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[26] Ker WH, Wagner WH. Gynecologic surgery and the management of hemorrhage.

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GynecologicSurgeryandtheManagementofHemorrhage

WilliamH.Parker,MDa,*,WillisH.Wagner,MD

b

Surgicalbloodlossofmorethan1000mLorbloodlossthatrequiresabloodtransfu-sionusuallydefinesintraoperativehemorrhage.1Intraoperativehemorrhagehasbeen

reportedin1%to2%ofhysterectomystudies.Acutelossofmorethan25%ofthepatient’sbloodvolumeoralossthatissufficienttorequireaninterventiontosavethepatient’slifedefinesmassivehemorrhage.2Cardiovascularinstabilitywithsignificanthypotensionoftenresultsfromalossof30%to40%ofthepatient’sbloodvolume.Morethan40%bloodlossislifethreat-ening.Severehemorrhagecanleadtomultiorganfailureanddeathunlessresuscita-tionisaccomplishedwithinanhour.Severepostoperativeanemiacanaffectmortality.Inastudyof300patientswhorefusedbloodtransfusionforreligiousreasons,itwasfoundthatpatientswithhemo-globinlevelsof5.1to7.0g/dLhadmortalityof9%.Mortalitywas30%inpatientswithhemoglobinlevelsbetween3.1and5.0g/dLand64%inthosewithhemoglobinlevelslessthan3.0g/dL.However,hemoglobinlevelsbetween7and8g/dLdidnothaveanyadverseeffectonmortality.3

PREOPERATIVEEVALUATIONPreoperativeevaluationofthepatientcanaidsurgicalplanningtohelppreventintra-operativehemorrhageorprepareforthemanagementofhemorrhage,shoulditoccur.

MedicalHistoryPersonalorfamilyhistoryofprolongedbleeding,postpartumhemorrhage,needfortransfusions,orpersistentanemiashouldbedetermined.vonWillebranddisease(VWD)occursin2%ofwomeninthegeneralpopulation;however,17%ofwomen

aDepartmentofObstetricsandGynecology,SaintJohn’sHealthCenter,UniversityofCalifornia

LosAngelesSchoolofMedicine,1450TenthStreet,SantaMonica,LosAngeles,CA90401,USAbVascularLaboratory,SaintJohn’sHealthCenter,2121SantaMonicaBoulevard,SantaMonica,

CA90404,USA*Correspondingauthor.E-mailaddress:wparker@ucla.edu

KEYWORDS󰀂Gynecologicsurgery󰀂Hemorrhage󰀂Hemostasis

ObstetGynecolClinNAm37(2010)427–436doi:10.1016/j.ogc.2010.05.003obgyn.theclinics.com0889-8545/10/$–seefrontmatterª2010ElsevierInc.Allrightsreserved.

多器官衰竭术前措施评估，减少术中出血及相关处理措施准备withmenorrhagiahaveVWD.Becausemenorrhagiaisacommonindicationforgyne-cologicsurgery,ahistoryofmenorrhagiasincemenarcheshouldtriggerfurthereval-uationbyahematologist.Ifthediagnosisismade,desmopressin(DDAVP)canbeusedtoreduceintraoperativebleedingbyincreasingtheplasmaconcentrationandactivityofvonWillebrandfactor.Womenwithreligiousbeliefsthatprecludetransfu-sionwithallogenicbloodshouldbeidentifiedbeforeelectivesurgery.Increasinghemoglobinconcentrationsbeforesurgeryshouldbestronglyconsidered(seelatersections).

