腹腔妊娠的临床诊断和治疗分析——附3例病例报道

目的:探讨腹腔妊娠的发病机制、诊断及治疗方案,以提高对该病的认知。方法:回顾分析3例腹腔妊娠患者的临床资料。结果:腹腔妊娠的临床症状不典型,腹部影像学常常用于该病的诊断。保守治疗、介入治疗和手术均是可供选择的治疗方案。结论:对于有内出血的腹腔妊娠患者,应积极手术;对于情况稳定者,可行介入治疗或药物保守治疗,一旦治疗无效,应积极行手术探查。     

妊娠期糖尿病空腹血糖值与诊断关系的探讨(附60例临床分析)

糖尿病作为当今世界的流行病其患病率正逐年上升 ,我国 2 5岁以上人群中 2型糖尿病 1980年不到 0 9% ,而1995年则是 2 5 % ,是 1980年的 3倍。按此上升速度到2 0 10年可达 6 %～ 8% [1] 。我院妊娠期糖尿病 (ＧＤＭ )占产妇的住院人数比例亦每年递增 ,1994年占 0 2 3 % ,1998年占 0 87% ,1998年约是 1994年的 4倍。因此 ,有必要对妊娠期糖尿病诊断中一些问题作一总结分析。1　资料及方法1.1　一般资料　以 1994年 1月 1日至 1998年 3月 2 5日在我院分娩的和资料较为完整的ＧＤＭ 6 0例作为分析对象。这些病例不论有无糖尿病症状 ,均在 (…     

原发性腹腔妊娠的临床诊断和治疗分析——附1例病例报道

目的:探讨腹腔妊娠的诊断以及治疗方案,以提高对该病的认识、降低患者死亡率以及减少产后并发症。方法:回顾性分析和总结我院收治的1例原发性腹腔妊娠的诊断及治疗方案。结果:该病例氨甲喋呤(MTX)保守治疗效果不理想,后经腹腔镜检查明确诊断,同时成功予以手术治疗。结论:腹腔妊娠临床症状不典型,早期诊断较困难,腹腔镜技术是一种有效的诊断和治疗方法,腹腔妊娠的早期诊断可明显改善预后。     

妊娠期肾病综合征发病特征的临床分析(附80例报告)

目的:探讨妊娠期肾病综合征的临床特点和治疗方法。方法:2005年1月～2008年12月共收治重度子痫前期患者257例,80例伴有肾病综合征为肾病组,177例重度子痫前期为对照组,回顾对比两组发病孕周、终止妊娠孕周,临床特点,各项生化指标,新生儿体重及母婴预后。结果:肾病组发病孕周和终止妊娠孕周早于对照组。肾病组24h尿蛋白、血清乳酸脱氢酶、尿素氮、肌酐及尿酸高于对照组,血清总蛋白、白蛋白低于对照组。肾功能损害较对照组严重。新生儿出生体重低于对照组,新生儿窒息率、围产儿死亡率高于对照组。肾病组无孕产妇死亡,对照组孕产妇死亡1例,死于子痫,颅内出血。结论:妊娠期肾病综合征是子痫前期的一种特殊类型,发病孕周早,病情重。在治疗子痫前期的基础上应综合治疗,适时终止妊娠,减少母婴并发症的发生。     

异位葡萄胎的诊断与治疗--附三例病例报告

目的：探讨异位葡萄胎的诊断和治疗,方法：回顾性分析我院收治的3例异位葡萄胎患者的临床资料。结果：异位葡萄胎患者的临床表现根据异位的部位不同表现各异,异位葡萄胎早期易发生局部浸润和远处转移,数字减影血管造影术,彩色多普勒超声,腹腔镜等检查在异位葡萄胎的诊断中具有重要作用,规范的化学治疗及耐药病灶的手术切除仍为其主要治疗手段,结论：异位葡萄胎患者应强调预防性化学治疗的重要性,并重视发生转移后的及时诊断与治疗。     

