Tubal pregnancy should be on how to prevent

Note menstrual period and puerperium middle of the reproductive system of health to prevent infection if the disease should have been timely to go to the hospital blood transfusion at the same time to do Caesarean section surgery detectors

How should the treatment of tubal pregnancy

For tubal pregnancy has always been the main method of treatment is surgery nearly a dozen years due to the high sensitivity of RIA β-hCG and high-resolution B-laparoscopic and the development of early diagnosis of ectopic pregnancy significantly increased so conservative surgery and drug treatment should be more In the clinical

A surgical therapy

(A) tubal resection: whether abortion-or fallopian tube ruptured tubal pregnancy can be removed in a timely manner to save lives bleeding children no longer have the women's fertility can be prepared simultaneously in the opposite tubal ligation need to retain the fertility of women if tubal lesions Break too long and too much loss of the fallopian tube membrane and blood vessels and / or indications of life in a serious state of a fallopian tube should be removed in line conservative surgery tubal bleeding can not control the fallopian tube should be immediately removed

Zhenma surgery can be carried out under local anesthesia or Caesarean section after the first stop bleeding with pliers Qianzhu bleeding to stop bleeding shock at the rapid blood transfusion to be improved after the shock of the steps by the side of salpingectomy as normal ovarian side should be retained as the contralateral With the normal requirements of tubal sterilization should be implemented ligation contralateral Luanguan patients with lesions in accordance with requirements of the situation and deal with lesions in principle, be best to shorten the operation time period should not be in acute bleeding or inflammation under consideration lose eggs was performed abdominal Free no infected blood for their own blood transfusion especially in the case of lack of blood transfusion for their rescue hemorrhagic shock is extremely effective measures at this time no blood coagulation is not thick with the smell no destruction of red blood cells under the microscope of not more than 30 percent each 100ml of blood plus 3.8% sodium citrate 10 ml of their blood should be more than 500 ml to 10 percent calcium gluconate 10 ~ 20 ml citrate to avoid poisoning with autologous blood transfusion without the timely added to internal bleeding and more serious hemorrhagic shock patients is very necessary Savings of the blood and reduce the financial burden of their fresh red blood cell can also avoid carrying ability of serum hepatitis and other infectious diseases in recent years some people put their own blood anticoagulant and may increase the clinical application of the recovery of the blood coagulation degree of People vary in order to give full play to the advantages of their own blood transfusion or increase sodium citrate or ACD solution suitable anticoagulant

(B) conservative surgery: the so-called conservative surgery to remove the heart is, in principle, as much as possible to retain tubal pregnancy of the anatomy and function to create the conditions for the future of intrauterine pregnancy

Indications: young women of this tubal pregnancy as the first pregnancy; children have been removed without the side tubal

Surgery: fallopian tube embryos incision removal of swelling in the affected parts of the film in the longitudinal axis parallel to the surface and tubal 1 ~ 2 cm incision gently squeezed out of pregnancy will then fine silk thread or 0 / 8 non-invasive sutures under the microscope Sutured incision will be used for that is not slit window closed incision and margin will be interrupted suture to stop bleeding into a "window" of pregnancy if, for the isthmus, with end-to-end anastomosis isthmus lesions near the corner of uterine tubal possible angle implantation in the uterus

To prevent postoperative adhesions retain fertility is one of the important measures can be placed in the abdominal cavity in the molecular dextran 250 ~ 300 ml, or 0.25 percent procaine 100 ml hydride de-250 mg glycerin 10 ml after the restoration of fertility treatment also very important If timely tubal-water treatment, such as promoting blood circulation decoction

(C) laparoscopic surgery: first used in laparoscopic for washing and flushing aspiration of blood found in the pelvic Yunluan implantation sites such as ampulla of pregnancy may be directly from the ampulla (the umbrella Division), or suction out tbsp Clamp to pregnancy, such as the Gap or the Department of the Ministry of tubal pregnancy would do in the incision of the vaccination of mesangial 5% POR-8 20 ~ 30ml to prevent ischemia, bleeding in the open Luanguan Luanguan dorsal Luanguan uplift the coagulation after the cut until the egg wall of pregnancy exposed by two non-invasive equipment, left the egg wall later tbsp clamp of pregnancy will gradually remove the final wash-rinse with implantation sites with Abdominal knot of suture to close the wound Luanguan serous

The Integrated Treatment

According to 8 are satisfied that the dialectic of tubal pregnancy, abdominal pain on blood-wook is unreasonable in promoting blood circulation Quyu should therefore be to the principle of pain for the treatment of patients with cold and heat actual situation Syndrome addition and subtraction and clinical classification (shock of stable mass-type) medication

(A) shock-type: hemorrhage shock stage more attention should be paid to actual situation both at the same time take into account the constitution of cold and heat as a result of tubal pregnancy itself is of internal bleeding and blood pressure to drop cold sweat looking pale and weak pulse to Xu Zheng according to an analysis of patients at the time such as Xu Zheng Air heavier use ginseng to prevent blood deficiency at the same time accompanied by promoting blood circulation to promote internal bleeding absorption Quyu

Recipe: Salvia 30 g TPG 10 g Taoren 10 g frankincense 10 g myrrh 10 g water to cook 300 ml in two virtual clothes were heavy and severe pain ginseng Canadian dollar rescue shock at the same time Hu and oxygen blood transfusion insulation to keep in systolic blood pressure-about 12 kpa

In the course of treatment to closely observe the pulse of blood pressure patients, such as abdominal pain and hemoglobin clear whether or not to continue to hemorrhage; patients with bed rest must be absolutely not too early to minimize activities of a sudden increase in abdominal pressure and body position changes in the factors that should be able to have blood transfusions and Caesarean section at any time the conditions Under this type of immediate treatment to individual patients with abdominal surgery has repeatedly refused to consider surgery again

(B) stable: a stable condition stable blood pressure to reduce abdominal pain free blood has been initially formed part of absorption or mass anti-abdominal tenderness Zhuoyin Tiaotong reduce the mobility of the gradual disappearance of vaginal examination may be touched on the main mass in accordance with the appropriate antidote to heat If Baicalin two-plus spent to prevent infection, such as Forsythia this period of bed rest is still mainly gradually appropriate activities

(C) mass-type: This type of blood stasis Positive microgastropods a mass in addition to promoting blood circulation by removing blood stasis, the main side should be broken by the Kennedy plot to eliminate mass of drug use good break Zhengjia the Tri-Ezhu it should be noted Tri-Ezhu tackling tough problems such as the use of drugs such as the length of this may have caused Deficiency Syndrome should be based on symptoms such as pulse to dangshen Astragalus Air drugs to accelerate the mass to absorb external application can be soft Kennedy ointment: 15 g of the maple wood turtle-15 g aeruginosa 15g increase to date 10 nuclear research Ximo were evenly mixed with gauze wrap placed lower abdomen plus hot packs or musk 0.6 g camphor 6 g's Blood 9 g Rosin 9 g Yin-Zhu 9 g total of four flavor drug research Ximo share buy cloth pieces On the plate of the last to join with musk, the mass affixed to the lower abdomen

Yunluan absolutely not in the positive pregnancy test can be added to the centipede two Achyranthes 15 g trichosanthin 9 ~ 15 g teeth soap 9 g to eliminate the embryo so that pregnancy tests were negative but the results may also not very happy with the β-hCG and monitoring the treatment of B - Can also increase use of MTX must accelerate Yunluan

Three drug treatment

Methotrexate (methotrexateMTX) is mainly used for non-ruptured tubal pregnancy tubal serous integrity of active bleeding tubal pregnancy product of the diameter of <3 ~ 4 cm abdominal blood in the <100 ml β-hCG <3000mIU/ml vital signs are stable young require fertility

Treatment methods: ① MTX oral 0.4 mg (kg d) 5 days for a general course of the amount of 25 mg / d by five days without clinical toxicity rarely applied; ② MTX intramuscular injection 0.4 mg / (kg d) 5 days for a A course of the authors report 23 cases of ectopic pregnancy after absorbing 95.7 percent of pregnant or laparoscopic confirmed by contrast 10/19 (52.6%) patients with tubal patency; ③ MTX-CF programme formyl Relationship (citrovorum factorCF) CF can be reversed MTX toxicity of the most commonly used method for the current MTX when the dosage of 1 mg / kg, plasma concentration of 10-8 M to be rescued by CF to achieve high efficacy and toxicity MTX infusion time

Tubal pregnancy can be complicated by the diseases

May be complicated by bleeding, such as shock

Tubal pregnancy easily confused with the diseases

With the differential diagnosis of diseases following:

An early pregnancy abortion abortion slower and more pain in the lower abdomen and more central parts of paroxysmal general vaginal bleeding in vaginal bleeding more than the number of hemorrhagic symptoms consistent with the general abdominal tenderness or a little tenderness with no general free movement of anti-Tiaotong vaginal examination of Zhuoyin Cervical no pain after the dome does not give full uterine size and the number of months in line with amenorrhea uterus next to a mass of more bloodshed have children or those with the patients and their families description diagnostic curettage

