一年之内,先查出乳腺癌,接着又查出卵巢癌。刘女士躺在浙江省中医院盆腔肿瘤中心病床上,始终想不明白为何自己会连连被“癌魔”盯上。所幸,经进一步检查确定,这两种癌都为原发癌,预后不至于像转移癌那么糟糕,她至少还有手术治疗的机会。先后出现两种原发癌,临床上称为“双原发癌”。省中医院盆腔肿瘤中心姚志韬医生告诉钱报记者,算上刘女士,他们最近2个月来已做了5例双原发癌手术,包括乳腺癌合并卵巢癌、结肠癌合并子宫内膜癌、卵巢癌合并子宫内膜癌。为什么双原发癌会频频出现?而又为什么偏偏是这些癌会成双成对出现?双原发癌的增多又警醒我们在防癌上又该有哪些新注意事项?38岁女老板一年内先后查出两种癌刘女士今年38岁,有爱她的丈夫、听话的儿子,如果不是“癌魔”的连连重击,她如今应该还是那个雷厉风行的女老板。然而,人生的转折就猝不及防发生在2017年底,刘女士跟往年一样做了个健康体检,发现右侧乳房有个肿块,再进一步检查,确诊乳腺癌。坚强的刘女士在家人的陪伴下做了右乳全切手术,完成了术后的化疗以及靶向治疗。时间在一次次复查中慢慢过去,一个个逐渐好转的指标也给这家人带来了重拾幸福生活的希望。可惜,好景不长,2018年底复查时,刘女士发现肿瘤指标CA125上升,这可是个指向乳腺癌与妇科肿瘤的指标,她非常担心是乳腺癌复发,但乳腺B超并未发现异常。在胆战心惊中又过了3个月后,CA125数值已高出正常值上限的7倍,说明她的身体肯定存在异常。根据医生的建议,刘女士做了PETCT检查,结果发现盆腔、肠间隙、肝脏表面等多处有肿块,且这些肿块的形态不规则,高度怀疑是恶性肿瘤。当时,刘女士一家将面对的有两种可能。如果这些肿块是乳腺癌复发的转移灶,那么她能做的只有全身化疗,且预后极差。而如果这些肿块是原发卵巢癌,那么她可以进行综合治疗,5年生存率或可达60%—70%。原发卵巢癌的典型症状是腹水,而刘女士恰好没此症状,她咨询了很多医生,都怀疑她是乳腺癌复发转移。最终,她带着一丝希望找到省中医院盆腔肿瘤多学科联合门诊,专家们讨论后,提出了患者双原发癌的诊断倾向,并为她实施了腹腔镜探查+盆腔肿瘤切除活检。报告在一个多星期的煎熬后出来,结果证实了MDT专家团队的推论。为了帮助刘女士有更好的预后,专家们再次讨论后制定了更精准的的治疗方案。如今,新辅助化疗疗程将结束,很快她将接受卵巢癌标准化手术和后续治疗。双原发癌间存在同源基因异常一个人身上接连出现两种癌,也并非刘女士一人遇上这件倒霉事。姚医生告诉钱报记者,最近2个月来,刘女士是他们接诊的第5例双原发癌,其中刘女士是年纪最轻的。事实上,临床上双原发癌一直都存在。姚医生说,国外对原发癌(主要是双原发癌)的比重在1%左右,国内近年来发病率有逐渐增高的趋势,在0.35%—2.4%。为什么双原发癌会频频出现?姚医生认为,与癌症发病年龄不断提前、诊治水平的提高癌症患者生存期延长、环境污染和不良生活方式等在致癌物中长期暴露等因素相关。而再仔细分析这5例双原发癌,分别是乳腺癌后得卵巢癌2例、结肠癌后得子宫内膜癌1例、子宫内膜癌后得结肠癌1例、卵巢癌后得子宫内膜癌1例。其实从癌症种类上来看相对集中。至于为什么偏偏是这几种癌老是成双成对出现?姚医生表示,那是因为双原发癌间存在同源基因异常。比如,乳腺癌与卵巢癌间同源的异常基因,就是大家熟知的BRCA-1/BRCA-2,这也就是为什么当年安吉丽娜朱莉预防性切除乳腺,两年后查出卵巢癌早期征兆又进行预防性切除。当然,对于大众而言,像安吉丽娜朱莉一样进行预防性切除脏器的作法太过极端,但针对性预防是必不可少的。乳腺癌、结肠癌、卵巢癌、子宫内膜癌等这些都是女性常见的恶性肿瘤。姚医生建议,对于直系家族病中存在肿瘤病史的女性,应做好相关高危因素的体检筛查。对于此类单原发肿瘤的女性,有必要做相关基因检测,如果发现同源异常基因,在随访观察时还得关注双原发癌的预防及筛查,尽可能早发现早治疗,以达到更好的预后。
