妇产科病例分析子宫内膜癌 - 英文版
妇科检查英文版
BIMANUAL EXAMINATION
THE vaginal fingers are moved to the right fornix of the vagina and the abdominal hand is moved to the right iliac fossa to feel the right adnexa.
PELVIC NATION
Placement and removal of the speculum:
Prior to insertion the labia minora are gently separated and the urethra is identified.
PHYSICAL EXAMINATION
GENRAL EVALUATION
b.Abdominal examination: The patient should be lying completely supine,and relaxed,the knees may be slightly flexed and supported as an aid to relaxation of the abdominal muscles.
Suprapubic palpation is designed to detect uterus,ovarian or urinary bladder enlargement.
Carefully check for abnormality of the abdominal organs— liver,gallbladder,spleen,kidney and intestines.
PELVIC EXAMINATION PELVIC EXAMINATION PREPARATION
妇产科案例分析
新疆医科大学妇产科临床病例分析指导第一临床学院妇产科学教研室目录一、妇科病历分析题1。
妇科急腹症2. 妊娠时限异常-流产3。
生殖道炎症4。
宫颈病变5. 子宫肌瘤6. 子宫内膜癌7.卵巢肿瘤8. 妊娠滋养细胞疾病9。
生殖内分泌疾病10.子宫内膜异位症11. 计划生育二、产科病历分析题1。
妊娠期高血压疾病2. 妊娠期肝内胆汁淤积症3。
异常分娩4. 妊娠晚期出血性疾病——前置胎盘5。
妊娠晚期出血—胎盘早剥6. 子宫破裂7。
产后出血8. 产褥感染妇科临床-—-—病历分析题一妇科急腹症病历1患者，女性，20岁，因“停经3个余，下腹痛3小时伴晕厥一次”入院。
末次月经2001年10月2日,停经44天查尿HCG（+)，B超提示：“宫内见孕囊21mm×21mm”.于2001年11月20日行药物流产，未见绒毛，当即给予清宫，但是仍然未见绒毛。
1周后复查尿HCG为弱阳性，10日后阴道出血止。
流产后未转经，有同房史。
于2002年1月13日18时30分左右突感下腹痛，伴肛门坠胀，晕厥一次，即来院就诊，查尿HCG（+）。
体格检查:血压55/30mmHg，心率 100次/分，体温正常，患者呈失血貌，下腹有压痛，移动性浊音(+），肝脾肋下未及.妇科检查：宫颈举痛明显，子宫增大如孕50天大小，左侧附件区可以触及10cm*9cm*8cm的包块，有压痛。
辅助检查：血红蛋白84g/L，血HCG：22162.0U/L。
盆腔B超：盆腔内见100mm×97mm×86mm的杂乱回声，轮廓不清，孕囊可能是在宫角部或子宫肌层。
腹盆腔有中等量积液.后穹隆穿刺抽出不凝血5ml。
◆最可能的诊断?◆诊断依据有那些？◆鉴别诊断◆治疗方案病历1答案：异位妊娠◆诊断：腹腔内出血、异位妊娠、失血性休克根据病史考虑是急腹症，妇科的急腹症主要有三大类,出血、感染和肿瘤并发症,这名患者显然是内出血型，应该考虑:异位妊娠、黄体破裂；子宫穿孔。
妇产科平行病历范文
妇产科平行病历范文英文回答：Obstetric Parallel Medical Record Template. Patient Information.Name:Age:Gravida:Para:Estimated date of delivery (EDD):Antenatal Care.Initial Visit:Medical history.Physical exam.Lab tests (e.g., blood count, urinalysis)。
Ultrasound.Follow-up Visits (weekly/biweekly):Weight gain.Blood pressure.Urine protein.Fundal height.Fetal heart rate.Ultrasound (as indicated)。
Labor and Delivery.Labor:Date and time of onset.Duration and intensity of contractions.Cervical dilation and effacement.Fetal position.Delivery:Mode of delivery (e.g., vaginal, cesarean)。
Time of delivery.Birth weight and length.Apgar scores.Postpartum Care.Immediate Postpartum Period:Vital signs.Fundal height.Lochia.Breastfeeding.6-8 Week Postpartum Visit:Physical exam.Lab tests (e.g., blood count, urine culture)。
Contraception discussion.Other.Prenatal Referrals:High-risk pregnancy.Genetic counseling.Nutrition counseling.Postpartum Referrals:Breastfeeding support.Postpartum depression screening. Childbirth education.中文回答：妇产科平行病历模板。
妇科英语知识点总结
妇科英语知识点总结妇科是医学中的一个重要分支，主要研究女性生殖系统的结构、功能和疾病。
妇科英语知识对医学人员来说是必备的，下面我们将介绍妇科英语的知识点。
一、妇科疾病1. 妇科肿瘤Cervical cancer 子宫颈癌Ovarian cancer 卵巢癌Endometrial cancer 子宫内膜癌Uterine fibroids 子宫肌瘤Ovarian cyst 卵巢囊肿2. 妇科炎症Pelvic inflammatory disease (PID) 盆腔炎Vulvovaginitis 外阴阴道炎Cervicitis 子宫颈炎Endometritis 子宫内膜炎3. 妇科功能性疾病Polycystic ovary syndrome (PCOS) 多囊卵巢综合征Endometriosis 子宫内膜异位症Premenstrual syndrome (PMS) 经前综合征Menopause 绝经期4. 妇科其他疾病Ectopic pregnancy 异位妊娠Pelvic organ prolapse 盆腔器官脱垂Uterine prolapse 子宫脱垂二、妇科检查1. 妇科常规检查Pelvic exam 盆腔检查Pap smear 巴氏涂片检查Colposcopy 阴道镜检查Ultrasound 超声检查2. 妇科特殊检查Hysterosalpingogram (HSG) 子宫输卵管造影Endometrial biopsy 子宫内膜活组织检查Laparoscopy 腹腔镜检查Cervical biopsy 子宫颈活组织检查三、妇科治疗1. 妇科手术Hysterectomy 子宫切除术Oophorectomy 卵巢切除术Tubal ligation 输卵管结扎术Endometrial ablation 子宫内膜消融术2. 妇科药物Contraceptives 避孕药Hormone replacement therapy (HRT) 激素替代疗法Antibiotics 抗生素Anti-inflammatory drugs 抗炎药3. 