The acute Salpingitis no history of amenorrhea and early pregnancy is no shock levy abdominal body temperature increased tension on both sides have abdominal tenderness vaginal examination after the dome is not full of normal on both sides of the uterus, often thickened mass Annex tenderness and sometimes significant side After the dome puncture can sometimes take Nongye WBC and neutral classification high negative pregnancy test in particular bleeding salpingits not only lower abdominal tenderness and sometimes anti-Tiaotong mobile Zhuoyin can occur after the dome puncture can take fresh blood of the former are often difficult to identify Caesarean section only after the diagnosis but it was reported that the majority of patients with recent history of abortion such as internal bleeding and more negative hCG (There are reports of up to more than 1200 ml) laparotomy that it is also necessary to see congestion and edema tubal thickening the blood outflow from the umbrella - Pathological not as acute inflammation villus

Three of acute appendicitis in early pregnancy without amenorrhea and no vaginal bleeding, abdominal pain and more from the beginning and then confined to the lower right abdomen is often accompanied with nausea and vomiting symptoms of internal bleeding check right lower abdominal tenderness, tension appendectomy mobile anti-Tiaotong no vaginal examination of Zhuoyin No pain of uterine cervix give normal if the proliferation of appendicitis or tubal affected the right side will have a broader scope of the annex to the right tenderness or bilateral or tenderness on both sides of the annex found no significant negative pregnancy test the temperature increase in high-WBC

4 capsule of ovarian torsion a history of abdominal mass to ease the pain such as the reverse for a transient; reverse the capsule after the formation of a sustained bleeding, abdominal pain and tenderness but is limited to mass anti-Tiaotong on and around the vagina without mobile Zhuoyin Check next to the uterus tenderness cysts no history of amenorrhea and no vaginal bleeding in early pregnancy but should pay attention to the history of early pregnancy has often prompted the ovarian tumor torsion

5 Luteal rupture occurred in the early menstruation and often occur in sexual intercourse after menopause and pregnancy is no no vaginal bleeding and abdominal pain nature of the same signs of pregnancy ruptured tubal pregnancy test negative

6 Qiaoke cyst rupture the disease in young women more prone to spontaneous rupture caused acute abdominal pain but no amenorrhea and early pregnancy in the history of the past without vaginal bleeding may have a progressive dysmenorrhea history of pelvic masses

What should be done tubal pregnancy check

A B-ultrasound images ultrasound as a diagnostic technique is simple and strong visual damage to the human body can be repeated inspections without the advantages of ultrasound images but complex inspection personnel to the technology and experience a greater disparity between the rate of misdiagnosis 9.1%

(A) intrauterine Images: intrauterine pregnancy with no fetal sac and fetal heart rate shoot the original pulse but false pregnancy sac plans sound like a rate of about 20 percent of pregnancy caused by endometriosis and uterine decidual within a small amount of storage General outline of the blood levels are not completely unclear edge is not structured weeks pregnant with no increase sometimes it can narrow the careful observation of the identification

(B) Gongpang mass and / or rectum Xianao uterine fluid characteristics: Mass General is the heart of pregnancy sac around the hematoma and the intestinal adhesion formed by climbing

1 tubal pregnancy before the rupture in the form of irregular Gongpang see a fuzzy edge of the low echo of pregnancy sac to a certain extent foreseeable in the region echo the low round or oval-shaped capsule pregnancy dark areas may even see a few cases of Bud and capsule inner tube Fetal heart throb for the original diagnosis of ectopic pregnancy conclusive evidence it was reported that the former accounted for 20% of fetal heart throb, 12 per cent

2 abortion tubal pregnancy occurred when blood from the umbrella-tubal Gongpang mass outflow in the uterus and rectum Xianao, to see a small amount of liquid was not free or low-echo echo dark area

3 ruptured tubal pregnancy occurred when the capsule as tubal pregnancy escaped early break due to bleeding Gongpang that high-echo echo within the mass distribution of disorder enhanced echo packets in pregnancy sac hematoma in a very small number of cases may even see the pregnancy sac echo can be seen and fetal bud If the original fetal heart throb repeatedly broken a long time break bleeding form of increased internal echo Gongpang mass disorder reflecting varying intensity seen on the edge of thickening of the old ectopic pregnancy

(C) of the Department of tubal pregnancy in Yunluan perforation into the muscle before the pregnancy sac that was wrapping the thickened muscle in his voice as rudimentary horn and uterine pregnancy more difficult to identify similarities between

The determination of hCG in the technical HCG past 10 years have been greatly improved application of hCG β subunit RIA correctly in early pregnancy diagnosis of ectopic pregnancy for a better way of the villi Fitness cell secretion of hCG extremely thin because of tubal mucosa muscle cells can not supply the necessary nutrition villi ectopic pregnancy in the plasma β-hCG concentration lower β-hCG RIA method can be measured with the existence of the ninth day Yunluan Whether in the normal early pregnancy every 1.2 to 2.2 days β-hCG increased 100 percent and 86.6 percent of ectopic pregnancy and its slow doubling time of their β-hCG also lower than the absolute value of pregnancy

After three puncture dome for the current diagnosis of ectopic pregnancy broad application of the method for taking such as septic or serous liquid can be ruled out but failed tubal pregnancy out of the liquid can not be ruled out tubal pregnancy such as mass hard not easy to extract the contents of time before the puncture First injection of saline can be a little more suction Huichou such as the brine was mixed with a small reddish-brown blood clots can be proved to be the old hematoma such as the taking of blood in the vein of misuse penetration while placing a short period of time after the blood coagulation tubal pregnancy Those which result of condensate

To further enhance the dome after the diagnosis of puncture after the dome will also puncture blood and peripheral blood for testing to slow down the former ESR for thrombocytopenia reliable basis regardless of abortion suppression ruptured tubal pregnancy as well as of their attack after the long suspense puncture blood fornix The ESR slow significantly slower average 12.1 mm; platelet also significantly reduced the average 100,000 fewer errors and contrary to wear and peripheral vascular blood vessels and blood platelet ESR almost exactly the same

Four laparoscopic general ectopic pregnancy can be confirmed by the inspection is not a typical case of application of laparoscopy value of ectopic pregnancy can be observed in detail the location and the surrounding organs and the relationship between the state of adhesion and in some cases surgery may be at the same time

Laparoscopic see: a tubal pregnancy implantation site tumor-like surface was dark Chisepenglong vascular proliferation Nuzhang such as intra-abdominal bleeding dark vision of the attachment block blood coagulation has observed slightly difficult pregnancy implantation of the abdominal cavity can be used when fully saline wash Clear vision so that the net easily observed at the same time of implantation sites can be intra-abdominal blood clot and rapid absorption of the net to ensure good vision

Five diagnostic curettage with the diagnosis of endometrial curettage to observe changes and not only see decidual villi can exclude intrauterine pregnancy

In addition, ectopic pregnancy was atypical endometrial hyperplasia similar to the change of endometrial cancer, accounting for about 10 to 25 percent gland was a high degree of bending Ju Chizhuang cytoplasm-nuclear dense foam with uneven like excessive secretion of the womb Membrane that is the so-called A Ruisi - Staten reaction out there is a certain diagnosis of patients with treatment but many have a longer period of time endometrial or uterine bleeding has been restored to the status of non-pregnancy is diagnostic curettage for the diagnosis of ectopic pregnancy have great limitations Of

6 Hysterosalpingography lipiodol contrast used in tubal pregnancy diagnosis must have a certain value that is not broken in the fallopian tubes to the uterus before the lipiodol contrast have the following characteristics:

(A) of the uterus like a flaccid expansion from the original triangle into a spherical

(B) can not see the neck as

(C) removal of the catheter lipiodol imaging contrast agent is not out of

More than 3:00 and intrauterine pregnancy lipiodol contrast, as the same and have the following characteristics and different intrauterine pregnancy

(A) no implantation in the uterus, as the Department of defects as

(B) intrauterine rugged edge

What are the performance of tubal pregnancy and how to diagnosis

Clinical performance

In tubal pregnancy or abortion after the breakdown of the phenomenon is obvious

A symptom

(A) of abdominal pain: more patients because of sudden abdominal pain to his attendance rate in more than 90 percent of regular starting side for severe pain such as lower abdomen was torn flu could spread to the whole abdominal pain and the extent and nature of internal bleeding related to the volume and speed as For the rupture of internal bleeding more quickly and stimulate the peritoneal arising from severe pain and can be spread to the entire abdominal such as tubal abortion is less than the slow bleeding abdominal pain often limited to the lower abdomen or side pain is also a small number of cases of lesser amount of bleeding more blood supremacy abdomen Stimulate the diaphragm produced on the abdomen and shoulder abdominal pain often misdiagnosed as acute abdomen such as repeatedly broken or repeated abortions can cause internal bleeding or a large number of internal bleeding several times a small amount of timely treatment is not yet set in the pelvic minimum hemagglutinin (uterine rectal Waterloo) and the anus caused serious pain falling

(B) amenorrhea: tubal pregnancy often have most of the duration of amenorrhea amenorrhea tubal pregnancy and pregnancy-related sites in the isthmus or ampulla are often in amenorrhea date about six weeks symptoms of abdominal pain that is a little more than two to three months in the period has always been the rule On the number of women appear on the phenomenon of internal bleeding should consider whether tubal pregnancy tubal pregnancy because of inter-muscular organizations around in the thick of pregnancy often three to four months it has broken the long history of amenorrhea asked to be asked in detail about menstruation The sustained quality of the number of days compared with the previous period should not be mistaken for vaginal bleeding Cars is a small number of tubal pregnancy menstrual villi generated by HCG not sufficient to reach menopause endometrial response to the phenomenon without amenorrhea