MedicationHistoryBecausecoagulationmaybeinhibitedbymedications,includingprescription,over-the-counter,oralternativeformulations,thesurgeonshouldinquireabouttheuseofthesesubstances.Patientsoftendonotmentiontheseproducts.Aspirin,oftenusedforfever,headache,orpainshouldbediscontinued7to10daysbeforesurgery.Aspirininhibitsplateletcyclooxygenasewithin1hourofingestion.4Thiseffectisirreversible,soplateletaggregationstudiescangiveabnormalresultsforupto10days.Nonsteroidalantiinflammatorydrugs(NSAIDs)causeinhibitionofcyclooxygenase,whichisreversible.Plateletfunctionreturnstonormalwithin24hoursafterthelastdoseofibuprofen,butwithmostotherNSAIDsplateletfunctionisabnormalfor3days.5Clopidogrelbisulfate(Plavix),along-actingoralantiplateletmedication,causesadose-dependentinhibitionofplateletaggregation2hoursafterthefirstdose.Withcontinueduse,ittakesabout5daysaftertreatmentisdiscontinuedforbleedingtimetoreturntonormal.A1.5%increaseinthefrequencyofsurgicalbleedingeventswasreportedinameta-analysisofmenandwomentakinglow-doseaspirinandundergoingnoncardiacsurgeriesandinvasiveprocedures.However,neithertheseverityofbleedingcomplicationsnortheperioperativemortalityincreasedforabdominalsurgery.6PatientswithahistoryofcardiovasculardiseaseorthrombosiswhotakeaspirinorPlavixforprophylaxisshouldbemanagedjointlywithaninternist.Continueduseofthesedrugsdependsonthepotentialriskofthromboticcomplicationsthatariseifaspirinisdiscontinuedversustherisksofperioperativebleedingassociatedwithcontinuedtherapy.7Stoppingaspirintherapyformorethan5daysinpatientswith

underlyingcardiovasculardiseasemayincreasetheriskofanacutecoronarysyndromeorstroke.Managementofwarfarinorheparinshouldalsobecoordinatedbytheprescribingclinician.

AlternativeMedicationsImpairedhemostasishasbeenshowntobemorethan2timesaslikelyforpatientsusingtraditionalChineseherbalmedicinesthanfornonusers.8Garlic,Ginkgobiloba,

andginsengmayalsoaffectcoagulationthroughtheinhibitionofplateletaggregation.9

PreoperativeLaboratoryEvaluation󰀂Abaselinehematocrit(Hct)shouldbeobtainedbeforesurgery,preferablyintime

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《妇产科学》习题(双语版)

《妇产科学》习题(双语版)

双语习题1- 选择题（50分）单选题●1.25岁初孕妇，孕38周，在门诊检查时主诉自觉胎动减少一天，查胎心率148次/分，为了解胎儿在宫内情况首先应作下列哪顶检查？A. 胎儿心电图B. CST试验C. 胎儿头皮血PH测定，D. NST试验E. 羊膜镜检查D [答案]●2.胎儿电子监测时，提示脐带受压的是A NST无反应型B 加速C 早期减速D 变异减速E 晚期减速D [答案]●3.初孕妇，孕38周，入院治疗3天，血压20/13.3kPa （150/110mmHg）、LOA、胎心140次/分，尿蛋白2.0g/24小时，水肿（+），宫颈软，宫颈管消退80％，行人工破膜及催产素引产12小时，无规律宫缩，下一步处理应是A 休息2天再继续引产B 加用抗生素，继续引产C 加大催产素浓度，继续引产D 剖宫产术E 降压解痉等待自然临产D [答案]●4.输卵管妊娠的发病部位最多见于输卵管的A 峡部B 壶腹部C 伞部D 间质部E 峡部与壶腹部之间B [答案]●5.一足月初产妇，临产3小时，宫缩持续25～35秒，间隔4～5分钟，胎心140次/分，先露头，浮，突然阴道流水，色清，宫口开1cm。

下列哪项处理不当：A 立即听胎心B 记录破膜时间C 鼓励产妇在宫缩时，运用腹压加速产程进展D 超过12小时尚未分娩，加用抗生素E 卧床、抬高臀部C [答案]●6.国际上对围产期规定有4种，我国采用的是下述哪一种？A 从妊娠满28周至产后1周B 从妊娠满28周至产后4周C 从妊娠满20周至产后1周D 从妊娠满20周至产后4周E 从胚胎形成至产后1周A [答案]●7.关于子宫正确的是A 成年女子的子宫长约7—8cm，宽约4—5cm，厚约4—5cm。