妇科其他治疗Intrauterine device (IUD) 宫内节育器Pelvic floor exercises 盆底肌锻炼Acupuncture 针灸Herbal medicine 中草药四、妇科常见诊断1. 妇科症状诊断Abnormal vaginal bleeding 阴道异常流血Pelvic pain 盆腔疼痛Vaginal discharge 阴道分泌物Menstrual irregularities 月经不调2. 妇科体征诊断Cervical erosion 子宫颈糜烂Uterine enlargement 子宫增大Ovarian cyst 卵巢囊肿Endometrial thickening 子宫内膜增厚3. 妇科实验室检查Hormone levels 激素水平Tumor markers 肿瘤标志物Cervical cytology 子宫颈细胞学检查Culture and sensitivity 细菌培养及药敏试验五、妇科护理1. 妇科术后护理Pain management 疼痛管理Wound care 伤口护理Emotional support 情绪支持Physical therapy 生理疗法2. 妇科产前护理Prenatal care 产前护理Labor support 分娩支持Breastfeeding education 哺乳教育Postpartum care 产后护理3. 妇科更年期护理Menopausal symptom management 更年期症状管理Hormone therapy counseling 激素治疗咨询Bone health assessment 骨健康评估Heart disease prevention 心脏病预防六、妇科预防1. 妇科癌症预防Regular screenings 定期筛查HPV vaccination HPV疫苗接种Healthy lifestyle 健康生活方式Avoiding risky behaviors 避免危险行为2. 妇科炎症预防Hygiene practices 卫生习惯Safe sex 安全性行为Avoiding irritants and allergens 避免刺激物和过敏原Vaccination 接种疫苗3. 妇科功能性疾病预防Weight management 体重管理Regular exercise 定期运动Healthy diet 健康饮食Stress management 应激管理以上是妇科英语知识点的总结，希望对你有所帮助。
子宫内膜癌36例临床病例分析
子宫内膜癌36例临床病例分析发表时间：2013-02-01T16:31:38.513Z 来源：《中外健康文摘》2012年第45期供稿作者：周建芬[导读] 目的分析和探讨子宫内膜癌的临床特点、分期和病理类型以及合并症情况。
周建芬（建湖县人民医院妇产科 224700）【中图分类号】R737.33 【文献标识码】A【文章编号】1672-5085（2012）45-0134-01【摘要】目的分析和探讨子宫内膜癌的临床特点、分期和病理类型以及合并症情况。
方法将2008年01月～2011年12月于我院住院的36例子宫内膜癌患者分为未绝经组和绝经组，分别统计分析其临床治疗和诊断资料。
结果未绝经组以月经紊乱为主要临床表现，而绝经组以阴道流血为主要临床表现;未绝经组分期低于绝经组；同时未绝经组合并症比例低于绝经组，两组差异显著（P<0.05）。
结论子宫内膜癌患者多以月经不调、阴道流血为主要临床表现，年轻患者分期低于年长者，同时早预防早发现早治疗能显著提高生生存率及生活质量。
【关键词】子宫内膜癌临床病例分析子宫内膜癌，又被称为子宫体癌，是起源于子宫内膜的一种恶性肿瘤[1]。
其临床发病率仅低于子宫颈癌，镜下可分为腺癌、鳞腺癌、腺角化癌、透明细胞癌，其中腺癌约占80%～90%。
早期患者无明显症状，仅在普查或妇科检查时偶然发现，晚期患者有明显临床表现如子宫出血、阴道排液、疼痛等[2]。
现将我院对36例子宫内膜癌患者的诊断资料分析情况报告如下： 1. 资料与方法 1.1 一般资料：回顾了2008年01月～2011年12月于我院住院的36例子宫内膜癌患者病历资料，将36例患者分为未绝经组（A组）16例和绝经组（B组）20例，A组：年龄为30～54岁，平均45.1岁，其中30-39岁年龄段3例，40-49岁年龄段9例，50-54岁4例；B组：年龄为52-72岁，平均56.5岁。
所有患者均经过分段诊刮,宫腔镜检查,以及影像学检查等确诊为子宫内膜癌。
子宫内膜癌
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病因
Etiology
子宫内膜癌的确切病因仍不清楚，可能与下列因素有 关： 1.Estrogens与雌激素的关系：长期刺激关系。 1). Endogenous Estrogens内源性激素 Ovaries卵巢、 Adrenal glands肾上腺。 内膜癌常与无排卵性功血，pcos（无排卵）功能性卵巢 瘤（分泌雌激素）等合并存在。内膜长期受雌激素刺 激而无孕激素拮抗，可能导致癌的发生。 。
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治疗
4. 激素疗法
Progesferone 对晚期、发展癌不能手术，或年轻者
需保留生育功能者，也应用此疗法。
机理：直接作用于癌细胞，延缓DNA和RNA复制，
从而抑制癌细胞的生长。
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治疗
5. 抗雌激素疗法： Antiestrogen therapy or Anfitumor chemotherayp tamoxifen TMX 有促使孕激素水平升高的作用，再用孕激素可 望提高疗效。
对于子宫内膜癌的临床分期多年来众说纷纭，各
执己见，以1968年国际抗癌协会和1970年国际妇 产科联盟的两种分期法应用较为普遍，且有不少 相似之处，也各有其长短。
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临床表现 Clinical Finding
内膜癌虽可发生于任何年龄，但基本上是一种老
年妇女的肿瘤，一般认为，内膜癌好发年龄比子 宫颈癌推迟10年。也就是绝经后妇女多见，平均 年龄在55岁上下，（福州妇幼保健院50~60岁， 18%，北京协和50~64岁，58%）。那么早期无症 状，一旦出现则表现为：
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临床表现
妇产科病例分析
妇产科病例分析病例分析一患者，女性，56岁，退休干部，因“绝经后2年反复阴道流血三月，伴脓血样白带一周”由门诊收入院。
患者两年前绝经，一直无特殊不适。
三个月前无明显诱因出现反复阴道流血，量少，暗红或鲜红色，时断时续。
因患者在绝经前2年曾有类似症状，未引起注意，未作诊治。
近数月来有白带增多现象，白带为水样，无异味。
近半月来有腰骶部疼痛，行走时加重。
近一周白带增多且为脓血样，伴有异味，遂来诊。
起病以来体重减轻约4公斤。
偶有头晕，大小便正常，大便习惯无改变。
既往史：既往有高血压病约8年，服“络活喜”“尼群地平”能控制血压。
绝经前2年曾出现反复不规则阴道流血，经诊刮提示为“简单型子宫内膜增生过长”经服妇康片数月后好转。
无手术和外伤史。
无药物和食物过敏史月经婚育史：14 ------54岁绝经。
已婚22年，G1P0A1，婚后约三年左右自然流产一次，以后无避孕但一直未孕。
丈夫体健，夫妻生活和睦。
个人史：无特殊爱好，长期生活于广州。
退休前从事文员工作。
不嗜烟酒。
家族史：父亲有高血压，母亲有糖尿病。
父母均健在。
家中姐妹共3人，其中有一妹妹亦有类似月经不调史。
体格检查：T36.9℃R20次/分P90次/分BP 160/90mmhg，身高153cm，体重70kg。
发育正常，营养中等，全身皮肤黏膜无黄染，全身浅表淋巴结无肿大。
头颅五官无畸形，颈无抵抗，气管居中，甲状腺不大。
双肺呼吸音清，未闻及干湿性罗音。
心律整，心率90次/分，各瓣膜区未闻及病理性杂音。
腹部平软，全腹无压痛和反跳痛，未扪及包块。