(C) irregular vaginal bleeding: tubal pregnancy in the endocrine Juehou caused endometrial changes result in degenerative changes and necrosis decidua was debris from the full-caused bleeding or bleeding is often irregular-shaped dark brown Some need to remove lesions (Surgery or drugs) to completely stop a small number of cases of vaginal bleeding in addition to more bloodshed comes from someone outside the uterus endarterectomy from the opinion of the oviduct

(D) of syncope and shock: in patients with abdominal pain often dizziness at the same time a cold sweat syncope syncope and palpitations or even the degree of shock and bleeding on the speed and volume

(E) the history of infertility: often the primary or secondary infertility history of Shanghai's 2822 report cases in the history of infertility accounting for 66.28%

2 signs

(A) general inspection: the body temperature normal shock absorption may be slightly lower when internal bleeding when the body temperature can be slightly higher but not more than 38 ℃ internal bleeding, blood pressure dropped pulse becomes faster weakened looking pale

(B) abdominal examination: abdominal tenderness are obviously anti-Tiaotong to the side of the most significant abdominal tonic for the more general peritonitis light show produced by bloody internal bleeding peritoneal infection to stimulate and general peritonitis different abdominal bleeding can occur for some time of mobile Zhuoyin Signs of slow bleeding or later to visit a hematoma in the abdomen and reached a semi-real sense of tenderness of mass

(C) vaginal examination: the vagina, often a small amount of vaginal bleeding from the uterine cavity often filled dome after the tenderness of the cervix is obviously flattering to be cervical pain or upward to around lightly touched when patients with severe pain in that sense are more internal bleeding Check often feel sense of floating in the uterus is normal uterus or just slightly larger than the soft side of the uterus can reach the fallopian tubes swell attendance time later in the uterus rectum Wochu touch real-time mass, the longer the blood of charter change Hard

With the value of the red blood cells and haemoglobin levels and the number of internal bleeding and the time of the inspection when the acute internal bleeding at the beginning of hemoglobin in the blood are often concentrated at that time because of the normal one to two days after hemodilution hemoglobin dropped, or continue to hemorrhage hemoglobin continue to fall so close observation Patients can repeat of hemoglobin for comparison WBC often as high as 10 × 109 / L

[Pathological changes:

Changes in a tubal pregnancy and the outcome of tubal pregnancy, because of lack of integrity tubal decidual Yunluan after implantation of its villi by proteinase direct role in the destruction of invasive muscle wall microvascular muscle damage caused bleeding and blood injection and Yunluan trophoblast Surrounding tissue between Yunluan was a muscle fiber and connective tissue surrounded by an envelope with Yunluan implantation may be different in different parts of the outcome

(A) tubal pregnancy abortion: ampulla occurred in the fallopian tubes (Figure 1) to its growth and development of multi-lumen protruding organizations vulnerable because often coated in 6 to 12 weeks of pregnancy bleeding into the cavity due to Yunluan close to the umbrella - Susceptible to squeeze into the abdominal cavity such as the integrity of all the embryos into the abdominal bleeding and peeling of a Fallopian tube is often less complete abortion sometimes separated embryos remain in the fallopian tube filled with blood within the cavity formation of fallopian tube embryos hematoma after the death of the majority but also absorbed a bloody tubal Fetal-block such as tubal hematoma of hemoglobin can be dissipated after a child-like pieces of meat when the ampulla incomplete abortion when pregnancy nourishment of the cells in a long time to preserve a vibrant and can still continue to this erosion of tubal organizations because of repeated bleeding from the hemorrhage Pool of blood in the fallopian tubes and umbrella-around final hematoma formation around the fallopian tubes because of intra-abdominal bleeding more and more blood gathered in the uterus from the uterus after the rectum Waterloo hematoma

Tubal pregnancy


(B) ruptured tubal pregnancy: more than in the fallopian tubes because of the lumen narrow isthmus Yunluan Flock to erosion of muscle wall and penetrate the wall serous final form of tubal rupture

Tubal pregnancy


Tubal pregnancy abortion because there is no rupture in the capsule vascular injury only from the villi stripping the bleeding can be so slow recurrent disease but rarely life-threatening bleeding but ruptured tubal pregnancy can cause tubal wall in the larger blood vessels in direct laceration Bleeding into the abdominal cavity often can be more serious life-threatening injury but has only a smaller branch or vein damage although the larger branches because of internal bleeding caused by arterial hypotension to gradually reduce bleeding and thrombosis temporarily stop bleeding isthmus rupture occurred earlier in the first week of pregnancy to In (Yunluan after fertilization in three to six days of implantation that capacity) it can no history of amenorrhea and clinical symptoms of ectopic pregnancy has emerged in the Department of interstitial implantation of the embryo to be three to four months before the beginning of this rupture When symptoms appear very serious uterine bleeding

In persistent cases often can not distinguish the study of abortion-or ruptured due to two types often staggered in clinical tubal often encountered because of incomplete abortion after the remnants of the villi to the growth and development and a tubal rupture

(C) secondary abdominal pregnancy: ruptured tubal pregnancy or abortion when the fetus from the umbrella-piercing or from the placenta still attached to the wall or from the breakdown of the outward growth attached to the uterus and fallopian tubes, etc. broad ligament Penbi Following the formation of The abdominal cavity of the mouth of pregnancy if the broad ligament rupture between the two peritoneal continue to grow embryos can develop into a broad ligament in pregnancy or extraperitoneal pregnancy abdominal pregnancy for another type

(D) advanced tubal pregnancy: individual tubal pregnancy can also grow to the third trimester of pregnancy

(5) pelvic hematoma and infection: the accumulation of Waterloo in the womb of the rectum through the retroperitoneal hematoma can be gradually response to the connective tissue layer of connective tissue wrapping around the adjacent organs and adhesion

(6) of embryos or fetal degradation: tubal pregnancy may be some degradation due to spontaneous Yunluan more in the fallopian tube plant in the mucous membrane folds ampulla not penetrated the wall although some invasive muscle wall but nutrition obstacles early embryonic death Weizhi significantly to the clinical symptoms and degeneration of the future for other reasons when a Caesarean section operation discovered

(7) Other: sometimes visible for tubal pregnancy tubal twin opposite may also be due to uterine blood flow and anti-blood individual tubal pregnancy co-exist with intrauterine pregnancy

The endometrial changes in tubal pregnancy, uterine muscle by the impact of endocrine hyperplasia mast so that the uterus is also larger than normal and soft but less than a month of amenorrhea significant change in endometrial shortly after fertilization was decidual change the decidua There is Yunluan linked to the survival of the fetus tubal pregnancy often only survive a shorter period of fetal death after uterine decidual often block (triangular) said shedding of the uterine (photo 1) or a small loss in the debris Many of the cases in the womb of the degenerative changes in the decidua from decomposition before it was even 50% of cases that have a genuine type of discharge

Tubal pregnancy

Yunluan after the death of endometriosis is a degenerative changes in the performance of endometrial often with the pregnancy must set the time

Degenerative secretion as: tubal pregnancy in some villus Juehou able to survive a period of time and some of these villi in-depth tubal muscle layer and the mother is closely linked to the degradation process luteal than normal pregnancy Juehou thus slow the new mature follicles also postponed in the luteal Decidual degradation in the process of the gradual decline in sex hormones with a variety of performance degradation or even shrinking but the process of endometrial decidual secretory phase development of the extreme degradation of performance is in the process of always maintaining production activities of the phenomenon

Renewable as: degenerative secreted by the endometrium, as the progressive renewable after a certain period of time between the density of gradually loose Xianguan were round or oval-shaped gland Chengyuan columnar epithelial cells in the cell nucleus neatly arranged at the bottom or the period for the majority of hyperplasia Films such as double-check them but there are still very small portion of production for the degradation of the image thus ectopic pregnancy and diverse images of endometrial concentration of progesterone and sex hormone estrogen Yunluan proportion of the duration and time of suspension from the Yunluan And so on

Diagnosis

Typical cases of acute abdominal pain and irregular short-term amenorrhea Some vaginal bleeding and there are primary or secondary infertility history; inspection side tubal swell tenderness; internal bleeding for some time appeared hemorrhagic shock in the diagnosis of suspicious persons may be still supporting inspection Methods of diagnosis

Ruptured tubal pregnancy in the former general is not any obvious symptoms of some patients in response to that is, early pregnancy loss of appetite, such as nausea and vomiting partial eclipse some patients the side of paroxysmal lower abdominal pain a double uterus no significant swell up or expand their slightly Side of a mass tenderness suspected tubal pregnancy and related support for further examination and diagnosis because of these characteristics no significant history of non-stop through the history of infertility mistaken for a small amount of vaginal bleeding IUD's reaction thus misdiagnosis rate of misdiagnosis of the disease increased more The risk of early diagnosis is the key to women's obstetrics and gynecology physicians and health workers to maintain a high degree of vigilance ① ideologically placed IUD after a small number of irregular vaginal bleeding under or without abdominal pain should be stopped in the history of the IUD reaction at the same time rule out the differences - Pregnancy to make the necessary checks and inform patients of self-care such as abdominal pain or bowel pain falling out follow-up should be organized to bring the doctors to check whether evacuation pathological decidua; ② belt-pregnancy abortion when the suction Air should be reviewed pregnancy test and B-examination with a view to rupture a clear diagnosis

Tubal pregnancy is what causes

A tubal chronic inflammation due to endometriosis Salpingitis tubal inflammation of the fallopian tubes narrow formation of adhesions or tubal twists and turns around so often inflammatory adhesions salpingitis Yunluan disruption caused not only shape the changes and the fallopian tube defect tubal endometrial cilia often affect their ability to wiggle Yunluan transitional

