子宫腺肌病病灶切除术后子宫瘢痕妊娠一例

本文报道1例子宫腺肌病病灶切除术后子宫瘢痕妊娠患者的诊治经过,并复习相关文献,探讨子宫腺肌病病灶切除术后的妊娠并发症及术后子宫瘢痕妊娠的诊治方法。患者35岁,孕2产0,子宫腺肌病病灶切除术后3年,停经66 d,间断阴道流血20余天,血β-hCG水平升高,影像学检查提示子宫底壁肌层瘢痕周围囊性灶,考虑异位妊娠,予甲氨蝶呤...     

异位妊娠与输卵管疾病的鉴别诊断

异位妊娠是妇产科常见急腹症之一,其危害为异位妊娠流产或破裂后导致腹腔内大出血,若未能及时积极抢救,可危及患者生命。异位妊娠中以输卵管妊娠最为常见,约占异位妊娠的95%～98%,因此异位妊娠与输卵管疾病的鉴别诊断具有十分重要的临床意义。1异位妊娠1.1临床表现异位妊娠未发生流产或破裂时,临床表现不明显。当发生流产或破裂时,患者突感一侧下腹部撕裂样疼痛,伴恶心、呕吐,血液积聚于直肠子宫陷凹可出现肛门坠胀感,血液流向全腹可出现全腹疼痛,血液刺激膈肌可引起肩胛部放射痛。由于起病急,出血多,常有晕厥,严重者出现休克。体征方面,体…     

21卷8期疑难病案讨论选登

1诊断①陈旧性异位妊娠;②输尿管阴道瘘。2诊断依据及分析患者既往月经规律,3个月前曾停经50天,阴道少量流血伴下腹部隐痛1周。入院查体:子宫饱满,质软;右附件区可触及实性包块,有压痛。血-βHCG 171U/L;B超检查子宫内膜线完整。根据停经、腹痛、阴道流血及盆腔包块、辅助检查结果,诊断应为异位妊娠。患者血-βHCG水平2个月后仍较正常高,说明仍有存活绒毛,且右附件区包块为实性、固定,应考虑为异位妊娠不全流产后形成陈旧性异位妊娠。异位妊娠不全流产后由于长期反复内出血而形成盆腔血肿,血肿逐渐机化变硬并与周围组织如子宫、卵巢、盆…     

子宫次全切除术后异位妊娠1例

1病例报告患者,34岁。因1个月前3次剧烈阵发性腹痛,于2010年5月28日入院。2004年7月,第2胎妊娠38周时因胎盘早剥行剖宫产和子宫次全切除术(切除原因不清),术后一般情况好,每月尚有少量月经来潮,l～2天净。末次月经:2010年1月23日,停经3个月期间,无恶心、呕吐及偏食等。4月23日出现阴道流血并伴有下腹隐约胀痛,自认为是痛经而未予重     

输卵管妊娠与其他部位异位妊娠的鉴别诊断

异位妊娠是指受精卵种植在子宫体腔以外部位的妊娠,可发生于输卵管、卵巢、腹腔、阔韧带、子宫颈以及残角子宫等,但最常见部位为输卵管,占90%以上。异位妊娠与慢性输卵管炎、输卵管周围粘连、盆腔结核、输卵管发育不良或先天性畸形及输卵管子宫内膜异位、宫内节育器、胚胎本身缺陷、受精卵游走及辅助生育技术等有关。输卵管妊娠临床表现主要为停经、腹痛及不规则阴道流血等,腹腔内出血多者可有休克表现。妇科检查见子宫正常大或略增大,子宫一侧可及大小不等、活动度较差的块状物,质较实,呈不规则型,也可有宫颈举痛。动态检测血HCG变化有助…     

辅助生殖术后的异位妊娠

辅助生殖术后最初12周出现腹痛及阴消血流血，应疑患异位妊娠的可能。盆腔检查结合血清β－hCG及经阴道扫描是早期诊断的必备条件，最终选择仍为剖腹检查。早期诊、治可拯救同时伴发的宫内妊娠，降低母亲的危险性。     