B 幼年时子宫体与子宫颈的比例为2:1C 子宫体与子宫颈之间最狭窄的部分为子宫峡部D 子宫峡部上端是组织学内口E 经产妇的子宫颈外口为圆形C [答案]●8.关于骨盆的平面，下述哪项是正确的A 骨盆入口平面呈纵椭圆型B 骨盆入口平面前后径比横径大C 中骨盆平面横径比前后径大D 中骨盆平面是骨盆最窄平面E 站立时骨盆入口平面与地平面平行D [答案]●9.A prolonged second stage of labor in the primigravid patient lasts longer thanA.1.0 hoursB.2.0 hoursC.8.0 hoursD.6.0 hoursE.4.0 hoursB [答案]●10.The size of normal uterus of adult is about:A. 4cm×3cm×1cmB. 8cm×3cm×1cmC. 8cm×5cm×1cmD.6cm×4cm×2cmE 7cm×4cm×3cmE [答案]●11.The most common cause of maternal death in China is:A.AbortionB.AnesthesiaC.EmbolismD.InfectionE.HemorrhageE [答案]●12.which of the following does the early pregnancy have in common?A. morning sicknessB. breast enlargementC. abdomen enlargementD. amenorrhea (cease of mense)E. urinary frequencyD [答案]●13.病理性缩复环最常见于A 高张性宫缩乏力B 软产道损伤C 头盆不称D 枕后位E 妇女型骨盆C [答案]●14.关于协调性宫缩乏力，正确的是A 宫缩极性对称性正常，仅收缩力弱B 多数产妇觉持续性腹痛，且产程延长C 不会发生胎儿宫内窘迫D 不宜静脉点滴催产素E 隐匿期不宜使用杜冷丁A [答案]●15.羊水过多为多于A 2000mlB 2500mlC 300mlD 200mlE 1000mlA [答案]●16.患者，女，25岁，初孕妇，为31周，外伤后突然剧烈腹痛，少量阴道流血，急诊送入院。

Unit10-A+B Gynecological Diseases 妇科疾病翻译

Unit10-A+B Gynecological Diseases 妇科疾病翻译

Unit 10 Gynecological Diseases第10单元妇科疾病Pre-reading Activitiesang预习工作. Read the following clinical situation and decide what kind of intervention you will suggest and what disease the patient might be suffering from.阅读下面的临床表现然后决定你将建议做那些干预，病人可能患了那种疾病。

A 55-year-old woman comes to the outpatient office complaining of pelvic pressure and ab-dominal fullness. Her last menstrual period (LMP) was 3 years ago.A、女性，55岁，门诊病人，住宿骨盆压迫感，腹部胀满。

末次月经为3年前。

在阅读这个文章前先理解一下术语。

Try to understand the following terms before you read the text.gynecological [ igainiks'bc^ikal] adj. of or relating to or practicing gynecology $3产科医学的n.ovarian [ ou'vesrisn] adj. of or involving the ovaries [解音I门卵巢的malignancy [ ms'lignsnsi]( medicine) a malignant state ；progressive and resistant to treatment and tending to cause "death 恶性（肿瘤等）salpingectomy [ iS2elpin'd3ekt3mi J surgical removal of one or both Fallopian tubes [妇产]输卵管切除术hysterectomy [ ihista'rektsmi] n. surgical removal of the uterus 子宫切除Text A Ovarian Gancort FocusAbout Ovarian Cancer iSigns and Symptomst Causes| DiagnosisClassificationStaging | Treatment+ Prevention主题A 卵巢癌重点：卵巢癌的相关体征和症状病因诊断分级分期|治疗预防About Ovarian Cancer关于卵巢癌Ovarian cancer is a cancerous growth arising from the ovary. Ovarian Cancer is the second most• 1 •• 2 •新编临床实用医学英语commonly diagnosed gynecologic malignancy，the deadliest gynecologic malignancy，and the fourth leading cause of cancer-related deaths in women in the USA. About 1 in 70 women eventually develop ovarian cancer，and 1 in 100 women dies of it. Ovarian cancer affects pre-dominantly perimenopausal and postmenopausal women.卵巢癌是一种子宫增生性癌。

未分化结缔组织病患者的妊娠结局、疾病演变及其影响因素

未分化结缔组织病患者的妊娠结局、疾病演变及其影响因素

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3.0T MRI直肠癌DISTANCE评估的术前指导价值