肠鸣音正常，未闻及金属音和气过水音。
脊柱生理弯曲，无压痛和扣击痛。
四肢活动正常，生理反射存在，病理反射未引出。
专科情况：外阴发育正常，无明显萎缩。
阴道通畅，壁光滑，可容两指，见多量脓血样白带，有臭味。
宫颈光滑，稍萎缩，宫口闭，见血性分泌物。
子宫前位，孕8周大小，质软，表面光滑，与周围组织无粘连。
双侧附件增厚，未及包块，无明显压痛。
子宫内膜癌疑难病例讨论模板
子宫内膜癌疑难病例讨论模板子宫内膜癌疑难病例讨论模板一、引言子宫内膜癌是女性生殖系统常见的恶性肿瘤之一，常常给临床医生带来诊断和治疗上的挑战。
在临床实践中，我们常常会遇到一些疑难的子宫内膜癌病例，这些病例可能因为病情复杂、症状不典型或者治疗效果不佳而导致医生们头疼不已。
本文将以子宫内膜癌疑难病例为主题，探讨如何应对这些疑难病例，帮助临床医生更好地诊断和治疗这一常见但又具有挑战性的疾病。
二、病例分析1. 病例描述我们首先来看一个实际的病例。
患者女性，45岁，主要症状是不规则阴道出血，持续时间已超过三个月。
患者还伴有下腹部隐痛和乏力感。
经过详细的检查和进一步筛查，确诊为子宫内膜癌。
2. 问题讨论这个病例中，我们需要讨论的问题包括但不限于：患者的症状表现是否典型？有无其他疾病或症状可能掩盖或干扰了子宫内膜癌的诊断？患者的芳龄和生育状况是否影响了治疗方案的选择？三、诊断与评估在讨论病例的基础上，我们需要探讨如何进行正确的诊断与评估。
这包括了病史采集的重要性，影像学检查和病理学检查的价值，以及如何进行全面的分期和分级评估。
四、治疗策略在确定了诊断和评估的基础上，我们将讨论子宫内膜癌的治疗策略。
这包括手术、放疗、化疗等传统治疗方法的优缺点，以及靶向治疗和免疫治疗在子宫内膜癌治疗中的应用前景。
五、疑难病例的个性化治疗我们将讨论如何针对疑难子宫内膜癌病例实施个性化治疗。
这涉及到病理学分型和分级对治疗方案选择的影响，靶向治疗在个性化治疗中的应用，以及如何在临床实践中应对治疗效果不佳的情况。
六、总结与展望通过对子宫内膜癌疑难病例的讨论，我们能够更深入地了解这一疾病的诊断和治疗方面的挑战，也能更好地探讨个性化治疗的可能性。
未来，随着科技的不断进步，相信我们能够在临床实践中更好地应对疑难子宫内膜癌病例，并为患者带来更好的治疗效果。
七、个人观点在本文中，我们所讨论的子宫内膜癌疑难病例，正是临床医生在日常实践中所面临的挑战。
妇产科病例分析
病例1●女性，29岁，下腹剧痛，伴头晕、恶心2小时●于2012年11月5日急诊入院平素月经规律，4-5/35天，量多，无痛经，末次月经，于10月20日开始阴道出血，量较少，色暗且淋漓不净，四天来常感头晕、乏力及下腹痛，二天前曾到某中医门诊诊治，服中药调经后阴道出血量增多，但仍少于平时月经量。
今晨上班和下午2时有2次突感到下腹剧痛，下坠，头晕，并昏倒，遂来急诊月经14岁初潮，量中等，无痛经。
25岁结婚，孕2产1，末次生产4年前，带环3年。
既往体健，否认心、肝、肾等疾患。
●查体：T36℃，P102次/分，BP80/50mmHg，急性病容，面色苍白，出冷汗，可平卧。
心肺无异常。
外阴有血迹，阴道畅，宫颈光滑，有举痛，子宫前位，正常大小，稍软，可活动，轻压痛，子宫左后方可及8cm×6cm×6cm不规则包块，压痛明显，右侧(-)，后陷凹不饱满。
●化验：尿妊娩(±)，Hb90g/L，WBC10.8×109/L，Plt145×109/L.B超：可见宫内避孕环，子宫左后7.8×6.6cm囊性包块，形状欠规则，无包膜反射，后陷凹有液性暗区。
(一)诊断1.异位妊娠破裂出血2.急性失血性休克(二)诊断依据1.有突发下腹痛，伴有急性失血和休克表现2.有停经史和阴道不规则出血史3.宫颈举痛，子宫左后可触及包块4.B超可见囊性包块，后陷凹有液性暗区(三）鉴别诊断(5分)1.卵巢滤泡或黄体囊肿破裂2.外科急腹症：急性阑尾炎、穿孔3.内科腹痛：急性肠炎、菌痢4、卵巢肿瘤蒂扭转5、急性盆腔炎（四）进一步检查(4分)1.后穹窿穿刺2.尿、粪常规、凝血常规3必要时内镜超声协助（五）治疗原则(3分)1.输液，必要时输血，抗休克2.开腹探查，清洗腹腔，左输卵管切除病例2●经产妇，5年前曾行剖宫产一次，现孕37周，产程中产妇感腹痛剧烈，查：宫高34cm，胎位LOA，头浮，胎心152次/分，宫缩强，50秒/2分，子宫体平脐处凹陷，产妇烦躁不安，BP120/80mmHg，心率110次/分。
肿瘤妇科疑难病例讨论
总结词
肿瘤复发和转移是肿瘤妇科的常见问 题，医生需要密切关注患者的病情变 化，及时调整治疗方案，提高治疗效 果。
病例三分析：手术与放疗
总结词
该病例的难点在于手术与放疗的 合理选择。
详细描述
患者为老年女性，确诊为子宫内 膜癌，医生建议进行手术治疗和 化疗。但患者患有多种基础疾病 ，手术风险较高。经过多次沟通 和讨论，最终决定采用放疗和靶 向治疗，病情得到控制。
本病例通过综合治疗方案成功治愈，患者生存 质量得到显著提高。
经验总结
治疗过程中，医生充分考虑患者个体差异，制 定针对性治疗方案，密切监测病情变化并及时 调整。
教训吸取
应更加重视患者的临床症状和体征，对异常情 况及时进行深入分析和处理。
病例二总结：复发预防策略与展望
预防策略
通过综合运用化疗、放疗和生物治疗等方法，有 效预防肿瘤复发。
分期
治疗建议
根据国际妇产科联盟（FIGO）分期标准， 该患者被分为ⅡB期（肿瘤侵犯＞1/2肌层 ，无宫体外蔓延）。
患者接受手术治疗，切除子宫及附件，并进 行盆腔淋巴结清扫。术后给予放疗和化疗。
病例二：卵巢癌
诊断
患者为老年女性，因腹胀、腹部胀痛就诊，妇检 发现盆腔包块，考虑为卵巢癌。
分期
根据美国癌症联合会（AJCC）分期标准，该患者 被分为ⅢC期（肿瘤侵及腹腔、盆腔或腹膜后淋巴 结，肿瘤破裂或腹腔、盆腔内种植）。
总结词
早期诊断和治疗是肿瘤妇科的关键，医生需要耐心、细致地与患者进行沟通，消除患者的疑虑，提高治疗效果。
病例二分析：复发与转移
总结词
详细描述
该病例的难点在于肿瘤复发和转移的 判断和处理。
患者为年轻女性，确诊为子宫颈癌， 经过手术治疗和化疗后病情得到控制 。但半年后，患者再次出现阴道流血 和腹痛，经过检查诊断为肿瘤复发和 转移。医生建议进行放疗和靶向治疗 ，但患者对治疗方案存在疑虑。经过 多次沟通和心理疏导，最终患者同意 进行放疗和靶向治疗，病情得到控制 。
子宫内膜癌疑难病例讨论记录范文
子宫内膜癌疑难病例讨论记录范文英文回答：Patient Information:The patient is a 55-year-old female who presented with abnormal uterine bleeding and was diagnosed with stage II endometrial cancer. She underwent a total hysterectomy and bilateral salpingo-oophorectomy, followed by adjuvant chemotherapy and radiation therapy. However, she experienced disease recurrence after 6 months and was found to have metastasis to the lungs and liver. Despite receiving multiple lines of systemic therapy, including hormonal therapy and immunotherapy, the disease continued to progress.Discussion:This case presents a challenging scenario of recurrent and metastatic endometrial cancer. The standard treatmentoptions have been exhausted, and the patient's disease is refractory to conventional therapies. The management of recurrent endometrial cancer