妊娠期急腹症的诊断与处理(附63例临床分析)

妊娠期急腹症是指母体在妊娠期间因某些疾病而并发急性剧烈腹痛。因其起病突然,而且症状易被妊娠的特征所掩盖,常给诊断和处理带来困难,导致病情加重,甚而危及母婴生命。我们总结了自1977至1986年10年间的妊娠合并急腹症,进行分析总结如下。资料分析一、发病率我院1977至1986年10年间共收治妊娠合并急腹症63例,同期住院妊娠妇女41143例,发病率为1.53‰。二、妊娠期急腹症分布情况主要发生于消化系统、生殖系统及泌尿系统,见表1.     

妊娠期急性胰腺炎的诊断与治疗

Ｓｃｈｍｉｄｔ在180年前就曾描述过妊娠与急性胰腺炎的关系,但100多年来,对这种关系的实质并不十分清楚。自20世纪70年代以来,随着医学影像技术的发展,妊娠期急性胰腺炎患者中胆石症的检出率逐渐增高,至80年代中、后期,大多数研究认为,胆道疾病与妊娠期急性胰腺炎密切相关,尤其胆石症是重要原因[1]。国外90年代的文献报道,妊娠期急性胰腺炎孕产妇及围产儿死亡已很少发生[2]。而目前国内妊娠期急性胰腺炎孕产妇发生死亡仍占有一定比例,其妊娠丢失率也较高。现就近年来国外有关妊娠期急性胰腺炎的病因、诊断、治疗及预后等的研究进展作一综述…     

Unintended pregnancy during the first year after breast cancer diagnosis

Objectives: Young women experience high levels of anxiety and distress during cancer diagnosis and therapy, and it can be devastating to become pregnant in this vulnerable state. Pregnancy during cancer treatment is strongly discouraged, as radiotherapy and chemotherapy administered during the first trimester of pregnancy result in increased congenital malformations.

Methods: In this study, we analysed an unselected, consecutive cohort of young breast cancer (BC) patients with regard to unintended pregnancy during the first year after BC diagnosis. We analysed all patients who were ≤40 years of age at initial BC diagnosis (n?=?100, mean age at diagnosis: 35.9 years), according to data from the Basel Breast Cancer Database. The frequency of unintended pregnancy was assessed, and particular attention was given to patients’ obstetric and reproductive history.

Results: Forty-two percent of the cohort (mean age 36.5 years) were identified as not at risk of unintended pregnancy during the first year after BC diagnosis. However, 58% of the cohort (mean age 35.6 years) were using an ineffective contraceptive method and thus were at risk of unintended pregnancy. The rate of unintended pregnancy was 3.5% in this group (two patients). Oncologists should be aware that the use of reliable contraception should be discussed before starting, and also during, adjuvant therapy.

Conclusions: Oncologists should consider actively referring young BC patients to a gynaecologist to ensure proper contraceptive counselling.     

Endovascular treatment of ruptured intracranial aneurysms during pregnancy: report of three cases

Subarachnoid hemorrhage from an intracranial aneurysm during pregnancy is a rare complication with high maternal and fetal morbidity-mortality. We report three cases of ruptured intracranial aneurysms during pregnancy, treated by the minimal invasive endovascular approach.     

乳腺癌术后再发卵巢癌的预防与诊治

乳腺癌是女性最常见的恶性肿瘤,如有未婚未育史、家族遗传史、三阴性乳腺癌、术后口服选择性雌激素拮抗剂及BRCA1/BRCA2基因突变者,应特别警惕乳腺癌术后再发卵巢癌的可能。通过基因检测、临床筛查及降风险输卵管卵巢切除术(risk-reducing salpingo-oophorectomy,RRSO)的方法,可以有效预防乳腺癌术后再发卵巢癌。而对于乳腺癌术后已经发现卵巢癌者,应尽早接受治疗。乳腺癌与卵巢癌的发病间隔≥5年的患者所占比例最高,提示获得长期生存的乳腺癌患者也要警惕卵巢癌的发生。     