外阴、阴道是女性生殖系统的门户,是女性感染性疾病、肿瘤性疾病临床表现的重要窗口。从了解阴道相关症状开始,可以获取许多女性生殖系统健康信息。阴道前后分别毗邻尿道和直肠,一者为湿,一者为毒;往内接受输卵管、子宫内膜、宫颈分泌物或反流液,由外接受男性生殖器以及体液的侵扰,纵然有天然守卫(乳酸杆菌),也难免失防。我们从最常见的阴道炎开始,讲述阴道里不可描述的忧愁!原来内裤洗错了!“下面痒”竟然是他的问题...“下面痒”是怎么了?可能和你的“他”有关...内裤要这么洗!胡乱啪啪和乱用洗液,当心下面痒不停反复阴道炎可能致癌!下面痒,一定是阴道炎吗?天冷了,点点的女性朋友小A为了少洗内裤,几天才换洗一次。有时图省事,不来大姨妈也用护垫。最近忽然感觉下面痒痒的,急忙跑来咨询:这是不是得了阴道炎?小内内要和女性的私密处亲密接触,如果不及时换洗这层盔甲,确实容易生病。那下面偶尔会痒,是得了阴道炎吗?内裤多久换洗一次合适?一起听听浙江省中医院妇科的姚志韬医生怎么说。下面痒,一定是阴道炎吗?开篇先科普,首先我们来看看,阴道炎是怎么来的——女性的阴道有自身的阴道菌群,它们互相平衡制约。而一旦这种平衡被破坏,病原体侵入,阴道炎就发生了,约有75%的女性一生至少患过1次阴道炎。一般来说,阴道炎喜欢这4种女性:1.处于生育期或围绝经期。生育期的女性性活动频繁,围绝经期女性雌激素水平低,这两类人容易发生感染;2.性伴侣数量≥2人,且啪啪前后没有清洗到位、做好保护措施;3.长期不规则使用抗生素、免疫力低下;4.经常阴道灌洗或非经期使用护垫。再回到第一个问题,下面痒,就一定是阴道炎吗? 那得看频率哦。如果私处的瘙痒只是偶然出现,可以先停用你的各种洗液、改穿透气的裤子看看是否有改善。但是,如果白带有以下这些表现,就要早点去医院妇科报道了。啪啪要有度,好身体少不了他的呵护有了性生活的女性,确实更容易成为阴道炎的目标对象。但要注意的是,如果阴道炎反复发作,可能“和他有关”哦。比如滴虫容易藏在男性的包皮褶皱、尿道内,因此无套或是不洁性行为都可能导致阴道炎的发生。所以为爱鼓掌前,请先仔细清洗装备再上战场,你好他好大家好。另外,阴道也是会“用进废退”的!性生活可以增加生殖器官的血液循环,适当的性生活也可以预防老年性阴道炎的发生。手术后、产后及时恢复性生活也有助于身体健康(不过恢复时间要遵医嘱哦)。小小歪个楼,你知道多久应该过一次性生活吗?可以参考这个表格并严肃认真地分享给他(咳咳):护垫别常用,内裤要勤换你是否和我的懒惰朋友小A一样,不爱换洗内裤、经常用护垫?现在点点也严肃而认真的批评你一下,不要懒惰!内裤要经常换洗,还有非经期不要用护垫!要知道,护垫的胶质让私处密不透风,而潮湿的环境正是细菌喜欢的温床。而内裤就像阴道的小窝,窝不干净,阴道自然易生病。那该如何选择和清洗内裤呢?● 尽量购买纯棉透气的浅色内裤,方便及时发现白带变化● 即便不洗澡也要每天用清水清洗外阴,并做到一日一换。换下的内裤要及时用温和的洗剂清洗,并冲漂干净,避免洗涤剂残留引起不适● 内裤清洗后,有条件可用热水烫一下,在阳光下暴晒干。若是身处持续阴雨天的南方,也可以用干净的吹风机和烘干机将内裤烘干特别提醒:阴道的邻居是每天要进行排泄的尿道和肛门,上完厕所一定要从前往后擦拭,避免将肛门的细菌带到前面来哦。9102年了,这些偏方别再信了点点碰到过这样的姑娘:“下面很痒”,也不好意思去医院,于是自己去偷偷买私处洗液,甚至是朋友圈不知名的凝胶等产品来用。还有的姑娘,禁不住美容院小姐姐的甜嘴,做了一些所谓“阴道灌洗排毒”的项目,结果洗得阴道菌群失调,反而真的得了阴道炎。115027308姚医生提醒大家:妇科洗液有很多种类型,如常见的洁尔阴、妇炎洁等,一些正规的大医院也有自己配制的中药洗剂。但使用这类产品前,首先要到医院确定病原菌后,再进行针对性治疗,其次可以选择药物口服或者栓剂处理。尤其忌讳“无病做清洁”(敲黑板!)。除了乱用洗液,点点还见过用所谓“偏方”治疗阴道炎反而导致病情加重的案例:把大蒜捣烂,往阴道里塞;用盐水或是醋水坐浴甚至当做阴道洗液往里冲洗等等......善待自己吧,阴道也是你身体的一部分呀。阴道炎可以治愈吗?反复发作当心致癌那么,阴道炎会致癌吗?阴道炎上行感染至输卵管,可能会造成输卵管积水,增加输卵管、卵巢患恶性肿瘤的风险;而支原体、衣原体的上行感染也可诱发子宫嫩模息肉样增生,长期炎症刺激有诱发癌变的可能。所以,若是阴道炎反复发作,一定要规范治疗,并且在治疗期间做到这4点:1.早诊早治。如果你是首次发作阴道炎,要早诊断早治疗,先到医院进行检测是哪一种类型的阴道炎,再根据结果用药。不同类型阴道炎治疗方案可能完全不同。一旦用错药,反而会加重病情。2.用药要按时足量。有些人用药两天,感觉症状被控制住了,于是擅自停药,但实际上病菌并没有消灭。反复如此,就导致前功尽弃。3.夫妻同治。阴道炎的发生可能和阴茎、阴囊藏污纳垢有关,因此治疗期间不要同房,后期也要戴套为爱鼓掌。4.不要擅自用洗液破坏阴道原有微生态环境。若无医嘱,日常只需用清水冲洗外阴即可。得了阴道炎不是什么可怕的事儿,要积极治疗并保持卫生才是正解。夫妻双方互相理解也很重要,记得分享给他,一起把这些坏毛病赶跑吧~