remains a significant clinical challenge, and there is a need for novel therapeutic approaches to improve outcomes in this patient population.Potential Options:1. Clinical Trials: The patient may be a candidate for enrollment in clinical trials evaluating novel targeted therapies or immunotherapies for endometrial cancer. These investigational agents may offer the potential for disease control and improved survival.2. Palliative Care: Given the advanced nature of the disease, the patient may benefit from palliative care to address symptom management, psychosocial support, and end-of-life care planning.3. Tumor Molecular Profiling: Comprehensive genomic profiling of the patient's tumor tissue may identify actionable genetic alterations or potential targets forpersonalized treatment approaches, such as targeted therapy or precision medicine.4. Supportive Therapies: Integrative and complementary therapies, such as acupuncture, meditation, and yoga, may help improve the patient's quality of life and well-being during the course of her illness.中文回答：患者信息：患者是一名55岁的女性，出现子宫出血异常，并被诊断为II期子宫内膜癌。
子宫内膜癌
临床Ⅰ-- Ⅳ期5年生存率
75%，51%，30%，10.6% 手术-病理分期5年生存率 I B期 Ⅱ 期 94% 84% IC期 Ⅲ 期 87% 40%—60%
十、随访 75%--95%术后2—3年内复发 随访时间： 术后 2年内，每3个月 1次 术后3~5年， 每6个月 1次 术后5年后， 每年1次 随访内容： 妇科三合诊检查 阴道细胞学涂片检查 胸片（6个月至1年） CA125检查， 必要时CT、MRI等。
辅助诊断方法 4、宫腔镜检查： 可直接观察有无病变，病变大小、部位， 或直视下取材，减少漏诊。 5、细胞学检查： 子宫内膜抽吸活检。 6、 CA125、 CT、MRI、淋巴造影
七、鉴别诊断： 绝经后及围绝经期阴 道流血为子宫内膜癌最常 见的主要症状，也是许多 疾病的共有症状。需鉴别： ⑴ ⑵ ⑶ ⑷ 功血 萎缩性阴道炎 子宫粘膜下肌瘤或内膜息肉 原发性输卵管癌：阴道排液（流
4、孕激素治疗： 晚期或复发者，不能手术切除 或年轻、极早期、要求保留生育功能者。 以高效、大剂量、长期应用为宜。 孕激素受体阳性者有效率达80%。 醋酸甲羟孕酮 已酸孕酮
九、预后 影响预后的因素主要有三方面： 1．癌瘤生物学恶性程度及病变范围。 2．患者全身状况。 3．治疗方案、并发症及严重程度。
高发年龄为50-60岁。
绝经后妇女占70%--75%，围绝经期妇女占 15%--20%，40岁以下仅占5%--10%。
占女性癌症总数7%， 占女性生殖道恶性肿瘤20%-30%。
一、发病相关因素
• Ⅰ型 雌激素依赖型（estrogen-dependent):单一雌 激素长期作用下，发生子宫内膜增生症 (单纯型或复 杂型，伴或不伴不典型增生），继而癌变。 无排卵性疾病（无排卵性功血，多囊卵巢综合 征）、长期服用雌激素的绝经后妇女。 占大多数，均为子宫内膜样腺癌，肿瘤分化好， 雌孕激素受体阳性率高，预后好。 患者较年轻，常伴有肥胖、高血压、糖尿病、不 孕、不育及绝经延迟。
子宫内膜癌病例讨论
– 阴道、直肠及膀胱未见异常，盆腔子宫周围脂肪信 号正常，未见确切肿大淋巴结。
MRI诊断：
– 1.子宫增大，宫腔内肿块，考虑子宫内膜癌，IIa期；
– 2.左侧附件囊肿。
病理结果
讨论
概述
子宫内膜癌（endometrial carcinoma）：即子 宫体癌，由子宫内膜上皮细胞发生的恶性肿瘤，发 病率仅次于子宫颈癌。
病因
尚未明了，一般认为与以下因素有关：
– 1.长期持续使用雌激素 – 2.在非活动性或萎缩子宫内膜基础上发生，
称为子宫内膜浆液性癌。此组平均年龄偏大， 肿瘤分化较差、预后差。
病理变化
1.肉眼观，分以下两型：
（1）弥漫型：子宫内膜弥漫性增厚，表面粗 糙不平，灰白质脆，常有出血坏死或溃疡形成， 并不同程度浸润子宫肌层；
内膜：T1略高信号、T2长带样高信号（为子宫 内膜及腔内分泌液）
– 修复期最薄仅1~3mm；分泌期最厚4~6mm，但不超 过10mm
– 生育期内膜信号较高，绝经后宫体萎缩、内膜变薄， 信号降低
宫颈：长4~5cm，厚3~4cm T2清晰显示3层结构：
– 内层黏膜和腺体均匀高信号；
– 中间层和外层：纤维肌肉性基质层，均由纤 维母细胞及平滑肌组成
内层厚3~8mm，呈低信号 外层厚2~8mm，呈中高信号
宫颈的3层结构与子宫体部的3层相 延续
女，46岁，以“阴道淋沥出血 一年”为主诉入院。
T1WI(轴位)
T1WI(轴位)
T1WI(轴位)
T2WI(轴位)
T2WI(轴位)
T2WI(轴位)
T1WI（矢状位）
T1WI（矢状位）
宫颈癌英文科普文章
宫颈癌英文科普文章Cervical cancer is a malignant tumor that occurs at the junction of squamous epithelial cells and columnar epithelial cells in the cervical vaginal or transitional zone, and is one of the most common gynecological malignancies.宫颈癌是发生在宫颈阴道部或移行带的鳞状上皮细胞及宫颈管内膜的柱状上皮细胞交界处的恶性肿瘤，是最常见的妇科恶性肿瘤之一。
1.Etiology of cervical cancer宫颈癌的病因The main cause of cervical cancer is human papillomavirus (HPV) infection. HPV is mainly transmitted through sexual contact, with approximately 80% of people being infected or exposed to HPV throughout their lives. Most infections are transient, and the body's immune system can completely eliminate them without posing a threat to health. However, some infections persist. Only sustained infection of high-risk HPV is possible to develop into cervical cancer.宫颈癌的病因主要是由于人乳头瘤病毒（HPV）感染导致。
Cervical Cancer宫颈癌-中英文
age at diagnosis of patients with cervical cancer is 52.2 years old.