Two tubal dysplasia or stunted, deformed tubal wall of muscle fiber of poor or lack of endometrial cilia its lack of form than normal fallopian tubes and small bending a thin spiral longer than normal to abnormal development of a porous diverticulum double-mouth or otherwise of a tubal Agenesis of the fallopian tubes as vice tubal

Three of the fallopian tubes endometriosis endometrial tissue can be penetrated between the fallopian tubes so that the Department of the Ministry of interstitial thickening lumen stenosis, or if one of the reasons for tubal pregnancy in the fallopian tube was raised different ovarian pelvic endometriosis of the fertilized eggs There may be some role-induced chemokine fertilized eggs in a location other than the intrauterine implantation

4 pelvic tumor oppression or traction can tubal thinning longer circuitous twists and turns through the obstacles Yunluan

Five of ectopic pregnancy and birth control measures intrauterine device will cause ectopic pregnancy is a concern and controversial issue in 1965 Li Pu first report of the IUD users a higher degree of ectopic pregnancy Most scholars believe that the IUD can be inert or activity Effective prevention of intrauterine pregnancy to prevent some of tubal pregnancy and can not prevent ovarian pregnancy at home and abroad in recent years with the incidence of ectopic pregnancy is significantly increased

Sterilization-new umbrella after a technical error, and so can be a tubal pregnancy

6 ectopic pregnancy Chlamydia infection is a major factor alone when chlamydia antibody titers 1:16 for the relative risk of 3.0 compared with 2.91 titer 1:64

Trichomonas vaginalis disease can be complicated by the diseases

Trichomonas vaginalis if the urethra or bladder Trichomonas parasite can cause urethral cystitis; Trichomonas vaginalis can be swallowed up by the sperm of infertile

Trichomonas vaginalis disease easily confused with the diseases

1. Candida vaginitis: vulvovaginal itching like cheese or bean dregs Leucorrhea vagina-like white Jiamo positive fungal inspection

2. Bacterial vaginosis: ① non-suppurative thick gray vaginal discharge; ② vaginal discharge fish flavor amine test positive; ③ vaginal discharge pH value increased 5.0-5.5; ④ secretions in the trail of

Trichomonas vaginalis examination of what should be done

A hanging drop method

Hanging drops of inspection Trichomonas vaginalis is the most simple method of positive rate of 80% -90% of Tu will be seized on the slide with a saline drip after Gai Bopian increase by 100-200 times the examination that protozoa flagella Fluctuations in film activity in saline 5% increase in the neutral red coloring trichomoniasis is not dead and can not be formed around the pink on white protozoa easy to recognize or 1,600 times the acridine orange liquid into a fresh specimens Didi on the fluorescent Microscopic observation that the worms with a light yellow-green fluorescent microscope particularly pretty direct detection rate high

The smear staining

Tu will secretions in the natural question on the slide after drying can be different Ranye Gram stain such as dyeing Reiter were Giemsa stain PAS staining and staining leishmaniasis this method can not only see the shape and content of trichomoniasis but also at the same time See the vagina in memory of other organisms, can also be used acridine orange stained fluorescent microscopy

3 culture

Will vaginal discharge or urethral discharge medium built-in 37 ℃ to join me in training-48 hours every 72 hours inoculation a blending of culture, take a drop smear staining microscope

4 immunological methods

Trichomonas vaginalis detection of antigen-specific immune commonly used methods are fluorescent antibody test for latex agglutination ELISA method, such as the positive rate of higher than the Pap smear but not a general clinical immunology inspection methods

Trichomonas vaginalis in which performance and how to diagnosis

[Clinical]

Trichomonas women vaginal infections after the general to go through the incubation period of 4-28 days mainly large number of vaginal secretions secretions smell Nongxing was serious when Leucorrhea foam can be mixed with the blood most of the patients have genital itching and burning sense of pain dysuria Frequency urgency or even intermittent hematuria often in the menstrual symptoms such as fatigue or pregnancy before and after the check after the increase can be found genital inflammation erosion labia minora edema vaginal and cervical mucosa urethritis redness and occasionally serious groin rub Black patients vaginal wall And cervical bleeding point and the erosion was a typical "Yangmei-like" cervix can be congestion and edema

Trichomonas infection male urethra is also the main place of 50-90% of asymptomatic persons from urethritis Niaotong frequency performance for 50-60% of the increase in urethral discharge was Nongxing or mucous secretions of only very few in the morning I have the urethra in a micro-droplet secretions disappeared after voiding often intermittent, sometimes the result is not without cause the patient's attention to the treatment are not very

[Diagnosis]

1. Vaginal trichomoniasis disease: ① vaginal discharge was more bubble-like; ② cervix and vagina wall was characteristic strawberry-like appearance inspection positive trichomonas

2. Trichomonas male non-gonococcal urethritis: ① urethra I mild redness and a small amount of blood or mucus secretions Nongxing; ② have cystitis or pyelonephritis; ③ trichomonas positive inspection

Trichomonas vaginalis disease is caused by what the

Trichomonas vaginalis the pathogenic strain as the insect host and physiological state of endocrine and immune function within the vaginal bacterial or fungal infections, such as changes in particular of women in pregnancy and the genitourinary system, more physiological disorders of inflammation in a few days after the vagina mucosa Edema in congestive cell degeneration shedding interleukin inflammatory response healthy women because of vaginal lactobacilli role in the pH value of between 3.8-4.4 can inhibit the growth of other bacteria known as not conducive to vaginal trichomoniasis growth of self-purification, however role in the vaginal trichomoniasis in the consumption of sugar The prejudice of Lactobacillus Jiaojie effects of lactic acid concentration so that vaginal pH to neutral or alkaline pregnancy and menstrual cycle after the vaginal physiological pH near neutral so that these are conducive to breeding trichomonas infection and thus a higher relapse rate

Correct location of anti-uterine dysmenorrhea Baojian Cao

Uterine blood from the impact of location unrighteousness, so often happened before or to menstrual periods Zuotong lower abdomen, and menstrual volume is too small, dark blood stagnation. Be more clinical lag Huoxue line, menstrual-tune the drugs, to its blood-profit down, the pain will ease. If further guidance in line with the appropriate health or Baojian Cao Gong activities, to help restore the uterus position is very useful.

(1) Baojian Cao:

① supine: 2 to 3 per day adhere to the supine and legs, slightly Quqi Shuangxi, for abdominal breathing 20 times. Abdominal breathing is not suction, chest expansion, abdominal uplift, not contraction of breath, chest and abdominal contraction depression.

② upright: Squat knees, and then erected, such as 20 times a day to adhere to three.

③ upright: Heel filed, and then put aside. Heel filed such as wearing high heels, heel down, such as wearing Ping Dixie, each time for 20 times a day to adhere to three.

④ supine: legs rotate around to Tuiqu Xi 20, knees at the knee as far as possible from exposure to the next day, to adhere to 2. These activities more easily, improving the pelvic circulation, increased abdominal strength, and correct location of the uterus is useful.

(2) health care work:

Cuore palm hands were affixed to the post after the waist, and 50 massage from top to bottom, Moldova to the local hot date, then paste the waist palm still three minutes, so to Xinjing, cortisone, God note. Gentle movements, awareness and action to be consistent and should not be excessive, breathing naturally, in the sense guided by the progressive movements and breathing with coordination. Action by the number of less to more, according to personal physical and determined to do three times a day.

The time bomb buried in the womb

Fibroids bleeding to the most common reason is the muscle of the uterus or cancer. They are called different names: fibroids, the type of fiber tumor, and of smooth muscle fibers, such as tumors. They are from the myometrium of the tumor (of growth), are usually benign (not cancerous).

In the middle, are abnormal in any location will lead to abnormal bleeding. Below we will be presented and discussed several middle Road anomaly.

Fibroids bleeding to the most common reason is the muscle of the uterus or cancer. They are called different names: fibroids, the type of fiber tumor, and of smooth muscle fibers, such as tumors. They are from the myometrium of the tumor (of growth), are usually benign (not cancerous). According to different sizes can cause pain, excessive bleeding or irregular bleeding, infertility, miscarriage, abdominal discomfort. Sometimes, large tumor in the abdomen to palpation to be.

The only treatment is surgical removal. Surgery and treatment methods can discuss the gynecologist.

There are two possible operation:

1, by the removal of (removal of uterine fibroids)

2, removal of the uterus (hysterectomy)

Fibroma of the often excessive menstrual bleeding period: bleeding or blood loss more time to increase. May be attributed to the increase of the uterus, the endometrium leading to the increase in surface area.

A small Dunan Beware of uterine fibroids

Slightly convex small Dunan often affected the aesthetics of the dress code. If weight loss is unsuccessful, we should pay attention to the physical condition, uterine fibroids may Bumei Guan is the culprit?

Case Analysis

At the 30-year-old Lisa is a successful woman, after graduating from university in an advertising company, from the grassroots to the now middle-level management positions. Her husband is a college classmates, the same great achievements in their career. Recently, Lisa gradually found his body became bloated, clothing under the small Dunan is obvious. Diet plan ended in failure in the circumstances, to remind her colleagues noted that their bodies strange: the growing number of urine and menstrual volume, lower abdomen, such as Zhuizhang. In the company of her husband carefully to the hospital for an examination and was diagnosed with uterine fibroids. Heard that the treatment of uterine fibroids to be removed, Lisa Lane Clinic in the collapsed…… because of their two busy career, has not to have children, with the uterus, it is deprived of her mother's rights.