直播视频地址:http://cdn.xylink.com/NewLive/pcWatch/index.html?liveId=ff80808166260d6701677725c55c2995&h=https://cloud.xylink.com (ppt内大量文字图片,未经授权,请勿转载,违者必究)
自从人类的有记录的历史开始,医学变成为了人类历史上不可缺少的一部分。外科手术也成为医学发展过程中波澜壮阔的重要内容。17世纪80年代开始,外科发展进入了新的纪元,Billroth胃大部切除、Whipple胰十二指肠切除、Miles直肠癌切除术、Dexon直肠癌切除术概念一直沿用至今。外科主要对创伤,感染,肿瘤,畸形和功能障碍等五大类疾病以手术或手法处理作为主要手段进行治疗。因此,手术就成为外科所特有的一种治疗方法。人们也往往把是否需要手术治疗作为区别内科还是外科疾病的标准。手术在治疗疾病的同时,伴随而来的是手术切口和疼痛。手术带来的不良影响,有时甚至会让医师对自己的职业理想产生错觉。因此减少并发症,也是外科医师不断改进的永恒方向。外科医生自己自从感觉自己的工作着实令人厌恶,就开始着手和疼痛宣战。廉森·朗医生在1842 年 3 月 30 日,在为一位摘除颈部肿块的患者成功实施了世界上第一例乙醚麻醉手术。在他之后,麻醉学的发展,科学逐渐在手术疼痛方面占据了上风。手术后会留下手术疤痕,这是不可避免的。外科手术后留下的瘢痕一直成为医生与患者尤其是年轻患者共同的困扰;而巨大的手术瘢痕,不仅影响到了美观,更影响病人术后的恢复。手术伤口愈合的基本过程---急性炎症期伤口愈合分为三个时期。炎症期在受伤后立即开始,在急性伤口中可以持续数小时至数天(手术、创伤),而在慢性伤口中受原发疾病的影响,炎症期可持续数周或甚至数月(下肢溃疡、压疮、糖尿病足溃疡等)。伤口的早期变化伤口局部有不同程度的组织坏死和血管断裂出血,数小时内便出现炎症反应,表现为充血、浆液渗出及白细胞聚集,形成局部红肿。伤口中的血液和渗出液中的纤维蛋白原很快凝固形成凝块,有的凝块表面干燥形成痂皮,凝块及痂皮起着保护伤口的作用。伤口愈合的基本过程---细胞增生期第二个时期指伤口发生的2~3天。伤口边缘的整层皮肤及皮下组织向中心移动,于是伤口迅速缩小,直到14天左右停止。伤口收缩是伤口边缘新生的肌纤维母细胞的牵拉作用引起的,而与胶原无关,其意义在于缩小创面。伤口愈合的基本过程---瘢痕形成期大约从第3天开始,伤口底部及边缘长出肉芽组织,填平伤口。毛细血管大约以每日延长0.1~0.6mm的速度增长,其方向大都垂直于创面,并呈袢状弯曲。第5~6天起纤维母细胞产生胶原纤维,其后一周胶原纤维形成甚为活跃,以后逐渐缓慢下来。随着胶原纤维越来越多,出现瘢痕形成过程,大约在伤后一个月瘢痕完全形成。疤痕重塑阶段从2个月,持续到6-12个月,甚至2-3年。此时成纤维细胞数量开始变少,血管开始退化,瘢痕内部形成一种新的平衡。成纤维细胞开始变成一种更强有力的细胞,牵拉瘢痕组织,使瘢痕变的牢固,创面缩小。正常情况下,1-3个月内疤痕仍处于增生状态;6个月会内瘢痕趋向于的稳定,然后萎缩;6-12月后瘢痕进入成熟期,疤痕逐渐软化,颜色与周围的皮肤颜色变得接近,疤痕表面出现褶皱,疼痛症状最终消失,瘙痒逐渐缓解。成熟期仍有明显病理性疤痕可采用手术、摩削、点阵激光、plasma及二氧化碳激光等综合方式治疗,但究其效果仍然是世界性难题。疤痕是伤口愈合过程中的一种自然产物,疤痕就像胶水一样,让伤口(或切口)长在一起,没有疤痕就没有伤口的愈合。腹部手术切口深达皮肤真皮和皮下组织的伤口,是需要疤痕来修复的,且疤痕一旦形成,终生不会自然消退。