Normal cervix
Cervical polyp
Acute cervicitis
Erosion of cervix
Cervical cancer
CERVICAL CANCER…..
HPV 6, 11, 40, 42, 43, 44,
54, 61, 70, 72, 81
Lead to:
Benign cervical changes
Genital warts
High-Risk
HPV 16, 18, Precancer cervical changes
31, 33, 35, 39,
·
Cervical Cancer
Cervical cancer
• Etiology （病因） : HPV • Diagnosis （诊断） : biopsy, stage • Theraphy （治疗） : surgery and radiation • Prevention （预防）
CERVICAL CANCER...
• Stage（FIGO）:
• Pelvic examination骨盆检查, Rectovaginal examination 直肠阴道检查, Intravenous pyelography (IVP)， ultrasonography or CT
• Staging is clinical, but can use IVP and CT
妇科英文病历模板
妇科英文病历模板篇一:妇产科英文模板CASEMedical Number: 756943General informationName: Yue Jun-rongAge: Forty- two years old Sex: FemaleRace: Han Occupation: UnemploymentNationality: ChinaMarital status: Married Address : Xiaochang county of Xiaogan cityin Hubei. Tel: 4835963Date of admission: Feb.27th, 2003Date of record: 3pm, Feb.27th, 2003 Complainer of history: the patient herselfReliability: ReliableChief complaint: The patient was found “myoma ofuterus” over two years ago and menometrorrhagia for 5 months.Present illness: In 1999, the patient was found “myoma ofuterus” in a physical examination. But she had nothing1uncomfortable and her catamenia was normal. She used some Chinese traditional medicine. About 5 months ago, she found the cycle of her catamenia was shorten from 30 days to 20 days and the period lasted from 2 days to 4 days. She felt no pain and the quantity was normal. She was accepted in our hospital and her diagnosis was “subserous myoma of uterus”.Since onset, her appetite was good, and both her spiritedness and physical energy are normal. Defecation and urination are normal, too.Past historyOperative history: Never undergoing any operation.Infectious history: No history of severe infectious disease.Allergic history: She was not allergic to penicillin or sulfamide.Respiratory system: No history of respiratory disease.Circulatory system: No history of precordial pain.Alimentary system: No history of regurgitation.Genitourinary system: No history of genitourinary disease. Hematopoietic system: No history of anemia andmucocutaneous bleeding. Endocrine system: Noacromegaly. No excessive sweats.2Kinetic system: No history of confinement of limbs.Neural system: No history of headache or dizziness.Personal historyShe was born in Hubei on July 16th, 1956 and almost always lived in Wuhan. She graduated from senior high school. Her living conditions were good. No bad personal habits and customs.Menstrual history: The first time when she was 14. Lasting 2 days every times and its cycle is about 30 days.Obstetrical history: Pregnacy 3 times, once nature production, induced abortion twice.Contraceptive history: Not clear.Family history: His parents are both alive.Physical examinationT 36.8?, P 80/min, R 20/min, BP 120/80mmHg. She is well developed and moderately nourished. Active position. The skin was not stained yellow. No cyanosis. No pigmentation. No skin eruption. Spider angioma was not seen. No pitting edema. Superficial lymph nodes were not enlarged.HeadCranium: Hair was black and well distributed. No deformities. No scars. No masses. No tenderness.3Ear: Bilateral auricles were symmetric and of no masses. No discharges were found in external auditory canals. No tenderness in mastoid area. Auditory acuity was normal.Nose: No abnormal discharges were found in vetibulum nasi. Septum nasi was in midline. No nares flaring. No tenderness in nasal sinuses.Eye: Bilateral eyelids were not swelling. No ptosis. No entropion. Conjunctiva was not congestive. Sclera was anicteric. Eyeballs were not projected or depressed. Movement was normal. Bilateral pupils were round and equal in size. Direct and indirect pupillary reactions to light were existent.Mouth: Oral mucous membrane was smooth, and of no ulcer or erosion. Tongue was in midline. Pharynx was not congestive. Tonsils were not enlarged.Neck: Symmetric and of no deformities. No masses. Thyroid was not enlarged. Trachea was in midline.ChestChestwall: Veins could not be seen easily. No subcutaneous emphysema. Intercostal space was neither narrowed nor widened. No tenderness.Thorax: Symmetric bilaterally. No deformities.4Breast: Symmetric bilaterally. Neither nipples nor skin were retracted. Elasticity was fine.Lungs: Respiratory movement was bilaterally symmetric with the frequency of 20/min. Thoracic expansion and tactile fremitus were symmetric bilaterally. No pleural friction fremitus. Resonance was heard during percussion. No abnormal breath sound was heard. No wheezes. No rales.Heart: No bulge and no abnormal impulse or thrills in precordial area. The point of maximum impulse was in 5th left intercostal space inside of the mid clavicular line and not diffuse. No pericardialfriction sound. Border of the heart was normal. Heart sounds were strong and no splitting. Rate 80/min. Cardiac rhythm was regular. Nopathological murmurs.Abdomen: Flat and soft. No bulge or depression. No abdominal wall varicosis. Gastralintestinal type or peristalses were not seen. There was not tenderness and rebound tenderness on abdomen or renal region. Liver was not reached. Spleen was not enlarged. No masses. Fluidthrill negative. Shifting dullness negative. Borhorygmus 5/min. No vascular murmurs.Extremities: No articular swelling. Free movements of all5limbs.Neural system: Physiological reflexes were existent without any pathological ones. Genitourinary system: Not examed.Rectum: not exanedInvestigationBlood-Rt: Hb 127g/l RBC 3.93T/l WBC 3.9G/lUrine-Rt: SG 1.070 pH 6.0B-ultrasound: 1. subserous myoma of uterus2. position of loop is normalHepatic function: NormalPT & APTT: NormalProfessional ExaminationPudendum: Married typeVagina: unobstructed, secretion is excessive, white and ropy.Os of cervix: No bleeding, slight anabrosis.Body of uterus: Big like a fist of man, hard and its surface is smooth.Others: NormalHistory summary1. Patient was female, 45 years old2. The patient was found “myoma of uterus” over two6year ago and menometrorrhagia for 5 months..3. No special past history.4. Physical examination showed no abnormity in lung, heart and abdoman. Professional examination can been seen above.5. investigation information: see aboveImpression: subserous myoma of uterusSignature: He Lin (95-10033)来源:杨帆| 分享(7) | 浏览(49)篇二:妇产科英文病历Inpatient HistoryName: Yali ZhouSex: FemaleAge: 38year Ward: No.8 Bed: No.816 Marital status: Married Birthplace: ShanghaiNationality: Han Provider: Patient, reliable. Record date: 2005-12-13G & O History: GW: 30+5weeks, G2P0, LMP: 2005-5-10; EDC: 2006-2-17Chief Complaint: G2P0, GW: 30+5weeks. This patient presents hypertension for 3 months, and systemic