiform mole.     

Total intravenous anesthesia for evacuation of a hydatidiform mole and termination of pregnancy in a patient with thyrotoxicosis

Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery.     

Value of ultrasound as a presurgical diagnostic tool in Obstetrics and Gynecology

Although relatively new, diagnostic ultrasound is an important part of the surgeon's armamentarium in preoperative diagnosis and patient preparation. In the field of gynecology, it is possible to differentiate between solid and cystic tumors, measure the extent of tumors in the pelvis and abdomen, define normal structures in relationship to pathologic changes and diagnose and follow patients with malignant disease. In obstetrics, ultrasound has proved effective in the evaluation of the fetus and detection of obstetric problems such as estimation of fetal weight and gestational age, diagnosis of placenta previa, hydatidiform mole and missed and incomplete abortions.     

The changes of clinical features of hydatidiform mole:analysis of 113 cases

Objective:To investigate the changes of the clinical features of hydatidiform mole.Methods:One hundred and thirteen cases of hydatidiform mole treated in Peking Union Medical College Hospital during 1989-2006 were reviewed retrospectively and a comparison was made to historic data(1948-1975)using χ2 test.Results:The median age was 28 years(ranges from 20 to 55 years).The median gestational age was 90.2 days.Vaginal bleeding remaines the most common presenting symptom,ocurring in 94 of 113 cases(83.2%).Fifty-two of 113 cases(46%)presented with excessive uterine size.Pregnancy induced hypertension syndome(PIH),hyperemsis,hemoptysis and theca lutein cysts occurred in 4 of 113(3.5%),12 of 113(10.6%),4 of 113(3.5%)and 19 of 113 cases(16.8%)respectively.Incidence of postmolar trophoblastic neoplasia was 21%(24 of 113).Campared to historic data,the incidence of vaginal bleeding and PIH were statistically lower(P<0.005).The incidence of postmolar gastational trophoblastic neoplasia(GTN)was increased moderately without statistical significance compared to historic data.Conclusions:Because of the wide use of ultrasonography and serum hCG test,the current patients with hydatidiform mole have been diagnosed earlier in gestation and the clinical features have changed.Patterns of medical practice should be changed accordingly.     

葡萄胎临床表现的新特点:113例葡萄胎临床分析

目的探讨葡萄胎临床表现的新特点。方法回顾性分析1989年11月至2006年5月我院收治的113例葡萄胎患者的临床资料。并与1948~1975年收治的葡萄胎的临床特点加以比较。使用χ2检验进行统计学分析。结果患者年龄20~55岁,中位年龄28岁。诊断葡萄胎时中位停经时间为90.2 d(13周);阴道不规则流血94例(83.2%);子宫大于孕周52例(46.0%);妊娠高血压综合征4例(3.5%),均在孕20周前确诊;妊娠剧吐12例(10.6%);咯血4例(3.5%);卵巢黄素化囊肿19例(16.8%);恶变24例(21%)。与1948~1975年收治的214例葡萄胎的临床特点比较,近期葡萄胎的诊断时间大大提前;症状也明显减轻,其中阴道流血和妊娠高血压综合征的发生率降低,均有显著性差异(P<0.005)。恶变率较既往稍高,但无显著性差异(P>0.05)。结论近期葡萄胎的诊断时间明显提前,临床表现有了新的特点,临床处理亦应随之有所改变。     

Discrimination of complete hydatidiform mole from its mimics by immunohistochemistry of the paternally imprinted gene product p57KIP2.