美丽工程师创造了许多办法掩盖疤痕,但女性朋友仍往往无法忽视疤痕存在的事实。古人说“上医治未病”,在手术无法避免的情况下,手术切口与缝合质量是影响疤痕产生的重要因素。首先,切口选择是其中最重要的环节。外科技术的不断发展,某些疾病已经从5-30cm切口的开腹手术,变为0.5-2.0cm钥匙孔切口的腹腔镜手术,甚至可以经自然腔道(脐眼、阴道、口腔、腋窝等)进行NOTES手术。其次,无菌技术、精细操作,使伤口在无张力的状态下才能够很快愈合和产生最小的限度的疤痕。其次,此外,切口方向与疤痕的产生也有着密切的关系,切口顺着皮纹方向,可减少术后疤痕形成的几率,也较少出现功能障碍。(下图为作者经单孔腹腔镜切除三个月大子宫腺肌症病灶腹壁切口照片,展开2.5cm,自然状态1.5cm)妇科微创手术进展:随着物质生活水平的日益提高,人们对于个人健康和形象美给予越来越多的关注。但疾病无情,严重影响了女性的健康和生命。在有效安全的给予治疗同时,如何缩小可见疤痕产生,隐匿可见疤痕位置,是所有外科医师尤其是妇科医师一生追求的目标。妇科手术有开腹、经阴道及内镜3种人径。手术入径和方式的选择就显得格外重要,从美观上讲,首先考虑经阴道,继而内镜,最后是开腹,当然还需要兼顾肿瘤的良恶性考虑。对于掌握技术的医师,针对某种疾患,可能3种途径都可以选择,而对于另一些疾病的处理可能不适宜或难于用某种途径。(下图为作者经单孔腹腔镜切除三个月大子宫腺肌症病灶腹腔内照片)手术后瘢痕管理:瘢痕体质的人,更容易形成切口瘢痕,需要手术后启动瘢痕预防。术后采取综合措施减少病理性疤痕的发生如:①加压疗法:(弹力套、弹力衣、弹力绷带等)通过压力使疤痕内血管管腔变窄、血流变少、疤痕组织缺少营养而抑制其增生。②饮食:手术后半年禁忌辛辣烟酒等刺激性食物,避免刺激瘢痕增生。③运动:手术后一月即可开始颈部锻炼,轻度的左右上下点头。半年内避免游泳,羽毛球等过度牵拉颈部的运动。④防疤痕药物:建议手术后切口贴免缝胶布一月,同时可以切口局部用硅凝胶材质的药物,硅酮类膏剂或贴剂,可减少皮肤水分蒸发,抑制疤痕组织毛细血管再生,从而使疤痕软化。注:上述的治疗仅对生长期疤痕作用明显。所有方法只能抑制疤痕生长,不能完全去除疤痕。作者介绍浙江省中医院妇科工作十余年,浙江省中医院妇科 主治医师;浙江省中医院 医务部 副部长;浙江省数理医学会盆腔整合医学学会委员兼学会秘书;浙江省抗癌协会妇科肿瘤分会青年委员;浙江省中医院盆腔肿瘤中心秘书;浙江省中医盆腔肿瘤MDT秘书熟练掌握妇科肿瘤手术,腹腔镜、宫腔镜、阴式等妇科微创手术,计划生育手术,生殖系整形手术等各类妇科手术,近年来在省内率先开展单孔腹腔镜(LESS手术及V-NOTE手术),在妇科微创领域手术技巧、设备研发方面取得不断进展的同时,在盆腔恶性肿瘤诊治方面建立团队优势,并运用中西综合治疗深入研究促进妇科术后、产后快速康复。
子宫内膜异位症是指原本生长于子宫内的子宫内膜在身体的其他部位生长导致的病变。异位子宫内膜可以附着在卵巢、输卵管、子宫的体部、子宫外表面、肠道或其他部位(罕见于肺、鼻腔、脑部)。Endometriosis happens when tissue normally found inside the uterus grows in other parts of the body. It may attach to the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts. As hormones change during the menstrual cycle, this tissue breaks down and may cause pain around the time of your period and longterm painful adhesionsor scar tissue. More than 5.5 million American women have symptoms of endometriosis.子宫内膜异位症的症状(Endometriosis Symptoms)月经前、经期或月经后的疼痛是最常见的症状。