edema for 2 weeks.7History of Present illness:The patient had regular menses previously. LMP: 2005-5-10; EDC:2006-2-17. Uric HcG test was positive after 40 days of amenorrhea. Fetal movements were felt in 4 months’ gestation. In 12+2weeks’ gestation, the patient’s blood pressure was found 160/90 mmHg when shecompleted her first ante-partum examination in Hospital of Women and Children’s Health in Huangpu District. Therewas no symptoms at that time, and she didn’t take anytreatment. Half a month ago, she presented edema on both the lower extremities, which expanded to the whole body gradually. She came to our hospital on Dec, 5th and took her sencond ante-partum examination. The bp was200/160mmHg, and uric protein(++) on dipstick test. She has occasional headaches, but no epigastric pain, no visual disturbances, no oliguria, no nausea or vomiting, no thoracic pain. She was admitted on 2005-12-6.After admission, she appears clear, with a good appetite, good sleeping, and normal urination and defecation.Past history: Patient denies history of hepatitis and tuberculosis. No history of allergies. Vaccinated regularly. Past medical history is uemarkable. Surgical history denied.8No history of severe trauma and transfusion.Review of systems:Respiratory system: No history of chronic cough or breathlessness. No hemoptysis or dyspnea.Cardiovascular system: No precordial pain. No palpation. No syncope. For details see present history.Gastroentestinal system: No history of chronic abdominal pain and diarrhea; No nausea or vomiting; No hematemesis and blood stool.Endocrinic system: No polydipsia or polyphasia or polyuria. No sudden change of character and intelligence.Hematologic system: No bruises or abnormal hemorrhage. No recurrent oral ulcer and gingival bleeding.Genitourinary system: No decreased libido; No vaginal dryness or vaginal bleeding; History of STD denied; No urinary frequency. No precipitant urination or dysuria. No hematuria or proteinuria.Neuropsychiatric system: No convulsion or anesthesia. No headaches. No abnormal orientation. No deterioration of memory or intelligence.Locomotor system: No arthralgia, no muscular atrophies or dystrophies.9Personal History:Born and grown up in Shanghai. Patient denied history of tobacco or alcohol use.Marital and Childbearing history: Married. 0-0-1-0; She had an abortion in 3 months’ gestation in Dec., 2004. Birthcontrol has been instructed.Family history: The patient’s Mother and a sister sufferedfrom hypertension. No family history of DM or stroke. No family history of nervous or mental diseases.Physical ExaminationT: 37? P: 89/minR: 20/minBP: 180/120mmHgGeneral appearance: Patient is a 38 years old female who appears pleasant, in no apperant distress, given her age, well developed andwell nourished. Oriented to person, place and time.Lymph nodes: Not enlarged.Skin: No jaundice or rashes. No cyanosis and bruises. No edema.Head: Skull and scalp normal. No tenderness. No loss of hair.Eyes: No edema in eyelids, no ptosis, no conjunctivalcongestion.Width of palpebral fissures is normal. No10jaundice. Pupil’s size and shape is normal. Corneal is clear. No exophthalmos.Ears: Auditory acuity is excellent. No ear purulent discharge.Nose: Shape is normal. No obstruction. No deviation of nasal septum.Mouth: No lips herpes. No cyanosis. No gums pyorrhea and bleeding. No tongue deviation. Tonsils not enlarged.Neck: Her neck is soft. Trachea is midline. No thyroid abnormality was found. Neck vein was not distended.Chest: Contour is normal. No sternum tenderness. The breasts are bilaterally symmetrical. No tenderness and mass.Lung:Inspection: Respiration regular. Degree of expansion is symmetry.Plapation: Tactile fremitus symmetrical.Percussion: extensive resonance to percussion.Ausculation: Clear to ausculation with no rubs noted.Heart:Inspection: No abnormal pulsation or retraction.Plapation: The apex beat can be felt in the 5th intercostal space 1 cm inside of the left mid-clavicular line.11Percussion: The border of cardiac is not enlarged.Ausculation: The heart sounds were of good quality and the rhythm was regular.Radial pulse is normal.Abdomen:Inspection: Universial abdominal bulge. Dilated veins observed.Palpation: Soft. Liver and spleen is not enlarged. Nontender. Murphy’s sign is negative. For details seeobstetric examination.Percussion: No shifting dullness. The upper border of the liver is in the 5th intercostal space.Ausculation: Bowl sound clear. 4/min.Spine and extremities: Severe edema in both lower extremities. No clubbed finger. No disorder of the movement of axial and appendicular bones.Reflex: Symmetrical, equal without pathological responses. Babinski sign and Kernig sign and hoffmann sign are all negative.Obstetric examinationPatient appears pleasant, given her age, well developed and12well nourished. No jaundice. No enlarged lymph nodes.Fetus: Abdominal girth: 93cm; height of fundus: 29cm; estimated fetal weight: 1600g; fetal position: LOA; point of fetal heart tone: ; fetal heart rate: 148/min; FM: active.Pelvis: 24-17-19-9 cm.Anorectal examination: fetal presentation: N/A; sincipital presentation: N/A; fetal membrane: not ruptured. Amniotic fluid: N/A;Flexion of knee: active.Laboratory and special examinationthDec. 6, Blood Rt: Hb: 121g/L; PLT 136×10e9Urine Rt: uric protein(++); occlude blood: (+++)Dec. 7th, Fetal Ultrasound: BPD: 78mm; HC: 259mm; AC: 238mm; FL:51mm; HL:49mm. fetal presentation: head; Position of placenta: right wall of uterus.Thickness of placenta: 23mm. Degree of placental maturity: ?; fetal heartbeat and fetal movement seen; amniotic fluid: 64mm. There is no hematocoelia or ascites. The lower edge of placenta is1323mm from thecervix.Umbilical A: P2: 0.87; R2: 0.59; S/D: 2.46.Fetal heart rate: 145/minDec. 8th, 24h uric protein: 7.5gDec.10th, serum potassium: 3.9mmol/LScr: 86umol/LALT: 25U/L ; AST: 30U/LFeatures of the case:1. Female, 38years old, G2P0, GW: 30+5weeks.2. This patient presents hypertension for 3 months, andsystemic edema for 2 weeks.3. PE: BP: 180/120mmHg. Obstetric exam: Fetus: Abdominal girth: 93cm; height offundus: 29cm; estimated fetal weight: 1600g; fetal position:LOA; point of fetal hearttone: ; fetal heart rate: 148/min; FM: active.Pelvis: 24-17-19-9 cm.Flexion of knee: active.4. Laboratory and special exam:Dec. 6th, Blood Rt: Hb: 121g/L; PLT 136×10e9Urine Rt: uric protein(++); occlude blood: (+++)14Dec. 7th, Fetal Ultrasound: BPD: 78mm; HC: 259mm; AC: 238mm; FL:51mm;Degree of placental maturity: ?; fetal heartbeat and fetalmovementseen; amniotic fluid: 64mm.Umbilical A: P2: 0.87; R2: 0.59; S/D: 2.46.Fetal heart rate: 145/minDec. 