Breast implants and breast cancer screening

Concern about breast prostheses impairing breast cancer detection has become a priority issue. This article provides a review of the literature on the influence of implants on early detection methods of breast cancer, specifically breast self-examination (BSE), clinical breast examination (CBE), and mammography. Background information on implants is presented, including indications for surgery, types of prostheses, location of placement, and associated complications. Conclusions from the literature suggest that the presence of implants may facilitate BSE and CBE, yet challenge interpretation of mammography. However, there is no evidence that these women will have a later stage diagnosis or a poorer prognosis if diagnosed with breast cancer.     

134例乳腺癌患者妇科并发症临床病理分析

目的 观察乳腺癌患者妇科并发症的临床病理特征，判断其与服用三苯氧胺（TAM）的关系。方法 对90例术后服用TAM的乳腺癌患者（TAM组）及另外44例同时期无TAM服药史的乳腺癌患者（对照组）进行回顾性分析。结果两组患者的就诊原因有明显的差异，TAM组B超检查发现异常占68．9％，对照组中阴道淋漓出血或月经改变的比率明显增加为31.8％，具有统计学意义（P〈0．05）。TAM组子宫内膜息肉的发生率为25．6％，明显高于对照组9．1％（P〈0．05）；TAM组子宫内膜增生的发生率为30．0％，明显高于对照组13．6％（P〈0．05）。TAM组及对照组出现子宫内膜癌的情况为1：3例。TAM组子宫肌瘤／腺肌症的发生率为66．2％，明显高于对照组44．1％（P〈0．05）。两组患者的宫颈及卵巢病理改变无明显差异，其中宫颈的病理改变以慢性宫颈炎为主（82．8％），卵巢的病理改变以功能性卵巢囊肿为主（34．2％）。服用TAM时间的长短与某些妇科异常情况出现的频率相关，如随着TAM服药时间的延长，子宫内膜息肉与宫颈息肉的发生率明显升高，具有统计学意义（P〈0．05）；而服用TAM时间的长短与肌瘤的发生、肌瘤变性无明显关系（P〉O．05）。134例乳腺癌患者妇科手术治疗以全子宫＋双附件切除术为主，TAM组为68．9％，对照组为61．4％，上环治疗分别占10．0％与2．3％。结论 乳腺癌患者服用TAM后子宫内膜病变与子宫肌瘤／腺肌症的发生增多，前者与服药时间长短有关。对所有乳腺癌患者应进行规律的妇科TVB监测或官腔镜检查，并接受有效的低刨治疗。     

Epirubicin for breast cancer during pregnancy: a case report

BACKGROUND: The rarity of breast cancer in pregnancy and conflict between the optimal maternal therapy and fetal risks make its management challenging. Chemotherapy is the standard treatment for advanced cases. Epirubicin as a combination agent has been reported for breast and other cancers in pregnancy but not as a single agent. We report a case of advanced breast cancer treated with epirubicin neoadjuvant chemotherapy in pregnancy. CASE: A 30-year-old primigravida with multifocal, grade 3 invasive ductal carcinoma, stage T2 N1M0, received 4 cycles of primary epirubicin chemotherapy in pregnancy from 23 weeks' gestation. The chemotherapy was well tolerated by the mother and fetus, and a good response was achieved prior to postnatal combination chemotherapy and definitive surgery. CONCLUSION: Epirubicin chemotherapy appears safe and effective in pregnancy.     

Thyroid cancer in pregnancy: a report of 3 cases

BACKGROUND: Thyroid cancer in pregnancy presents a unique challenge to the thyroid specialist and the obstetrician. We report 3 cases of thyroid cancer diagnosed during pregnancy. CASES: Three cases of papillary thyroid carcinoma were diagnosed during pregnancy, at the 14th, 19th and 40th weeks of gestation. The first 2 cases underwent thyroidectomy immediately after the diagnosis, while in the third the operation was deferred until the postpartum period. All 3 women delivered healthy infants, who were 2 months to 8 years of age at the last follow-up visit. CONCLUSION: If well-differentiated thyroid cancer is diagnosed prior to the midtrimester, it is possible to carry out the surgical intervention in the midtrimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy.     