3.0T MRI直肠癌DISTANCE评估的术前指导价值

现代消化及介入诊疗　２０２１年第２６卷第４期ＭｏｄｅｒｎＤｉｇｅｓｔｉｏｎ＆Ｉｎｔｅｒｖｅｎｔｉｏｎ２０２１牞Ｖｏｌ．２６牞Ｎｏ．４　ＳｕｒｇｅｒｙＲｅｇｉｓｔｒｙ［Ｊ］．ＯｂｅｓＳｕｒｇ，２０１６，２６（９）：２１２７ ２１３０．［８］　张鹏思，杨腾飞，裴冬梅．职业人群生活方式和心理因素对肥胖的影响［Ｊ］．中国医科大学学报，２０２０，４９（１２）：１０７６ １０８１．［９］　ＭａｄａｎＡＫ，ＭｅｎａｃｈｅｒｙＳ．Ｓａｆｅｔｙａｎｄｅｆｆｉｃａｃｙｏｆｉｎｉｔｉａｌｔｒｏｃａｒｐｌａｃｅｍｅｎｔｉｎｍｏｒｂｉｄｌｙｏｂｅｓｅｐａｔｉｅｎｔｓ［Ｊ］．ＡｒｃｈＳｕｒｇ，２００６；１４１（３）：３００ ３０３．［１０］ＶｉｌｏｓＧＡ，ＴｅｒｎａｍｉａｎＡ，ＤｅｍｐｓｔｅｒＪ，ｅｔａｌ．Ｎｏ．１９３ ＬａｐａｒｏｓｃｏｐｉｃＥｎｔｒｙ：ＡＲｅｖｉｅｗｏｆＴｅｃｈｎｉｑｕｅｓ，Ｔｅｃｈｎｏｌｏｇｉｅｓ，ａｎｄＣｏｍｐｌｉｃａｔｉｏｎｓ［Ｊ］．ＪＯｂｓｔｅｔＧｙｎａｅｃｏｌＣａｎ，２０１７，３９（７）：ｅ６９ ｅ８４．［１１］王春阳，韩璐，郭凤．悬吊线法经脐单孔腹腔镜在妇科手术的应用［Ｊ］．中华腔镜外科杂志（电子版），２０１８，１１（１）：３５ ３８．［１２］王丹莹，刘海元，史宏晖，等．不同腹壁通道在单孔腹腔镜卵巢囊肿剔除术中的应用［Ｊ］．生殖医学杂志，２０１７，２６（７）：６８９ ６９３．［１３］ＶｉｌｏｓＧＡ，ＶｉｌｏｓＡＧ，Ａｂｕ ＲａｆｅａＢ，ｅｔａｌ．Ｔｈｒｅｅｓｉｍｐｌｅｓｔｅｐｓｄｕｒｉｎｇｃｌｏｓｅｄｌａｐａｒｏｓｃｏｐｉｃｅｎｔｒｙｍａｙｍｉｎｉｍｉｚｅｍａｊｏｒｉｎｊｕｒｉｅｓ［Ｊ］．ＳｕｒｇＥｎｄｏｓｃ，２００９，２３（４）：７５８ ７６４．［１４］ＷｏｌｔｈｕｉｓＡＭ．ＶｅｒｅｓｓＮｅｅｄｌｅＣｒｅａｔｉｏｎｏｆａＰｎｅｕｍｏｐｅｒｉｔｏｎｅｕｍ：ＩｓＩｔＲｉｓｋｙ？ＲｅｓｕｌｔｓｏｆｔｈｅＦｉｒｓｔＢｅｌｇｉａｎＧｒｏｕｐｆｏｒＥｎｄｏｓｃｏｐｉｃＳｕｒｇｅｒｙ ＳｎａｐｓｈｏｔＳｔｕｄｙ［Ｊ］．ＪＬａｐａｒｏｅｎｄｏｓｃＡｄｖＳｕｒｇＴｅｃｈＡ，２０１９，２９（８）：１０２３ １０２６．［１５］盛慧然．腹腔镜与开腹手术对直肠癌患者应激反应、免疫功能及并发症的对比分析［Ｊ］．现代消化及介入诊疗，２０１９，２４（５）：４９７ ５００．［１６］谢茂云，黄耀，林志群，等．免气腹法与气腹法穿刺置入第１套管针在腹腔镜胆囊切除术中的应用比较［Ｊ］．山东医药，２０１９，５９（３５）：４９ ５１．［１７］ＫｏｓｕｔａＭ，ＰａｌｍｉｓａｎｏＳ，ＰｉｃｃｉｎｎｉＧ，ｅｔａｌ．