8th, 24h uric protein: 7.5gDec.10th, serum potassium: 3.9mmol/LScr: 86umol/LALT: 25U/L ; AST: 30U/LDiagnosis and differential diagnosis:Diagnosis: 1. Severe pre-eclampsia. This patient is a 38-year-old woman, who presents with hypertension and edema. Pre-eclampsia is hypertension associated with proteinuria and edema, occurring primarily in nulliparas after the 20th gestational week and most frequently near term. Other clinical findings of the patient include uric protein (++),etc. These lead to the diagnosis of pre-eclampsia, which feature the clinic status of the latter. The patient has (1) blood pressure 180/120mmHg(160/110mmHg);15(2)proteinuria(++) on dipstick testing and 7.5g (5g)in a 24-hour period. Conclusively, she can be classified as severe pre-eclampsia.Pre-eclampsia is a multisystemic syndrome, primary investigations reveal that she has occasional headaches, but no epigastric pain, no visual disturbances, no oliguria, no nausea or vomiting, no thoracic pain, indicating that there are no many complications at present. Further evaluations are indispensable, which requires more careful investigations.2. Chronic essential hy pertension. The patient’shypertension began from the 12w of gestation, which indicate thatshe has chronic hypertension. Besides, she has a family history of hypertension. After all, she doesn’tpresent severe complaints when her blood pressure were as high as 200/160mmHg. All these lead to the diagnosis of chronic hypertension. To confirm the diagnosis, the blood pressure after delivery should be evaluated.Differential diagnosis: 1. chronic essential hypertension associated with pregnancy. Essential hypertension associated with pregnancy can also cause a very high blood pressure. However, given the age,proteinuria and edema are possibly not complications of hypertension, indicating that she has16superimposed pre-eclampsia. Besides, the symptoms of proteinuria and edema are temporally associated with gestation.2. Chronic hypertension due to renal disease. This includes chronic hypertension due to interstitial nephritis, chronic glomerulonephritis, SLE, diabetic glomerulosclerosis, and so on. In these occasions, the patient would also possibly present hypertension, proteinuria and edema, but her proteinuria was found recently and she didn’t have any symptoms associated with renal diseases previously. In addition, her serum creatinine is in the normal scale (Scr: 86umol/L), which contradicts the hypothesis that she has a renal disease. So the diagnosis of chronic hypertension due to renal disease is not considered at present.Further investigations and treatments:1. Close observation and monitoring, plus quick evaluation: daily weighing; q4-6h monitoring of blood pressure; daily monitoring ofprotein in urine; Regular liver and kidney function testing; Ultrasound of the abdomen; Fetus heartbeat monitor; Conduct ophthalmoscopy examination to evaluat e the severity of the patient’s condition; Conduct PT,APTT, FDP, 3P test to evaluate the coagulant function.172. Rests: Lie in bed on left side.3. Magnesium sulfate administration with close observation offlexion of knee, respiratory rate and urine.4. Control hypertension with Labetalol or Nitroglycerin. The goal of bp control is diastolic pressure《110mmHg andMAP《140mmHg.5. Administer furosemide to control edema.6. Cautious evaluation of the maternal and fetal complications and take action correspondingly. Severe maternal complications include edema of the brain, pulmonary edema; DIC; HELLP syndrome; renal failure. Indicative symptoms include headache, epigastric pain, visual disturbances, oliguria, nausea and vomiting, thoracic pain, etc.7. Use corticosteroids to accelerate fetal lung maturity.8. Delivery. In an effort to reduce perinatal morbidity and mortality, delivery should be delayed. If the patient develops into the following conditions: 1.Blood pressure consistently higher than 100mmHg diastolic in a 24h period or confirmed higher than 110mmHg; 2. Rising serum creatinine; 3. Persistent severe headache; 4. epigastric pain; 4. abnormal liver function tests; 5: Thrombocytopnia; 6: HELLP18syndrome; 7: Eclampsia; 8: Pulmonary edema; 9: Abnormal antepartum fetal heart rate testing; 10: SGA fetus with failure to grow on serial ultrasound examinations.Clinic diagnosis: 1. Severe pre-eclampsia2. Chronic essential hypertension Signiture: /Jacky Luo 篇三:妇科英文病历CASEMedical Number: 756943General informationName: Yue Jun-rongAge: Forty- two years oldSex: FemaleRace: HanOccupation: UnemploymentNationality: ChinaMarital status: MarriedAddress: Xiaochang county of Xiaogan city in Hubei. Tel: 4835963 Date of admission: Feb.27th, 2003 Date of record: 3pm, Feb.27th, 2003 Complainer of history: the patient herself Reliability: Reliable Chief complaint: The patient was found “myoma ofuterus” over two years ago and menometrorrhagia for 519months.Present illness: In 1999, the patient was found “myoma ofuterus” in a physical examination. But she had nothing uncomfortable and her catamenia was normal. She used some Chinese traditional medicine. About 5 months ago, she found the cycle of her catamenia was shorten from 30 days to 20 days and the period lasted from2 days to 4 days. She felt no pain and the quantity was normal. She was accepted in our hospital and her diagnosis was “subserous myoma of uterus”.Since onset, her appetite was good, and both her spiritedness and physical energy are normal. Defecation and urination are normal, too.Past historyOperative history: Never undergoing any operation.Infectious history: No history of severe infectious disease.Allergic history: She was not allergic to penicillin or sulfamide. Respiratory system: No history of respiratory disease.Circulatory system: No history of precordial pain.Alimentary system: No history of regurgitation. Genitourinary system: No history of genitourinary disease.20Hematopoietic system: No history of anemia and mucocutaneous bleeding.Endocrine system: No acromegaly. No excessive sweats.Kinetic system: No history of confinement of limbs.Neural system: No history of headache or dizziness.Personal historyShe was born in Hubei on July 16th, 1956 and almost always lived in Wuhan. She graduated from senior high school. Her living conditions were good. No bad personal habits and customs.Menstrual history: The first time when she was 14. Lasting 2 days every times and its cycle is about 30 days.Obstetrical history: Pregnacy 3 times, once nature production, induced abortion twice.Contraceptive history: Not clear.Family history: His parents are both alive.Physical examinationT 36.8?, P 80/min, R 20/min, BP 120/80mmHg. She is well developed and moderately nourished. Active position. The skin was not stained yellow. No cyanosis. No pigmentation. No