Expert Analysis

Why only 30 years old, in peacetime there is no symptoms, how to suffer from uterine fibroids? » This makes Lisa very puzzled. Uterine fibroids female reproductive system is the most common benign tumor, the so-called women "of the first", the incidence rate was as high as 20 percent to 30 percent, more common in women of childbearing age. According to statistics, 35 women over the age of about 25 percent in uterine fibroids, but most patients because of fibroids small, asymptomatic, but failed to find. Clinical reports show that the incidence of uterine fibroids in only 4% to 11%.

In recent years, with work and the pressure of increasing environmental pollution, and many other factors, led to the current number of uterine fibroids and the rising incidence of the younger age of onset trend, and even the youngest patients was 15 years old. Its two main reasons: First, improvement of living standards, too many people to take health care products, and high estrogen food and the other is female menstrual changes in time, early menarche time, extend the age of menopause, women walking time To extend and increase the incidence of uterine fibroids.

Destroy uterine fibroids preservation

Surgical removal of the uterus will also deprive women of reproductive rights, more easily affect the couple's sex life is that many patients may arise after the operation ovarian failure and all kinds of menopause symptoms, serious endocrine disorders, life and health status will be affected.

Radiofrequency ablation, as is now relatively advanced for the treatment of uterine fibroids, the biggest advantage is that it can not surgery, not removal of uterine fibroids will be under the premise of elimination, to bring new hope to patients. The technology can be 2 to 15 cm on the treatment of uterine fibroids, the entire operation only 10 to 20 minutes, bleeding and not less bleeding, less pain, trauma and rapid recovery, fewer complications, the general does not require hospitalization.

The technology to destroy uterine fibroids, while retaining the structure and function of the uterus, fibroids do not damage the surrounding normal tissue. At the same time, it will not nervous system endocrine system, cardiovascular system, bone metabolism and the Second Sex in the levy of side effects. RF therapy will not cause the physical and psychological burden on patients to ensure that women's quality of life, not the birth of young women, is a guarantee of their reproductive rights.

Uterine fibroids mainly for patients with abnormal menstruation, the lower abdomen can be palpable mass, Leucorrhea increased lumbar acid, lower abdomen Zhuizhang, abdominal pain, frequency and other symptoms, most patients have no discomfort.

Lisa's like symptoms or more obvious, increasing the number of urine and menstrual volume, lower abdomen Zhuizhang, microgastropods enlargement. This should arouse the attention of the high. Fibroids or greater growth in the cervix, broad ligament, etc., there may be squeezed adjacent pelvic organs of the clinical symptoms, caused frequency, urgency, dysuria, and so on. Have information to statistics, up to 69 percent of patients with uterine fibroids showed lower abdomen mass, filling the early morning of fasting when the bladder is often the most obvious and easily reached with mass, usually a little attention will be aware of.

Although uterine fibroids is a benign tumor, but because of relatively rapid growth of fibroids, when bad blood, may have different degrees of degeneration. Fibroids larger, more severe ischemia, the more secondary degeneration, such as with ovarian lesions, and so on. Medicine reported that 41 percent of abortion and uterine fibroids, but also may lead to infertility, miscarriage, premature delivery, even with the existence of cervical cancer at the same time, not for this kind of thinking is wrong, once discovered, should be timely Treatment.

Regular gynaecological examinations

As the female reproductive tract diseases high, Liu Kunfan director remind women friends: At a regular basis to the hospital for gynaecological examinations. As the majority of women health awareness is not strong, very easily infected with vaginitis. After the inflammation and infection has not caused enough attention, and often their own medicines to pharmacies or vaginal washing their Cypriot medicine, so in fact undermine the vaginal acid-base balance, reduced immunity. On long-term, lower vaginal immunity, they will be recurrent inflammation.

To remind women friends, sexual life of women, especially women over the age of 35 in each of the best for one to two gynecological medical examination. Minors reproductive system of women due to incomplete, if premature sexual life, at high risk of reproductive tract diseases. Gynecological diseases many cases with men dirty sex life and therefore should strengthen the health habits of the male education, women themselves should also be Clean, at the same time not to have sexual partners. 18 to 48-year-old is now in women of childbearing age, reproductive system disease incidence rate is generally higher than other organs of the disease and thus women should have a better understanding of their reproductive systems, to be good at observing their own physical changes, the need for regular health Inspection, take preventive measures. Once the diagnosis is uterine fibroids, the treatment should take active measures to strive for the best time for treatment.

Mast and cervical glands cyst

Mast and cervical glands cyst is a common chronic cervicitis performance, mast and cervical glands cysts can stand alone, can also simultaneously. The former refers to the increase of cervical volume, which is due to various reasons for opening the closed glands, glandular secretions retention and formation of cysts.

Cause cervical mast reason is: Because of the long-term chronic inflammatory stimulation, cervical organizations in congestion, edema, cervical glands and stromal hyperplasia, Xianguan around hyperplasia by the extrusion, the mucus glands from the difficult, and formed Retention cyst, a cyst to the superficial glands of the cervix highlighted the surface, it is easy to observe, and the deep cysts often leads to cervical glands were different degrees of enlargement, the larger, general customary called cervical mast. Deep gland cyst eye difficult to find, but do B-examination can see a cervical muscle intramural size of the circle of dark areas.

As the surface of mast cervical injury or inflammation can also stimulate a squamous cell loss, columnar epithelial hyperplasia and the formation of erosion. When inflammation after treatment, cervical local congestion and edema dissipated, cervical squamous cell surface to be covered, for the restoration of smooth-like. However, the proliferation of connective tissue is not dissipated, still exist, the cervix remains the appearance of its mast, and sometimes even increased 1 - 2 times more.

Cervical mast and the main gland cyst Leucorrhea clinical symptoms for more. In addition, because proliferation and inflammation of connective tissue along the side or the Palace of cervical sacral pelvic ligament to the spread, the patients often complained of a lumbosacral pain or perineum Zhuizhang flu, which is more prominent cervical mast two symptoms.

Cervical mast of colposcopy see: cervical increased significantly, partially because of chronic inflammation induced cervical bleeding, cervical surface was green gray, squamous cell thick, in-junction that scales ranging from the number of the Qing Baise or pale yellow Retention cyst, cyst surface vessels that branch, the capsule contents for the Jiaodong-like mucus. Cervical be a smooth surface-or-erosion, erosion Miantu three percent acetic acid after a "Putao Chuan" change. Squamous cell area can sometimes see the large blood vessels, lower branches.

Hypertrophy of the uterus: Western medicine - the differential diagnosis

1. And various pregnancy-related bleeding: uterine hypertrophy of the amount that vaginal bleeding, but no history of menopause, there is no response to early pregnancy, and pregnancy-related variety of bleeding, such as abortion, mole, have stopped The history, and pregnancy tests, B super-examination will help the differential diagnosis.

2. Dysfunctional uterine bleeding: dysfunctional uterine bleeding patients, bleeding have no laws, and many occurred in puberty and menopause, without increasing the uterus or only slightly increased the number of uterine hypertrophy in women of childbearing age and prolific , Bleeding for more performance and the amount or shorten the normal cycle, the uterus increased significantly, a large duck eggs and even Eluan large.

3. Uterine fibroids: Uterine mast of a small and easy to intramural uterine fibroids or confusion within the submucosal fibroids. For the performance of this disease also increased the uterus, menorrhagia, but can be found attending a double uterus of a rugged hardware or flu. Through the B-examination, the diagnosis.

4. Adenomyosis: consistency of the uterus also showed increases, generally not more than three months of pregnancy size, accompanied by the disease or menstrual disorders, menstrual period before the uterus slightly increase than usual, slightly soft, after the restoration of menstruation To peacetime size.

[Prompt diagnosis:

1. Hypertrophy of the uterus in the early stage, the general was not obvious symptoms, only for the performance of menorrhagia, attention should be paid and dysfunctional uterine bleeding, uterine fibroids submucosal, adenomyosis identification. B-do require regular inspection to prevent misdiagnosis.

2. Hypertrophy of the uterus, often in the 40-year-old women, and often prolific history. Therefore, the productive capacity of women with vaginal bleeding, should be the first to consider the diagnosis of the disease, but the older (45 years old and above) or repeated bloodshed, Jiuzhibuyu, should be held diagnostic curettage, do pathological examination, to exclude the womb Film malignant transformation.

3. Manifestations of the disease by the mast of a uniformity of the uterus, the surface nodules no grievance, no probe inspection detect uterine deformation, do not feel a mass there.

Uterine hypertrophy of the 41 cases of misdiagnosis

Hypertrophy of the uterus is due to consecutive multiple pregnancy, childbirth, chronic inflammation or uterus, uterine wall fiber proliferation of connective tissue disease. Because of its low incidence of clinical performance similar to uterine fibroids, adenomyosis and dysfunctional uterine bleeding (blood work), easily misdiagnosed. Our hospital in January 1980 to October 1997 were treated 41 cases of uterine mast, are misdiagnosed, the analysis of the report are as follows.

1 clinical data

1.1 general information on the incidence of this age group 28 to 54 years old, an average of 46.2 years of age. Marriage age <20 38 cases, full-term birth four times more than 37 cases.

1.2 clinical manifestations of 38 cases a period of increased menstrual extended, four cases of the menstrual cycle shortened, three cases have lower abdominal pain or discomfort history.