对一些女性来说,这种疼痛可能会导致局部功能和行为障碍,尤其是发生在性交过程中或之后、排便或排尿时的疼痛。它有时会引起骨盆和腰骶部的疼痛。当然,许多患有子宫内膜异位症的女性症状轻微或没有症状,提示这些症状的发生可能与异位内膜生长的位置有关。Pain just before, during, or after menstruation is the most common symptom. For some women, this pain may be disabling and may happen during or after sex, or during bowel movements or urination. It sometimes causes ongoing pain in the pelvis and lower back. Many women with endometriosis have mild or no symptoms, though. The symptoms may be related to the location of the growths.原发性痛经还是子宫内膜异位症?(Just Cramps or Endometriosis?)大多数女性的月经期都有轻微的疼痛。这些症状可能会从非处方止痛药中得到缓解(包括非甾体止痛药或活血化瘀中药)。如果疼痛持续2天以上,或影响你正常生活,或在月经结束后继续,必须警惕子宫内膜异位症的可能,告诉你的妇科医生(也包括作者)。Most women have some mild pain with their menstrual periods. They may get relief from over-the-counter pain medications. If the pain lasts more than 2 days, keeps you from doing normal activities, or remains after your period is over, tell your doctor.子宫内膜异位症和青少年(Endometriosis and Teens)子宫内膜异位症可以从第一次月经开始,并伴随女性一生直至绝经。如果你的月经相关疼痛足以干扰你的生活,千万不要单独忍受,医师的指导和治疗会有很大帮助。首先应该是症状跟踪随访,并适当服用止痛药。这一点,基本上对青少年女性患者的治疗选择与成人相同。Endometriosis pain can begin with the first menstrual period. If your menstrual pain is strong enough to interfere with activities, you should consult your physician. The first step may be tracking the symptoms and taking pain medication, but ultimately the treatment options for teens are the same as for adults.子宫内膜异位症与不孕(Endometriosis and Infertility)有时,子宫内膜异位症的第一个或唯一症状就是怀孕的问题。有三分之一的女性患有不孕症,原因尚不清楚。伤疤可能是罪魁祸首。好消息是,医学治疗可以帮助人们克服不育,而怀孕本身可以缓解子宫内膜异位症的症状。Sometimes the first -- or only -- symptom of endometriosis is trouble getting pregnant. Infertility affects about a third of women with the condition, for reasons that aren't well understood. Scarring may be to blame. The good news is that medical treatments can help someone overcome infertility, and pregnancy itself can relieve some symptoms of endometriosis.