医学汉英翻译记忆库27(5000条)

Chinese English他们发现如果不能从组织学上除外自然流产，髙达40%的异位妊娠诊断错误。

They found that the presumptive diagnosis of ectopic pregnancy is inaccurate in nearly 40 percent of cases without histologic exclusion of a spontaneous pregnancy loss.然而,尚缺乏有效的评价子宫内膜取样的时机和方式的研究。

Nevertheless, the need and method of endometrial sampling must carefully be weighed against the limited risks of methotrexate.有研究Pipelle活检是否可作为刮宫术的替代,发现其取得绒毛的敏感性为30%-63% (Barnhart, 2003b;Ries,2000)。

Pipelle biopsy was studied as an alternative to curettage and found inferior, with sensitivity of obtaining villi ranging from 30 to 63 percent (Barnhart, 2003b; Ries, 2000).与此对比，用刮宫取得组织的冷冻切片确定妊娠产物的准确性要超过90% (Barak， 2005 ；Spandorfer, 1996)。

By comparison, frozen section of curettage fragments to identify products of conception is accurate in over 90 percent of cases (Barak, 2005; Spandorfer, 1996).新的血清标志物Novel Serum Markers有一些小规模的研究来评价新的、诊断异位妊娠的标志物。

A number of small studies have been done to evaluate the utility of novel markers to detect ectopic pregnancy.Daniel等（1999)发现血管内皮生长因子(vascular endothelial growth factor, VEGF)的浓度〉 200 pg/L可以用来鉴别诊断异位妊娠和正常或死亡的宫内妊娠，其敏感性、特异性和阳性预测值分别为 60%、90%和86%。

Daniel and associates (1999) found that vascular endothelial growth factor (VEGF) in concentrations <200 pg/mL could differentiate between an ectopic and a normal or arrested uterine pregnancy with a sensitivity, specificity, and positive predictive value of 60, 90, and 86 percent, respectively.此外，还有学者研究癌抗原125 (cancerantigen 125，CA125)、血清肌酸激酶和胎儿纤维连接蛋白浓度作为异位妊娠的标志物（NeSS 1998;Predanic,2000)。

In addition, cancer antigen 125 (CA 125), serum creatine kinase, and fetal fibronectin concentrations have been investigated (Ness, 1998; Predanic, 2000).近日，质谱为基础的蛋白质组学技术也被用来确定正常妊娠和它的一些疾病（尚卡尔，2005年）的生化蓝图。

Recently, mass spectrometry-based proteomic techniques have also been used to determine the biochemical blueprint of normal pregnancy and some of its disorders (Shankar, 2005).诊断评价总结Summary of Diagnostic Evaluation临床医生在只有50%的自然流产患者的妊娠产物中发现绒毛，另外有30%的绒毛被病理科医生发现。

Chorionic villi in specimens from women with the diagnosis of spontaneous abortion were identified clinically in only half of cases and by the pathologist in another 30 percent.因此,剩下的20%的患者仍然有异位妊娠的可能性(Lindahl, 1986)。

Thus in 20 percent of women, an ectopic pregnancy was still a consideration (Lindahl, 1986).诊断性腹腔镜仍然是诊断异位妊娠的金标准（图 7-9，彩图7-3)。

Confirmation by diagnostic laparoscopy remains the gold standard for diagnosis of ectopic pregnancy (Fig. 7-9).应用现有的高敏感性的诊断手段，异位妊娠完全可以在术前得到诊断。

That said, with sensitive diagnostic modalities available, ectopic pregnancy can typically be diagnosed prior to surgery.图7-9腹腔镜图像FIGURE 7-9 Laparoscopic photograph.用钝型的拨棒暴露一个蓝色、增大的输卵管壶腹部。

The blunt probe elevates a blue, distended left tubal ampulla.(由 Kevin Doody 博士提供）(Courtesy of Dr. Kevin Doody.)应用规范的循证医学的方法可以帮助异位妊娠的诊断。

Use of an evidence-based algorithm will facilitate identification of an ectopic pregnancy.经过适当的临床评价后，所有生育年龄的可疑异位妊娠的患者均应检查尿hCG。

After appropriate clinical evaluation, all reproductive-aged women with any suspicion of pregnancy should be tested using a sensitive urine -hCG assay.如果结果为阳性、超声检查不能证实为宫内妊娠、没有急性腹腔内出血的征象，应该怀疑异位妊娠的存在，然后进一步进行如图7-10所示的检查。

Following positive testing, if an intrauterine pregnancy is not confirmed by sonography, no signs of acute intra-abdominal hemorrhage are present, and an ectopic gestation is suspected, then an evaluation such as the one depicted by the algorithm in Figure 7-10 may be used.Gracia等（2001)进行了一项研究来发现6种评价手段先后顺序如何才能更有效地发现异位妊娠以及减少对宫内妊娠的干扰。

Gracia and colleagues (2001) performed a decision analysis of six diagnostic strategies to evaluate which sequence of tests was most efficient in yielding the fewest missed ectopic pregnancies and interrupted uterine pregnancies.他们发现在孕早期腹痛或阴道出血的患者最佳的检査手段为TVS。

They found the best strategy to be TVS for all women with first-trimester pain or bleeding.如果结果不能明确诊断，然后应测定血清hCG水平。

If findings are not diagnostic, then serum -hCG levels are measured.应用这种检查策略，只有1%的潜在宫内妊娠受到干扰，并且没有异位妊娠漏诊，确诊的平均时间为1.5天。

Using this strategy, only 1 percent of all potential uterine pregnancies were interrupted, no ectopic pregnancies were missed, and the average time to diagnosis was 1.5 days.由于超声检查发现官内妊娠的总体敏感性低于93％(由于陈旧的超声设备、无经验的超声医师、患者肥胖或不适、解剖改变）。

他们建议先测定血清hCG水平，在超过警戒水平的患者进行超声检査。

In the event that overall sensitivity of available sonography for detecting uterine pregnancy is less than 93 percent because of older sonographic equipment, an inexperienced sonographer, patient obesity or discomfort, or distorted anatomy they recommend measurement of serum -hCG levels first, reserving sonographic examination for those women with levels above the discriminatory zone.图7-10异位妊娠的诊断步骤FIGURE 7-10 Algorithm of ectopic pregnancy evaluation.-hCG= - 人绒毛膜促性腺激素，D＆C =刮宫术; IUP =宫内妊娠; TVS =阴道超声。