日喀则市异位妊娠临床特点及诊治现状

目的:了解日喀则市异位妊娠的临床特点及诊治现状。方法:回顾分析2014年1~12月日喀则市人民医院收治的95例异位妊娠患者的临床资料。结果:95例患者中,83例有停经史,76例有阴道流血,90例有腹痛。所有患者均行腹部超声和后穹窿穿刺,未做腹腔镜检查,诊断依赖超声、血β-h CG测定和后穹隆穿刺。患者均行剖腹探查术,输卵管妊娠行患侧输卵管切除术或保留患侧输卵管的保守性手术。结论:在日喀则市,停经后阴道流血和腹痛是异位妊娠常见症状,诊断依赖后穹隆穿刺,腹腔镜术尚未开展。     

侵蚀性葡萄胎致腹腔内出血、休克误诊为异位妊娠1例

1 病例报告 患者,27岁,G1P0.因停经2月余,下腹坠痛伴阴道流血3天于2012年4月25日急诊入院.平素月经规律,末次月经:2012年2月15日.1月前因停经40天在当地医院行人工流产术,自诉手术顺利,术后1周阴道流血停止,绒毛情况不详.3天前无诱因突发下腹坠痛伴阴道流血就诊我院,门诊以"异位妊娠破裂,腹腔内出血,失血性休克"急诊收住院.患者既往体健.入院查体:贫血貌,血压80/50mmHg,脉搏不清;心肺听诊未见异常;下腹部稍隆起,全腹压痛、反跳痛及肌紧张明显,移动性浊音阳性.妇科检查:外阴发育正常,阴道通畅,宫颈举痛明显,阴道后穹隆饱满,触痛阳性,盆腔触诊不满意.尿妊娠试验阳性.     

子宫峡部妊娠误诊刮宫致大出血及甲氨蝶呤致骨髓抑制1例

子宫峡部妊娠是一种较少见的特殊类型的妊娠,由于该病临床表现缺乏特异性,诊断困难,容易延误诊治,导致不良结局。现将我院1例子宫峡部妊娠误诊刮宫致大出血应用甲氨蝶呤导致骨髓抑制报道如下。1病例报告患者34岁,因人工流产术后不规则阴道流血37天,门诊行清宫时出现大出血于2003年7月4日入院。该患者既往月经规律,G3P1(正常产1次,人工流产2次),因停经48天,阴道不规则流血19天,门诊B超检查提示为“宫内妊娠”,于2003年5月28日在我院门诊行人工流产术,术中见绒毛。术后阴道流血仍持续不断,考虑为吸宫不全,18天后再次行刮宫术,刮宫时出现大出…     

阴道直肠隔子宫内膜异位症25例的诊断治疗

目的 :探讨阴道直肠隔子宫内膜异位症的诊断和治疗方法。方法 :回顾分析1986至 2 0 0 2年手术病理证实的阴道直肠隔子宫内膜异位症 2 5例。结果 :发病年龄平均39岁 ,临床表现为各种形式的盆腔痛及不育 ,6 6 .7%合并有肠道症状。病灶位于阴道直肠隔内 ,单发 2 0例 ,多发 5例 ,直径 1～ 4cm。术前药物治疗中假孕疗法 7例 ,4例症状缓解 ,3例无效 ;假绝经疗法 8例 ,6例症状缓解 ,2例无效。 2 3例行手术治疗 ,2例行病灶切除术 ,11例行全子宫及阴道直肠隔异位病灶切除术 ;3例行全子宫单侧附件及阴道直肠隔异位病灶切除术 ;7例行全子宫双附件及阴道直肠隔异位病灶切除术。术后 6例用药物治疗 ,3例假孕疗法 ,3例假绝经疗法。在平均 15 .2月的随诊中 ,2 0例 (80 % )症状缓解 ,5例 (2 0 % )复发 ,其中 4例于术后 1年内复发 ,多发灶位于阴道直肠隔 ,1例于术后 14月复发 ,多发灶位于阴道残端。根治性手术组 (全子宫双附件及阴道直肠隔异位病灶切除术 )无 1例复发 ,非根治手术组 5例复发 ,两组差异有显著性 (P <0 .0 1)。结论 :阴道直肠隔子宫内膜异位症临床少见 ,通常有盆腔痛及不育 ,肠道症状的发生率高。临床诊断依靠妇科三合诊 ,药物治疗可以短期缓解症状 ,根据年龄、症状、生育要求采取个体化的手术治疗是主要的     

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND: Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS: Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS: The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.