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患者,女,49岁。孕2产2。主因发现下腹肿物伴尿频、尿急2个月,加重7天,尿量减少继之尿闭,于1994年8月10日入院。基层医院行导尿后肿物仍存,尿急缓解,后又复发。5天前在省级医院B超示:(1)双肾囊性占位;(2)盆腹腔巨大多房占位。查体:BP26.5/16/kPa,突眼,甲状腺Ⅲ度肿大,腹部膨隆,如孕足月大小,质软、囊性变,不活动,边界不清,移动性浊音(—),叩实,肠鸣音正常。妇查:外阴经产型,阴道后壁膨出,囊性感。宫颈暴露不出(前为耻骨联合,后为肿物,将阴道上端压扁,子宫上移于耻骨联合之上),子宫前位,偏左,稍大于正常,质硬,表面不平,不活动,无压痛。右上可及32cm×28cm囊性肿物,充满盆腹腔,囊实相间,不活动,无压痛。初诊:(1)右侧卵巢粘液性囊腺瘤;(2)甲状腺囊肿;(3)多囊肾;(4)高血压。经术前准备6天,在连硬麻醉下剖腹探查。术中见:双肾囊性变(左肾9.9cm×4.5cm,右肾11.2cm×5.1cm)。子宫如孕40天大小,左角有3cm×3cm×2cm浆膜下肌瘤,右侧阔韧带内上达季肋部,下达盆底部33cm×28cm×25cm囊实相间肿物,双卵巢正常。故行肿瘤+子宫切除术。肿物在阔韧带前后叶中完整剥出,无蒂,大体标本观察:肿瘤32cm×28cm×25cm大小,囊实相间,实处质硬,囊液为桔红色,虽多房。病理报告:阔韧带平滑肌瘤囊变出血。术后17天拆线,伤口甲期?
Patient, female, 49 years old. 2 pregnant 2. The main findings of lower abdominal mass with frequent urination, urgency 2 months, increased 7 days, followed by decreased urine output urine, admitted on August 10, 1994. Primary hospital line catheter remains after the tumor, urinary urgency, and then relapse. 5 days ago in the provincial hospital B ultrasound showed: (1) double renal cystic space; (2) large abdominal multi-chamber abdominal mass. Examination: BP26.5 / 16 / kPa, exophthalmos, Ⅲ degree thyroid enlargement, bulging abdomen, such as full-term pregnancy size, soft, cystic degeneration, inactivity, unclear boundary, shifting dullness (-), Taoshi fact, normal bowel sounds. Fucha: vulvar by type, vaginal posterior wall bulging, cystic sexy. Cervical exposure is not (before the pubic symphysis, after the mass, the vaginal upper flattening, the uterus moved above the pubic symphysis), anterior uterus, left, slightly larger than normal, hard, uneven surface, inactive , No tenderness. Upper right and 32cm × 28cm cystic mass, full of abdominal cavity, capsule and white, inactive, no tenderness. New diagnosis: (1) Right ovarian mucinous cystadenoma; (2) Thyroid cysts; (3) Polycystic kidney disease; (4) Hypertension. Six days after preoperative preparation, exploratory laparotomy under hard anesthesia. See surgery: double renal cystic degeneration (left kidney 9.9cm × 4.5cm, right kidney 11.2cm × 5.1cm). Uterus, such as 40-day-old size, the left corner of 3cm × 3cm × 2cm subserosal fibroids, the right broad ligament up quarter quarter rib, issued pelvic floor 33cm × 28cm × 25cm capsule solid phase tumor, double ovary normal. So line tumor + hysterectomy. Tumor in the broad ligament before and after the leaves completely stripped, pedicle, the general observation of the specimen: tumor size 32cm × 28cm × 25cm, capsule solid phase, the actual hard, cystic fluid is orange, although more room. Pathology report: broad ligament leiomyoma cyst bleeding. 17 days after the stitches, wounds a period?