skin eruption. Spider angioma was not seen. No pitting edema. Superficial lymph nodes were not21enlarged. HeadCranium: Hair was black and well distributed. No deformities. No scars. No masses. No tenderness.Ear: Bilateral auricles were symmetric and of no masses. No discharges were found in external auditory canals. No tenderness in mastoid area. Auditory acuity was normal.Nose: No abnormal discharges were found in vetibulum nasi. Septum nasi was in midline. No nares flaring. No tenderness in nasal sinuses.Eye: Bilateral eyelids were not swelling. No ptosis. No entropion.Conjunctiva was not congestive. Sclera was anicteric. Eyeballs were not projected or depressed. Movement was normal. Bilateral pupils wereround and equal in size. Direct and indirect pupillary reactions tolight were existent.Mouth: Oral mucous membrane was smooth, and of no ulcer or erosion. Tongue was in midline. Pharynx was not congestive. Tonsils were not enlarged.Neck: Symmetric and of no deformities. No masses. Thyroid was not enlarged. Trachea was in midline.ChestChestwall: Veins could not be seen easily. No subcutaneous22emphysema. Intercostal space was neither narrowed nor widened. No tenderness.Thorax: Symmetric bilaterally. No deformities.Breast: Symmetric bilaterally. Neither nipples nor skin were retracted. Elasticity was fine.Lungs: Respiratory movement was bilaterally symmetric with the frequency of 20/min. Thoracic expansion and tactile fremitus were symmetric bilaterally. No pleural friction fremitus. Resonance was heard during percussion. No abnormal breath sound was heard. No wheezes. No rales.Heart: No bulge and no abnormal impulse or thrills in precordial area. The point of maximum impulse was in 5th left intercostal space inside of the mid clavicular line and not diffuse. No pericardialfriction sound. Border of the heart was normal. Heart sounds were strongand no splitting. Rate 80/min. Cardiac rhythm was regular. Nopathological murmurs.Abdomen: Flat and soft. No bulge or depression. No abdominal wall varicosis. Gastralintestinal type or peristalses were not seen. Therewas not tenderness and rebound tenderness on abdomen or renal region. Liver was not reached. Spleen was not enlarged. No masses. Fluidthrill23negative. Shifting dullness negative. Borhorygmus 5/min. No vascular murmurs. Extremities: No articular swelling. Free movements of all limbs.Neural system: Physiological reflexes were existent without anypathological ones.Genitourinary system: Not examed.Rectum: not exanedInvestigationBlood-Rt: Hb 127g/l RBC 3.93T/l WBC 3.9G/lUrine-Rt: SG 1.070 pH 6.0B-ultrasound: 1. subserous myoma of uterus2. position of loop is normalHepatic function: NormalPT & APTT: NormalProfessional ExaminationPudendum: Married typeVagina: unobstructed, secretion is excessive, white and ropy.Os of cervix: No bleeding, slight anabrosis.Body of uterus: Big like a fist of man, hard and its surface is smooth. Others: Normal24History summary1. Patient was female, 45 years old2. The patient was found “myoma of uterus” over twoyear ago and menometrorrhagia for 5 months..3. No special past history.4. Physical examination showed no abnormity in lung, heart and abdoman. Professional examination can been seen above.5. investigation information: see aboveImpression: subserous myoma of uterusSignature: He Lin (95-10033)25。
子宫内膜癌ESMO
治疗
• ESMO指南认为，目前尚无有力的证据支持 孕激素可用于子宫内膜癌患者术后的辅助 治疗。 • FIGO指南及NCCN指南亦认为辅助性孕激素 治疗不能提高生存率，而用于术后绝经症 状管理的雌激素替代治疗，ESMO指南及 FIGO指南并无提及，NCCN指南则认为雌激 素替代治疗不会增加子宫内膜癌的复发风 险。
治疗
• 对于阴道复发的患者，ESMO推荐的标准治 疗为外照射+后装放疗。
• 对于中心型的盆腔复发，可选择的治疗方 式为手术或放疗。 • 其他部位的盆腔复发，可考虑放疗+/- 辅助 化疗。 • 晚期病变的治疗可个体化综合应用手术、 放疗或化疗。
治疗
• 对转移性及复发性病变的治疗，ESMO指南 认为应包括内分泌治疗或细胞毒药物化疗。
病理分型
• 1、子宫内膜样腺癌75%（分泌型、纤毛状、乳头状或绒 毛腺癌） • 2、腺癌伴鳞状上皮化生； • 3、腺棘癌（良性鳞状细胞成分）； • 4、腺鳞癌（恶性鳞状细胞成分）； • 5、子宫浆液性乳头样（5-10%）； • 6、透明细胞1-5%； • 7、恶性中胚叶混合瘤或癌肉瘤（1-2%）； • 8、子宫肉瘤（平滑肌肉瘤，子宫内膜间质肉瘤，未分 化）3%； • 9、粘液性（1%）； • 10、未分化癌。
治疗
• 关于术后的辅助化疗，ESMO认为对于低分 化的I期患者，有以下高危因素时应采用含 铂的化疗方案：年龄大、淋巴脉管受累或 肿瘤体积较大。 • 对于II-III期的患者则应常规加用术后化疗。
治疗
• 多项研究表明，对于高危组的病人，术后 辅助化疗的效果与术后放疗的效果相当， 而对于那些年龄大于70岁、深肌层受累、 低分化、II期患者或I期伴腹水细胞学阳性的 患者，术后辅助化疗的作用优于放疗。 • 在多项研究中，术后辅助化疗+放疗对比单 纯放疗，前者均能提高高危组患者的无进 展生存率及减少复发的机率。
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rm the patient and family and sign informe surgical treatment
15
10
hypertensive disease
5
diabetes mellitus
5
二、Diagnostic basis
20分
1.Have a history of postmenopausal vaginal bleeding
7
2.Vaginal discharge is usually increased
Physical examination: T: 36.7℃, P80 times/min, R20 times/min, BP 150/100mmHg. Fat, superficial lymph nodes are not visible, cardiopulmonary auscultation is normal, abdomen is flat and soft, there is no pressure pain and rebound pain, liver andspleen are not visible under the rib, and both lower limbs are not swollen.
Terms: according to the above case summary, please send the preliminary diagnosis,
diagnostic basis (if there are two or more diagnosis, should be separately listed their
5
三、The differential diagnosis
10分
1.Atrophic vaginitis
4
2.Dysfunctional endometrial bleeding
4
3.Submucosal myoma or polyp of the uterus
1
4.Cervical cancer, uterine sarcoma, fallopian tube cancer and other malignant diseases
Criteria for the analysis and score of obstetrics and gynecology cases
Evaluation criteria
Total score
score
一、Primary diagnosis
20分
Postmenopausal vaginal bleeding（5points）：Endometrial cancer（5points）
4
3.hypertensive disease, diabetesin the past
4
4.there is a small amount of blood in the vagina. The cervix is smooth and flaccid (2 points). Anterior uterine position, slightly larger (3 points).
1
四、further examination
20分
1.B-mode ultrasonography
5
2.fractional curettage
5
3.CA125
5
4.hysteroscopy
5
五、principle of treatment
30分
1.finishpreoperative examination (5 points), control blood pressure and blood glucose (5 points)
Case analysis of gynecology and obstetrics
case abstract：
XX，56years old，Menopause 2 years, vaginal bleeding for half a month。The patient complainedthat shmenopause 2 years ago, vaginal bleedingisless than the amount of menstruation, no blood clot, no abdominal pain, dizziness, fatigue and other discomfort.Atthe sametime,more vaginal discharge, color white, no odor.socome tooutpatientdepartment fortreatment. Has a history of hypertension for more than 10 years, diabetes for 2 years, has been treated with medicine。G3P2。
Gynecological examination: vulva (-), vagina unobstructed, small amount of blood can be seen, cervix smooth, impotence. The fornix shape was normal, the anterior uterine position was slightly larger, and no abnormality was observed in the bilateral adnexal area.
diagnosis), differential diagnosis, further examination and treatment principle of
writing on the answer sheet.
Exam time: 10 minutes. Total of 100 points