Hormonal contraception and risk of breast cancer: a critical look

Abstract

Today health professionals are not only required to know medicine, but scientific reading, interpretation, and communication of new data. The new information about contraception and hormonal therapies must be analyzed by gynecologists to determine whether or not the new data are applicable to their patients and if it has an impact on their health. Recently a new study of hormonal contraceptives and the risk of breast cancer was published. In this study, the investigators found an elevation of the relative risk of breast cancers on the users versus the nonusers of hormonal contraception. After analyzing the publication and other data available, it is our opinion that it is a very low increase of the risk and its impact should be evaluated case by case, not forgetting to take into account the numerous beneficial effects that hormonal contraception have.     

29例剖宫产瘢痕妊娠诊断及治疗方式的探讨

目的探讨子宫下段剖宫产瘢痕妊娠的临床发病特点、诊断标准及其治疗策略的选择,为临床合理诊治提供依据。方法收集2007年1月至2010年6月华中科技大学同济医学院附属同济医院妇科病房收治的29例子宫下段剖宫产瘢痕妊娠患者的临床资料,分析其临床发病特点、诊断及其治疗过程。结果子宫下段剖宫产瘢痕妊娠发病率为1.43/1000次妊娠。29例患者均有停经,27例(93.10%)患者有不同程度的阴道出血,其中19例(65.52%)患者出血总量超过500ml,5例(17.24%)患者因失血过多致失血性休克,26例(89.66%)患者血β-hCG(14.03～200000U/L)水平升高。29例均由盆腔三维彩色多普勒超声检测诊断,诊断准确率100%。治疗方法中,药物治疗23例(成功3例,成功率10.34%),清宫术7例,双侧髂内动脉栓塞或结扎21例,剖宫产瘢痕妊娠病灶切除术18例。治疗后监测血β-hCG水平恢复正常时间为2～7周,平均(4.01±0.23)周,无严重不良反应。结论子宫下段剖宫产瘢痕妊娠的治疗方法多样化,其中甲氨蝶呤药物联合双侧髂内动脉结扎和剖宫产瘢痕妊娠病灶切除手术方法出血较少且疗效显著。应争取早期确诊,并及时选择合理的治疗方法。     

乳腺癌术后伤口并发症的探讨--附164例报告

目的 探讨乳腺癌术后伤口并发症发生的原因和相关危险因素及其防治措施。方法2004年1月-2004年11月我院接受乳腺癌手术治疗的164例连续乳腺癌患者。手术方式包括乳腺癌改良根治术和保留乳房手术。术中常规留置负压引流直至24h引流量小于20ml后拔除。记录每口引流量、患者住院天数、术后皮瓣积液、皮瓣坏死、伤口感染情况。结果164例患者发生共发生皮下积液30例（18．3％）；电刀游离皮瓣明显增加了皮瓣积液的发生率（OR=2．39，P=0．014）；腋窝淋巴结转移数目1-4个（OR值=2．56，P〈0．05）和5-10个（OR值=6．20，P〈0．05）时其发生皮瓣积液危险均高于腋窝淋巴结阴性的患者。电刀游离皮瓣的患者总引流量多于手术刀游离皮瓣组，改良根治术后的总引流量也多于保乳手术组（P〈0．01）。乳腺癌术后发生皮瓣积液明显延长了患者的住院时间（P〈0．01）。患者的年龄、肿瘤分期、接受新辅助化疗及腋窝淋巴结清扫数目都和术后是否发生皮瓣积液无关（P〉0．05）。结论保持通畅引流、合理使用电刀和恰当加压包扎是预防切口并发症的关键。