The p57KIP2 protein is a cell cycle inhibitor and tumor suppressor encoded by a strongly paternally imprinted gene. We explored the utility of p57KIP2 as a diagnostic marker in hydatidiform mole, a disease likely the result of abnormal dosage and consequent misexpression of imprinted genes. Using a monoclonal antibody on paraffin-embedded, formalin-fixed tissue sections, the authors evaluated p57KIP2 expression in normal placenta and in 149 gestations including 59 complete hydatidiform moles, 39 PHMs, and 51 spontaneous losses with hydropic changes. p57KIP2 was strongly expressed in cytotrophoblast and villous mesenchyme in normal placenta, all cases of partial hydatidiform moles (39 of 39) and all spontaneous losses with hydropic changes (51 of 51). In contrast, p57KIP2 expression in cytotrophoblast and villous mesenchyme was absent or markedly decreased in 58 of 59 complete hydatidiform moles. In all gestations p57KIP2 was strongly expressed in decidua and in intervillous trophoblast islands, which served as internal positive controls for p57KIP2 immunostaining. p57KIP2 immunohistochemistry can reliably identify most cases of complete hydatidiform mole irrespective of gestational age and is thus a useful diagnostic adjunct, complementary to ploidy analysis, in the diagnosis of hydatidiform mole.     

Partial hydatidiform mole

A case of partial hydatidiform mole is presented, occurring in a young primiparous woman after natural conception. She presented with incomplete miscarriage. Histological diagnosis of partial mole was made. Failure of beta HCG to fall resulted in the start of chemotherapy. WHO scoring placed her in low risk group. In spite of the low risk, she required third line chemotherapy for complete eradication of disease.     

完全性葡萄胎绒毛凋亡与基因表达的相关研究

目的 :探讨完全性葡萄胎绒毛凋亡、增殖活性与 Bcl-2、Bax、Fas、Fas-L及增殖细胞核抗原 ( PCNA)基因表达的相关性。方法 :收集正常早孕绒毛标本及近一年归档的完全性葡萄胎绒毛蜡块 ,原位末端标记法 ( TUNEL)进行细胞凋亡的组织学检测 ,免疫组织化学法测定 Bcl-2、Bax、Fas、Fas-L、PCNA的分布与含量 ,原位杂交法测定 Fas、Fas-Lm RNA的分布与含量。结果 :正常早孕绒毛有少量凋亡细胞 ,主要分布于合体滋养细胞 ,Bcl-2、PCNA蛋白仅在细胞滋养细胞表达且含量丰富 ,Bax、Fas、Fas-L蛋白在合体滋养细胞表达且含量低下。完全性葡萄胎绒毛合体滋养细胞凋亡较正常早孕明显增多 ,Fas、Fas-L 蛋白及其 m RNA不仅在合体滋养细胞而且在细胞滋养细胞表达均明显增强 ,Bcl-2、Bax蛋白在两种细胞中表达也增强 ;PCNA蛋白仅见于细胞滋养细胞 ,含量丰富。结论 :完全性葡萄胎绒毛凋亡细胞增多 ,主要经 Fas/ Fas-L 转录与翻译水平介导 ,表现为高凋亡与高增殖共存现象 ,可能与其无控生长的特性相关。     

The value of the fractional hormonal tests in the diagnosis of hydatidiform moles: Report of two cases

Two cases of hydatidiform mole admitted to a rural (100-bed) hospital within two years are reported.In both cases fractional hormonal tests were found to be positive in high dilutions and led to the correct preoperative diagnosis.     

产前超声早期诊断胎儿前腹壁异常的临床意义

目的探讨早孕及中孕早期超声诊断胎儿前腹壁异常的临床意义。方法回顾性分析我院早孕及中孕早期超声诊断的21胎前腹壁异常胎儿超声表现及随访结果,分析比较前腹壁异常的超声声像图特征。结果早孕及中孕早期超声筛查出21胎胎儿前腹壁异常,均在首次超声检查时发现,均经引产直接观察或病理检查进一步证实;其中脐膨出12胎,泄殖腔外翻1胎,体蒂异常8胎。7胎接受羊水穿刺检查,1胎脐膨出为13-三体,余染色体未见异常。结论早孕及中孕早期超声检查可有效诊断及鉴别诊断前腹壁异常,具有重要临床意义。