ＳａｆｅｔｙｏｆＶｅｒｅｓｓｎｅｅｄｌｅｉｎｓｅｒｔｉｏｎｉｎｌａｐａｒｏｓｃｏｐｉｃｂａｒｉａｔｒｉｃｓｕｒｇｅｒｙ［Ｊ］．ＳｕｒｇＬａｐａｒｏｓｃＥｎｄｏｓｃＰｅｒｃｕｔａｎＴｅｃｈ，２０１４，２４（１）：ｅ１ ｅ４．［１８］卢锐敏，郑燕生，罗立杰，等．结直肠癌肝转移腹腔镜同期同切口手术可行性的临床研究［Ｊ］．现代消化及介入诊疗，２０２０，２５（４）：４７７ ４８０．［１９］孟凡强，刘孝明，刘海滨，等．超重和肥胖患者建立气腹新穿刺点的探讨［Ｊ］．中国医刊，２０１９，５４（１１）：１２０６ １２０７．［２０］ＫａｓｓｉｒＲ，ＢｌａｎｃＰ，ＬｏｉｎｔｉｅｒＰ，ｅｔａｌ．Ｌａｐａｒｏｓｃｏｐｉｃｅｎｔｒｙｔｅｃｈｎｉｑｕｅｓｉｎｏｂｅｓｅｐａｔｉｅｎｔ：ｖｅｒｅｓｓｎｅｅｄｌｅ，ｄｉｒｅｃｔｔｒｏｃａｒｉｎｓｅｒｔｉｏｎｏｒｏｐｅｎｅｎｔｒｙｔｅｃｈｎｉｑｕｅ？［Ｊ］．ＯｂｅｓＳｕｒｇ，２０１４，２４（１２）：２１９３ ２１９４．［２１］王刚，程庆，张冲，等．泌尿外科经腹腹腔镜腹壁穿刺血管损伤的临床分析［Ｊ］．中华腔镜泌尿外科杂志（电子版），２０１９，１３（２）：１２１ １２４．［２２］ＡｍｂａｒｄａｒＳ，ＣａｂｏｔＪ，ＣｅｋｉｃＶ，ｅｔａｌ．ＡｂｄｏｍｉｎａｌｗａｌｌｄｉｍｅｎｓｉｏｎｓａｎｄｕｍｂｉｌｉｃａｌｐｏｓｉｔｉｏｎｖａｒｙｗｉｄｅｌｙｗｉｔｈＢＭＩａｎｄｓｈｏｕｌｄｂｅｔａｋｅｎｉｎｔｏａｃｃｏｕｎｔｗｈｅｎｃｈｏｏｓｉｎｇｐｏｒｔｌｏｃａｔｉｏｎｓ［Ｊ］．ＳｕｒｇＥｎｄｏｓｃ，２００９，２３（９）：１９９５ ２０００．［２３］郝敬侠．预见性防止腹腔镜手术中气腹产生并发症的护理措施［Ｊ］．中国医药指南，２０１３，１１（３２）：２４６ ２４７．［２４］杨卫华，张松柏．有腹部手术史的腹腔镜阑尾切除术闭合法建立气腹１３３例报告［Ｊ］．中国微创外科杂志，２０１３，１３（４）：３７４ ３７５．［２５］杨平，黄宗海，彭翔，等．腹腔镜手术中经脐缘穿刺与经脐孔基底垂直穿刺气腹的对比研究［Ｊ］．海南医学，２０１３，２４（１１）：１５９３ １５９６．（收稿日期：２０２１ ０１ ２８）（本文编辑：南清振）作者单位：６４１４００四川省简阳市人民医院（１放射科；２病理科）通信作者：赵良清，Ｅ ｍａｉｌ：ｚｈａｏｌ１９８１１＠１６３．ｃｏｍ基金项目：四川省重点研发项目（ＺＤＹＦ２０１９１０３）·诊疗技术·３．０ＴＭＲＩ直肠癌ＤＩＳＴＡＮＣＥ评估的术前指导价值赵良清１，俸跃波１，周强１，蒋炜杰２ 【摘要】目的　探讨３ ０Ｔ磁共振成像（ＭＲＩ）直肠癌“ＤＩＳＴＡＮＣＥ”评估的术前指导价值。