1.3-assisted check B-41 routine inspection, are indications that the uterus increases, including 26 cases of uterine fibroids, seven cases of adenomyosis. 10 cases before operation of diagnostic curettage, a pathology report for the seven cases of endometrial hyperplasia have Shing.

1.4 misdiagnosed disease and surgery for uterine fibroids misdiagnosis seen 29 cases, seven cases of adenomyosis, Gong blood five cases. 41 cases were performed Caesarean section hysterectomy. See in the uterus of uniform size increase, smooth surface. Pathological examination reports: 41 cases are hypertrophy of the uterus, uterine fibroids and with no adenomyosis.

2 discussion

① 2.1 misdiagnosis of the disease rare. Our hospital in January 1980 to October 1997 to hysterectomy patients in the 660 cases, the mast of the uterus only 41 cases, accounting for 6.2 percent. ② related literature has not yet aroused the attention of physicians, specialist physicians lack the knowledge of the uterus mast, considering the time of diagnosis and more common diseases, leading to misdiagnosis. ③ on condition of not comprehensive, single and thinking, the number of menstruation, menstrual extension of the uterus on the increase of cases diagnosed with uterine fibroids. 41 cases of this group attending the first impression for almost all of uterine fibroids, the neglect of hypertrophy of the uterus, resulting in before, during repeatedly misdiagnosed. ④ mast of the uterus without a clear diagnostic criteria.

2.2 The author made the following diseases and the need to identify

2.2.1 uterine fibroids: ① uterine fibroids patients often without prolific history, but some patients have combined the history of infertility or miscarriage. Gynaecological examinations at the Palace of uterine fibroids for not more than symmetry processes, quality hardware, the Palace of size depends on the size and number of how many fibroids, submucosal fibroids in more than blowing up when touched, and uterine hypertrophy of the uterus by a uniform , For more than two months of pregnancy size, a small number of three-month pregnancy size, soft. ② uterine fibroids especially the larger fibroids, oppression symptoms are often more pronounced, Mast of the uterus and the general oppression no symptoms.

2.2.2 adenomyosis: ① adenomyosis many infertility, dysmenorrhea, in particular, aggravated sexual history of dysmenorrhea. ② gynaecological examination of adenomyosis showed increased uterine uniform texture but hard. ③ uterine lipiodol contrast to the diagnosis of the disease to a certain extent help. This shows that intrauterine expanded access to iodized oil from the uterine muscle, a kind diverticulum processes.

2.2.3 Gong blood: ① more reactive blood after menarche in or near menopause, menopause performance in the short-term amenorrhea follow-up to massive bleeding, uterine mast in general do not occur in adolescent women, menstrual bleeding for more performance and more normal cycle Or shortened. ② gynaecological examinations of patients uterine blood work normal size or slightly increased, and uterine hypertrophy of the general increase significantly. Such as the Bank of blowing up the 10 cases, seven cases of endometrial hyperplasia pathology report of the Shing.

2.3 How objective analysis, evaluation of results of examinations had reported [1] B super-diameter <3 cm of uterine fibroids, the misdiagnosis rate was as high as 48.5 percent. And the Group of 41 cases of mast in the B-26 cases of uterine fibroids tips, in fact, fibroids diameter <3 cm, of which 22 cases of muscle intramural fibroids, one case of multiple fibroids. This may ① with the mast of uterine smooth muscle cells in the uterus mast, in muscle connective tissue proliferation, lymphatic and blood vessels clear expansion, proliferation, enhance the cause of the uterine wall echo. ② may ultrasonic transmission process in the body as a result of refraction, reflection and multiple scattering caused by a false impression, and so on. Therefore, clinical physician for the B-tips of small uterine fibroids in particular, no significant changes in the form of muscle intramural fibroids, in combination with history, symptoms, gynaecological examinations, to make the correct diagnosis and treatment.

2.4 Traiman [2] After the 43 cases diagnosed as hypertrophy of the uterus to hysterectomy and to carry out retrospective analysis, by its diagnosis should include bleeding, uterine symmetry increased, diffuse uterine muscle hypertrophy and exclude other endometrial Bleeding lesions. And in particular to help shape of indicators can be sure of their diagnosis, diagnostic criteria for the morphology of uterine weight ≥ 120 g, muscle thickness ≥ 2.0 cm. This should be the standard clinical diagnosis from doctors to the mast of the uterus to make a correct diagnosis.

Transvaginal color Doppler ultrasonic energy differential diagnosis of adenomyosis and hypertrophy of the uterus

Adenomyosis and uterine hypertrophy of the differential diagnosis in both clinical or ultrasound examination is more difficult, the paper confirmed by surgery and pathology of the 45 cases of adenomyosis and seven cases of a mast of a retrospective analysis, Discussion on the two main transvaginal ultrasound sonography and color Doppler flow imaging (CDFI) characteristics, particularly color Doppler energy (CDE) features aimed at improving both the diagnosis rates are now 52 cases of adenomyosis and uterine hypertrophy of the ultrasonographic features, color Doppler and energy characteristics of the report are as follows.

1 information and methods

1.1 in the general hospital maternity line hysterectomy and pathologically confirmed 45 cases of adenomyosis, aged 29 to 50 years old, an average of 39-year-old, seven cases of uterine hypertrophy, aged 32 to 51 years old, an average of 41 years. Simple adenomyosis 37 cases, adenomyosis merger of eight cases of uterine fibroids.

1.2 Methods LOGIQ700 of color Doppler ultrasound diagnostic apparatus, vaginal probe frequency of 7.0 MHz, color Doppler frequency of 5.0 MHz. Observation of two-dimensional images of uterine shape, contour, the muscle wall echo, endometrial line offset whether measured before and after the uterine size and wall thickness. Then CDFI, CDE observation of uterine muscle wall flow, and pulse Doppler detection, measurement peak systolic velocity (Vmax), end-diastolic velocity (Vmin) and resistance index (RI). Finally, the results of ultrasound examination and pathology results compared.

2 results

Adenomyosis audio and visual performance for the uniformity of the uterus or heterogeneity increased in the past for the increase after the trail. Echo uneven muscle wall, the increase was small and low-echo echo staggering 12 cases, the echo of inequality within the muscle wall that hypoechoic small Nangqiang, a honeycomb of 30 cases, the lesions into small pieces with no echo (about the size 1.5 ~ 2.1cm) 3 cases, merging eight cases of uterine fibroids. Adenomyosis good part is the back wall of the uterus, often from the back wall thickening obvious, and makes endometrial line Shaopian ago. CDFI show increased blood flow to the uterus, diseases muscle wall that point, strip red, blue blood flow. CDE performance for the uterine muscle wall rich blood flow, blood vessel thickening, with a diffuse congestion, lines pulse Doppler detection, measurement Vmax, Vmin and RI, the results for the high-speed high resistance artery spectrum, RI value of 0.79 ± 0.08, Flake in the dark vein to the region to record the spectrum.

Uterine hypertrophy of audio and visual performance of the uterus to increase regular shape, thickness uniformity of muscle to Qian Houbi thickening Obviously, the muscle wall or even a slightly lower or less uniform Shaoqiang echo, five cases of this group were slightly lower Echo, two cases were Shaoqiang echo. CDFI showed that blood flow within the uterine muscle wall no significant changes were scattered in point, spot-like red, blue-and blood flow. CDE showed diffuse distribution of macular, radial flow and distribution of a concentric weakening trend and are not easy to record vein spectrum, pulse Doppler test for high-speed medium-resistance index, RI value of 0.6 ± 0.06.

3 discussion

Adenomyosis and uterine hypertrophy of both the history and signs and two-dimensional image, have many similarities: the menstrual history of increased menstrual extension, dysmenorrhea, lumbosacral pain; signs of increased uterine; Two-dimensional image of the thickened muscle, echo inequality can be confused by the diagnosis. Transvaginal ultrasound CDFI and CDE to provide both the differential diagnosis of great help, especially the latter. Transvaginal color Doppler ultrasound examination of the uterus understanding of the Doppler signal than ideal for inspection by the abdomen, abdominal examination of the use of low-frequency probe to ensure that the necessary penetration, relatively poor resolution, image quality affected , Limited the accuracy of diagnosis. High frequency of vaginal probe (5 ~ 7.5 MHz), the probe near the pelvic organs and reduce the penetration of the requirements can receive high-resolution 2-D images and high sensitivity of the color flow signal, get more Information, help to improve diagnosis [1].

CDE than CDFI, CDE response to the campaign is the number of red blood cells, rather than show the direction of movement, CDE not rely on the Doppler angle from the impact of aliasing, also showed that a regional signal, can detect very slow RBC campaign, when the average velocity is zero time, CDE still can show blood flow in the region [1]. Therefore CDE CDFI with a high sensitivity to detect very low flow rate and the low level signals, CDE CDFI can not show a clear flow of small terminals show, and fully reflects the changes in blood flow, CDE of the flow of low-velocity sensitivity, to better show the vascular lesions in the trees and vascular network. At the same time in the form of vascular structure, CDE CDFI showed that the blood vessels more long, multi-branch, vascular tree relatively complete [2]. CDE compensate for the deficiencies of the CDFI, to provide more diagnostic information.

Adenomyosis lesions peripheral vascular see rough mess, blood vessel thickening shows, embracing, the wall smooth, clear [2]. Wall muscle lesions rich blood flow signals, with a diffuse congestion, the blood supply was high resistance characteristics of high-speed, easy to record the spectrum vein. Hypertrophy of the uterine muscle, blood vessels due to distribution and vascular resistance have no significant change [3], and it showed similar to the normal uterine blood flow signals showed diffuse distribution of macular, radial flow, the distribution of concentric weakened, not records Spectrum to the vein, the blood supply was high-speed characteristics of middle-resistance index.