子宫内膜异位症的病因(What Causes Endometriosis?)研究人员们并不能完全确定子宫内膜组织为什么会在子宫外生长,但提出了有几种支持理论。有理论认为遗传原因导致,一些异位子宫内膜细胞可能从出生起就存在。另一种理论认为,含有子宫内膜细胞的经血会通过输卵管回流到盆腔,而不是从阴道中排出,这些细胞被认为会粘附在器官上,并随着时间的推移不断增加和出血。细胞也可以通过其他方式移动到其他部位,例如在剖腹产时的人为因素和肺、鼻腔等处的血行播散。Doctors don't know why endometrial tissue grows outside of the uterus, but they have several theories. Heredity plays a role, and some endometrial cells may be present from birth.Another theory suggests that menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These cells are thought to stick to organs and keep growing and bleeding over time. Cells could also move to the pelvic cavity other ways, such as during a C-section delivery. 子宫内膜异位症的易感人群(Endometriosis: Who Is at Risk?)子宫内膜异位症常见于一下女性人群:年龄30-40岁;未生育;经期长于7天月经周期短于28天;月经初潮发生于12岁前;家族中有子宫内膜异位症病史(妈妈或姐妹)The condition is more common in women who:Are in their 30s and 40s;Have not had children;Have periods longer than 7 days;Have cycles shorter than 28 days;Started their period before age 12;Have a mother or sister who had endometriosis诊断-伴随症状(Diagnosis-Tracking Symptoms)症状的模式可以帮助鉴别子宫内膜异位症,包括:疼痛发生的时间规律;疼痛严重程度;疼痛持续时间;改善或诱发、加重因素;生活质量影响;疼痛与性生活或大小便的关系及影响Your pattern of symptoms can help to identify endometriosis, including:When the pain happens;How bad it is;How long it lasts;A change or worseningof pain;Pain that limits your activities;Pain during sex, bowel movements, or urination.诊断-盆腔检查(Diagnosis: Pelvic Exam)首先医生会做盆腔内诊(妇科检查)来了解你的卵巢、子宫和宫颈是否有任何异常。检查有时会提示是否有卵巢囊肿或子宫内膜异位造成的瘢痕性内异结节。当然,医生还会排出鉴别其他可能导致类似症状的盆腔疾病。Your doctor will do a pelvic exam to check your ovaries, uterus, and cervix for anything unusual. An exam can sometimes reveal an ovarian cyst or internal scarring that may be due to endometriosis. The doctor also looks for other pelvic conditions that could cause symptoms similar to endometriosis.