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1 病例资料 患者女,34岁。因停经35天,不规则阴道出血10天,腹痛10小时于1991年11月23日入院。患者未次月经1991年11 月18日,入院前10天开始不规则阴道出血,较正常月经量少,未治渐止。近几日晨起感恶心、欲吐、纳差。入院前l0小时突感左下腹剧烈疼痛,并逐渐扩散到全腹,伴肛门下坠感及便意感,头晕,口渴。患者发病后体温一直正常。否认外伤史。1年前曾有肝炎史。入院时体检:体温37℃,脉率96次/分,呼吸26次/分,血压15/12kPa。发育正常,营养良好,神志清楚,贫血貌。盹部膨隆,有肌卫,全腹有压痛及反跳痛,肝脾末触及。妇科检查:外阴经产式,阴道正常,宫颈有举痛,后穹隙饱满,宫体有飘浮感,附件未发现明显异常。后穹窿穿出不凝山血液。拟诊为宫外孕急诊行剖腹探查术,术中发现下腹及盆腔陈旧性出血约1000ml。子宫、附件等盆腔脏器无破裂出血。向上探查发现肝脏为中度结节性硬化。脾中度肿大,其上极、膈面之中部及后侧部各有一
1 case data patient female, 34 years old. Due to menopause 35 days, irregular vaginal bleeding 10 days, abdominal pain 10 hours in November 23, 1991 admission. No menstruation in patients with November 18, 1991, 10 days before admission began irregular vaginal bleeding, less than normal menstrual flow, did not go away. In recent days up nausea, vomiting, anorexia. L0 hours before admission suddenly felt severe pain in the lower left abdomen, and gradually spread to the whole abdomen, accompanied by anal fall sense and sense of purpose, dizziness, thirst. After the onset of the patient’s body temperature has been normal. Denied the history of trauma. He had a history of hepatitis 1 year ago. Physical examination on admission: body temperature 37 ℃, pulse rate 96 beats / min, breathing 26 beats / min, blood pressure 15 / 12kPa. Normal development, good nutrition, conscious, anemic appearance. Department of napnales bulging, muscle Wei, the whole abdomen tenderness and rebound tenderness, liver and spleen touching the end. Gynecological examination: genital production, normal vagina, cervix have pain, after the dome full, Palace floating feeling, no significant abnormal attachment. After the vault piercing out non-condensable mountain blood. To be diagnosed as ectopic pregnancy emergency laparotomy, intraoperative abdominal bleeding and pelvic found about 1000ml. Uterus, annex and other pelvic organs without rupture bleeding. Up exploration found that the liver is moderate tuberous sclerosis. Spleen moderate enlargement, the pole, the diaphragm surface of the middle and the back of each one