Transvaginal ultrasound CDE more objective response to the disease of the uterine muscle wall flow situation, CDE showed that the blood flow more complete and rich, visual images, easier to understand, for adenomyosis and uterine hypertrophy of the differential diagnosis More information.

Pathological findings of uterine fibroids

From the Organization in view, uterine fibroids from the uterus muscle cells, blood vessel wall of the smooth muscle cells without mature into muscle cells, but the latter has not been clear on the organization of the concept.

So far, the cause of uterine fibroids is not yet clear. According to large clinical observation and experimental results show that fibroids is a dependent on the growth of tumors of estrogen. Such as clinical common in women of childbearing age, 30 to 50-year-old, especially in the high-estrogen environment, such as pregnancy, high estrogen exogenous circumstances such as significant growth, and gradually narrow the fibroids after menopause. Fibroids patients with congestive also accompanied ovarian, swell, endometrial growth is too long, and it reveals too much to stimulate estrogen-related.

Uterine fibroids and endocrine disorders have a relationship. Application of exogenous sex hormones and uterine fibroids after Keluomifen increase, inhibit or prevent sex hormone levels reduce the growth of fibroids, shrinking fibroids and improve the clinical symptoms.

From the Organization in view, uterine fibroids from the uterus muscle cells, blood vessel wall of the smooth muscle cells without mature into muscle cells, but the latter has not been clear on the organization of the concept. Human uterine fibroids may occur from the undifferentiated mesenchymal cells into smooth muscle cell differentiation process. Multiple uterine fibroids may be due to the origin of the myometrium, and more focus incubation. Access to sexual maturity, the residual muscle in the undifferentiated mesenchymal cells and smooth muscle cells mature in estrogen and progesterone cycle under its continuous role in proliferation, differentiation and mast process, repeated in a long time, the final form Tumor.

What is cervical mast

Cervical mast is a chronic cervicitis. As pathogen infection of cervical mucous membrane caused by inflammatory changes. Cause cervical mast pathogens have mycoplasma, chlamydia, bacteria, viruses, I suggest you do to a hospital gynaecological examination of cervical secretions, according to inspection results, symptomatic treatment. Cervical TCT, if necessary, to do the inspection, from the early cervical cancer. A simple cervical mast will not affect the pregnancy, but severe cervicitis, can cause endometritis, tubal ovarian inflammation, tubal adhesions, obstruction, resulting in infertility infertility.

The main reason is caused by:

(1) to stimulate long-term chronic inflammation, cervical congestion, edema, cervical glands and stromal hyperplasia resulting in various degrees of cervical mast.

(2) in the deep cervical glands may arise mucus retention, ranging from the size of a cyst, cervical become mast.

Cervical mast sometimes greater than normal cervical 2 to 4 times that of cervical surface can be smooth, may have erosion. Cervical general hard texture, which is caused by the proliferation of connective tissue fibers.

Cervical mast general do not need treatment, if there is erosion, can cure cervical erosion.

Treatment:

1, physical therapy for moderate and severe erosion, is the effect of better treatment methods as soon as possible, generally only once to cure.

1) of electricity, iron and ironing erosion of the first contact so that the tissue coagulation, a callus skin, about two weeks after the start shedding skin scab, wound healing normally takes six to eight weeks. Surgery should be menstrual net after three to five days. Yan, Jiyong Annex. Leucorrhea after treatment can be temporarily increased or bleeding. If more bleeding can be disinfected gauze pressure to stop bleeding, 24 hours after removal. Deficiency is sometimes due to scar contraction of cervical stenosis.
2) frozen with liquid nitrogen therapy rapid cooling device, placed in the probe erosion of 1 to 3 minutes, and after rewarming removed so that the lesions frozen necrosis. After treatment can be two to three weeks out of a lot of water discharge. Advantage is less bleeding and cervical stenosis occurred.

3) laser treatment laser charring Jiejia organizations to erosion, the healing process with the first two treatment methods.
Postoperative physical therapy, more than a large number of yellow water samples from the vagina Leucorrhea outflow of varying duration, should maintain genital cleansing, generally takes six to eight weeks to recover. In the wounds have not yet fully healed, should be avoided bath, wash and vaginal intercourse. After a review every week to observe the healing. Note whether cervical stenosis, if any, can be gently probe expansion.

2, drug therapy applied to mild erosion, as follows:

1) 10 to 30 percent silver nitrate solution or 10% Cotton stick with iodine-affected area carefully coated with silver nitrate, should be applied to normal saline so that the extra silver nitrate become corrosive silver chloride. 2 times a week, four to six times for treatment, if necessary, repeat.

2) use of potassium dichromate James Cotton carefully hand-affected area, in the period after the net on the drug once, in the next after repeat, the greater the erosion surface, and sometimes effective. Tuyao ago, the first by 0.1 percent Bromogeramine Shijing cervical mucus, after the dome home cotton ball two, anti-drug burn down vaginal mucous membrane. Albert took out after the cotton ball, and then 75 percent alcohol Cotton Kaishituyao (formula: K2Cr2O7 10 g, concentrated sulfuric acid 75 ml, add water to 100 ml).

3, surgery on cervical mast, the erosion of Shenguang and involving the neck, and (or) suspected malignant, for cervical cone removed. The organization sent to all of the seizure. This method smaller scars, after cervix to maintain the status quo.

Hypertrophy of the uterus

[Outlined]

Hypertrophy of the uterus (hypertrophy of uterus), the uterus is even greater, muscle thickness of 2.5 cm above , ranging from level with a bleeding disease.

[Diagnosis]

More maternal, menstruation and more than one of the uterus and increased endometrial thickening normal or individual with a polyp, but the majority of normal pathological examination, a few shows that proliferation can be diagnosed as hypertrophy of the uterus. Should pay attention to and identification of uterine fibroids, especially for a single nuclear intramural muscle or under the mucous membrane, increasing its Palace uniform, and often not easy identification of the uterus mast, scraping through consultation and exploration of intrauterine B-examination can help diagnosis. But there are still a small number of cases in order to laparotomy when diagnosed.

In addition, attention should be paid with adenomyosis, endometrial cancer and other diseases identification.

[Treatment]

Chinese medicine treatment can control menorrhagia, and improve the general condition; androgen therapy can reduce blood volume. Conservative treatment fails, may consider hysterectomy. Ovarian normal under the age of 50, should be retained.

[ET]

(A) more maternal chronic uterine involution incomplete: more women within the myometrium elastic fibers in smooth muscle and blood vessels around the inter-proliferation, causing uterine mast.

(B) of ovarian dysfunction: continuing to stimulate estrogen can myometrium hypertrophy. On the clinical features of the common uterine bleeding patients, especially longer course, have different levels of the uterus increases.

(C) cause inflammation: slow Annex Yan, pelvic connective tissue inflammation and chronic myositis uterus, uterine muscle, caused Collagen fiber proliferation, uterine fibrosis.

(D) pelvic bleeding, uterine caused connective tissue proliferation, can also be caused by uterine mast.

(5) myometrium vascular sclerosis: primary vascular diseases, such as the uterus.

[Pathological changes:

The disease is the basic pathological changes in the uterine muscle and smooth muscle cells in the vessel wall.

(A) general view: a uniform increase of the uterus, muscle hypertrophy of 2.5 ~ 3.2 cm. cut off-white or pink, hardness increase, a woven-fiber arrangement. 1 / 3 muscle vascular eminence, normal or endometrial thickening, and sometimes that the merger of small leiomyoma (diameter of less than 1 cm) or endometrial polyps.

(B) examination: Image see inconsistencies, the following form: ① simply smooth muscle hypertrophy. Microscopy and normal myometrium the same, no collagen fibers hyperplasia, there is no significant change in vessel walls; ② myometrium in the collagen fibers hyperplasia, a uterine fibrosis; ③ muscle within the vessel wall changes: arteriovenous significant expansion , The new blood vessels around the success of the mission fibroelastosis.

[Clinical]

The main symptoms are excessive menstrual volume, continued extension of the number of days; some performance for the period shortened to about 20 days, the number of days of continuous and no significant change or extend the period of performance for the period, but the small amount.

For many patients with the maternal, and the majority of three-over. Sick a long time and who was more bloodshed in anemia Maung gynaecological examinations increased uterine uniform, the general size for the six weeks of pregnancy, a small number of more than eight weeks of pregnancy size, texture more tenacious. Bilateral ovary can be slightly increased, there are multiple follicular cysts.

[Prevention]

As are many reasons for the disease, and some can prevent its occurrence, such as doing a good job of family planning, prevention of post-natal infection, post-partum uterine contraction delinquents should be given timely uterine contraction drugs. Appropriate attention to post-natal prone or supine knee-chest and postnatal movement to prevent the uterus after down, to reduce pelvic congestion. Positive treatment of ovarian dysfunction, to avoid hormones, such as the continuing stimulus.

Too much blood and "hypertrophy of the uterus"

A primary school teacher Miss Zhang, 40-year-old, has been excessive menstrual of six years, sometimes as a blood Chung, the majority of walking time over eight days, until the "functional uterine bleeding" treatment less effective. The B-through gynecological examination found that the uterus uniform increase, as in 2-3 months pregnant look, diagnosed as "hypertrophy of the uterus."

Uterine hypertrophy of the uterus is that even increased, and with varying degrees of a bleeding disease. The clinical performance of menorrhagia, and sustained numerous extended performance for the cycle has been shortened to about 20 days, the volume and sustained no significant change in the number of days or performance for the period continued falling into, but not much blood. Firming catch menstrual pain, back pain, usually the amount Leucorrhea.

At present, the uterus hypertrophy of the basic pathological changes, both in the myometrium blood vessels, muscle fiber and connective tissue. The cause of the uterus caused hypertrophy generally have the following areas:

First, producing too many infertile women. As many times motherhood, the myometrium, the elastic fibers, in between the smooth muscle and blood vessels around the proliferation, thus leading to the uterus hypertrophy, or because of repeated in puerperal infection, which caused incomplete uterine involution.

Second, ovarian dysfunction. Excessive secretion of estrogen, long-term stimulus, which caused hypertrophy myometrium.

Third, chronic inflammation. Annex to the uterus or chronic inflammation caused substantial uterine fibrosis, can lead to uterine mast.

4, pelvic congestion, or myometrium vascular sclerosis. Also can cause uterine connective tissue proliferation, leading to the uterus mast.

As the disease such as the amount of menstrual symptoms can easily function of uterine bleeding and confused, so should pay attention to clinical differentiation. For example, dysfunctional uterine bleeding have no laws, and many occurred in adolescence or menopause, the uterus does not increase or slightly increased the number of uterine mast in the productive and reproductive age women, although the quantity but more normal cycle Or shortened, the uterus increased significantly. In addition, intramural uterine fibroids and submucosal fibroids, uterine uniform have increased, the amount of menstrual symptoms, can B Chaodeng detailed examination, and uterine mast of a differential.

Uterine hypertrophy of the treatment, first application of drugs, including hemostatic, androgen drugs and traditional Chinese medicine to control bleeding, such as drug treatment does not work, they have adopted all or hysterectomy, the surgical excision therapy.

The uterus "troubles"

Some of the uterus can no abnormal symptoms, menstruation, sexuality, pregnancy, childbirth, and so has no abnormal performance, and life will not be found, or even when the physical examination was found. However, some part of the reproductive system function in patients with varying degrees by the impact of sexual maturity, marriage, or during pregnancy, labor, the symptoms were not found.

Overview

Congenital anomalies of the uterus is the most common abnormal genital mutilation a form of clinical significance also relatively large.

Cause

On both sides of the kidney in the process of evolution, subject to certain factors influence and interference in the evolution of the different stages of development formed to stop all kinds of abnormal development of the uterus.

Symptoms

Some of the uterus can no abnormal symptoms, menstruation, sexuality, pregnancy, childbirth, and so has no abnormal performance, and life will not be found, or even when the physical examination was found. However, some part of the reproductive system function in patients with varying degrees by the impact of sexual maturity, marriage, or during pregnancy, labor, the symptoms were not found.

(A) menstrual abnormalities: congenital absence of the uterus or uterine Shiji with amenorrhea. Naive patients with type uterus can be no menstruation, may have on a small, delayed, dysmenorrhea, menstrual irregularities, such as performance of double uterus, often in patients with double uterus angle there may be periods of excessive menstrual and duration of the extension.

(B) of infertility: the uterus, Shiji uterus, uterine and other childish type of uterine dysplasia, often one of the main reasons for infertility.

(C) pathological pregnancy: abnormal development in the uterus after pregnancy often cause abortion, premature or abnormal Abnormal Fetal Position. Even during pregnancy can occur spontaneously uterine rupture. Kok residues such as uterine tubal patency, Yunluan can implantation in the uterus residual slot, but because of its myometrium dysplasia, and often rupture in pregnancy, with symptoms of ectopic pregnancy.

(D) of production, post-natal pathology: malformation of the uterus often coexist myometrium stunted. Delivery can yield of abnormal cervical expansion difficulties, to produce a result even uterine rupture. The vaginal delivery may be stranded in the placenta, postpartum hemorrhage or post-natal infection. Double uterus in pregnancy, the pregnancy of uterine growth and development, such as non-uterine pregnancy in the uterus of the rectum Waterloo, childbirth can cause obstruction of dystocia. Double uterus, uterine or dual-angle septate uterus patients, in the post-natal pregnancy may be due to non-side in case of uterine hemorrhage from Decidual.

Check

If patients have primary amenorrhea, dysmenorrhea, infertility, habitual abortion, each pregnancy is not Abnormal Fetal Position or produce such as history, should first think of the possibility of uterine deformities, and further asked in detail about history and carry out gynaecological examinations. When necessary, the use of intrauterine detection probe size, direction, or Hysterosalpingography, with a clear diagnosis. Genital deformities often combined urinary system abnormalities or lower digestive tract abnormalities, if necessary, for IVP or barium enema examination. When found under the urinary tract or digestive tract malformations, the need to check for genital malformation in detail, including the uterus, abnormal.

Treatment

Uterine abnormality, if not caused clinical symptoms, may not have to be addressed. Stunted as a result of the uterus caused amenorrhea, dysmenorrhea, infertility or habitual abortion, endocrine therapy trial, the detailed treatment methods detailed in the relevant sections. Where the drug treatment after suffering patients who can not be lifted, may consider surgery. Such as dysmenorrhea, may consider removal of uterine malformation. Uterine malformation caused as a result of abortion, premature birth, the situation may be different deformities were to take surgery.

How should the prevention of uterine mast

As are many reasons for the incidence of some of its occurrence can be prevented if good family planning to prevent post-natal infection postpartum uterine contraction delinquents should be given timely attention to post-natal drug uterine contraction appropriate prone or supine knee-chest and postnatal movement to prevent uterine After the inverted reduce pelvic congestion positive treatment of ovarian dysfunction to avoid the continued stimulation of estrogen, such as

How should the treatment of uterine mast

Chinese medicine treatment can control and improve the general menorrhagia; androgen therapy can reduce the bloodshed of conservative treatment may be considered invalid hysterectomy under the age of 50 should be retained normal ovarian

Uterine hypertrophy can be complicated by the diseases

Can be complicated with cervical erosion, and other

Uterine mast easily confused with the diseases

Should pay attention to and adenomyosis endometrial cancer and other diseases identified

Uterine mast should do what checks

Diagnostic curettage intrauterine exploration and B-examination may be aided diagnosis but there is still a small number of cases should be clear diagnosis laparotomy

What are the performance of the uterus mast and how to diagnosis

Clinical performance



The main symptoms of excessive menstrual continued for a few days extension; some performance for the cycle shortened to 20 days about the number of days of continuous and no significant change or extend the period of performance for the period but the small amount

Patients with more maternal and for the majority of production for more than three hours long illness, was more bloodshed in anemia Maung gynaecological examinations of uterine uniform increase for the six weeks of pregnancy in general size of a small number of more than eight weeks of pregnancy size more resilient texture can be slightly increased bilateral ovarian Multiple follicular cysts

The disease is the basic pathological changes in the uterine muscle and smooth muscle cells in the vessel wall

(A) general view: uterine muscle hypertrophy in a uniform increase of 2.5 ~ 3.2 cm cut off-white or pink hardness increase was woven-fiber bundle with 1 / 3 in the muscle or blood vessels eminence normal endometrial thickening This shows that sometimes the merger of small leiomyoma (diameter of less than 1 cm) or endometrial polyps

(B) examination: Image inconsistencies have seen the following form: ① simply smooth muscle cells and mast were observed normal myometrium with the same vessel wall collagen fibers hyperplasia no significant change; ② myometrium, collagen Fiber hyperplasia formation of uterine fibrosis; ③ muscle within the vessel wall changes: arteriovenous significant expansion in new blood vessels around the success of the mission fibroelastosis

Diagnosis

More and more women menstruation and increasing consistency of uterine or endometrial thickening of the normal individual was polypoid but a small number of pathological examination revealed that the majority of normal proliferation can be diagnosed as hypertrophy of the uterus and uterine fibroids should pay attention to identifying in particular for a single nuclear muscle wall Or mucous membrane under the Palace of uniform who are often difficult to increase hypertrophy of the uterus and through consultation scratching differential intrauterine exploration and B-examination can help the diagnosis but there are still a few cases in laparotomy, in order confirmed

In addition attention should be paid with adenomyosis endometrial cancer and other diseases identified

Mast from the uterus is what causes

(A) more maternal chronic uterine involution incomplete: more women within the myometrium in elastic fibers and vascular smooth muscle of the uterus caused hyperplasia around the mast

(B) of ovarian dysfunction: estrogen can stimulate the sustained muscle hypertrophy of the uterus on the common features of bleeding in patients with longer duration in particular has a different degree of increased uterine

(C) cause inflammation: Annex chronic pelvic inflammation of connective tissue inflammation and chronic myositis caused uterine myometrium collagen fibers within the uterine fibrosis hyperplasia

(D) pelvic connective tissue proliferation of uterine bleeding caused by uterine hypertrophy can be

(5) myometrium vascular sclerosis: primary vascular diseases, such as uterine

The treatment of cervical leukoplakia

[Treatment]

As for the white spot benign cervical lesions, the general rule out the possibility of malignant cervical lesions, cervical, for treatment of iron or frozen. Associated with the severe cervical erosion, could be considered Palace cervical-removal, and pathology for biopsy to determine whether early cervical cancer, in order to take timely further treatment. Of asymptomatic patients can be closely observed, regular follow-up.