诊断:盆腔影像学检查(Diagnosis: Pelvic Scans)以目前的技术,虽然不可能单独使用影像技术来确认子宫内膜异位,但医生可能会要求进行超声、CT扫描或MRI检查以帮助诊断。通过扫描使用声波、X射线或带有射频脉冲的磁场来形成图像并解读分析,这些可能能够检测出不同程度的子宫内膜增生或囊肿。Although it isn't possible to confirm endometriosis with scanning techniques alone, your doctor may order an ultrasound, CT scan, or MRI to help with diagnosis. These may be able to detect larger endometrial growths or cysts. The scans use sound waves, X-rays, or magnetic fields with radiofrequency pulses to create the images.诊断-腹腔镜技术(Diagnosis-Laparoscopy)腹腔镜检查是目前公认的确定盆腔子宫内膜异位的唯一可靠方法。妇科医生通过肚脐上的一个小切口使腹部膨胀。通过切口插入的腹腔镜观察设备。有必要的话,妇科手术医生可以将小块组织取出后进行病理检查(组织活检)——以确认诊断结果。(当然,国内的医生通常在手术过程中就进行冰冻病理检查,并采取治疗措施)Laparoscopy is the only sure way to determine if you have endometriosis. A surgeon inflates the abdomen with gas through a small incision in the navel. A laparoscope is a viewing instrument that's inserted through the incision. The surgeon can take small pieces of tissue for a lab to examine -- called a biopsy -- to confirm the diagnosis.治疗-止痛药物(Treatment-Pain Medicine)止痛药物,如对乙酰氨基酚和非甾体类抗炎药(NSAIDs),如布洛芬或萘普生等,常用于缓解子宫内膜异位带来的疼痛和痉挛。但这些药物只缓解症状,而不是就子宫内膜异位症进行根因治疗。Pain medications, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, often help relieve the pain and cramping that comes with endometriosis. But these drugs only treat the symptoms and not the underlying endometriosis.治疗-口服避孕药(Treatment-Birth Control Pills)口服避孕药能控制雌激素和黄体酮的水平,使你的月经周期稳定而规律,并减少月经量。口服避孕药能减轻子宫内膜异位症的痛苦。适应症允许下,医生会推荐避孕药连续口服治疗或孕激素治疗方案。给药途径有多种,孕激素治疗也有通过皮下注射或宫内节育器缓释的方法。但一旦停止服用药片后,子宫内膜异位症又会失去控制。Oral contraceptives manage levels of estrogen and progestin, which make your menstrual periods shorter and lighter. That often eases the pain of endometriosis. