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患者,女,33岁,2胎1产。于1987年10月23日因剧烈头痛,频繁呕吐,CT检查拟诊“右枕叶占位性病变”,于10月25日急诊手术,病理报告:转移性绒癌。摄胸片示:两肺转移性肿瘤。β—hCG>4μg/L。11月7日转入我科。患者曾于1985年10月作人流术,术后月经规则。1987年10月12日因停经40d,伴阴道流血4d,且出现“早孕”反应,在某院行“刮宫术”,刮出物病理报告:流血期宫内膜,未见蜕膜及绒毛,术后阴道流血停止。体检:T36℃,R18次,HR82次,BP14.1/8.53kPa,心前区未闻及杂音,两肺呼吸音粗糙,肝肋下2cm,质软,脾(一)。妇检:外阴:经产式;阴道:粘膜正常,未见有转移结节;宫颈:重度糜烂,着色;宫体:前位,正常大小,软,活动;两侧附件:(一)。住院经过:从11月10日开始采用5-Fu+KSM双化疗,同月16日CT扫描发现:肝、脾多发性占位病灶。此后继续双化疗,并将5—Fu的半量改为口服。1988年4月2日,复查CT扫描示:肝内病灶基本消失,脾
Patient, female, 33 years old, 2 fetuses 1 birth. On October 23, 1987 due to severe headache, frequent vomiting, CT examination to be diagnosed “right occipital space-occupying lesions”, on October 25 emergency surgery, pathology report: metastatic choriocarcinoma. Chest radiograph shows: two lung metastatic tumors. β-hCG> 4 μg / L. November 7 into my department. Patient was abortion in October 1985, postoperative menstrual rules. October 12, 1987 due to menopause 40d, with vaginal bleeding 4d, and the emergence of “early pregnancy” response in a hospital “curettage”, scraping the pathology report: bleeding endometrium, no decidua and villi, Vaginal bleeding after surgery stopped. Physical examination: T36 ℃, R18 times, HR82 times, BP14.1 / 8.53kPa, precordial no smell and noise, rough breathing sounds of both lungs, liver ribs 2cm, soft, spleen (a). Vaginal: normal mucosa, no metastatic nodules; Cervical: severe erosion, coloring; Palace: anterior, normal size, soft, activities; attachment on both sides: (a). Hospitalized: From November 10 began to use 5-Fu + KSM double chemotherapy, the same month on the 16th CT scan found: liver and spleen multiple lesions. After that, continue double chemotherapy and change the half amount of 5-Fu to oral. April 2, 1988, review CT scan showed: liver lesions disappeared, spleen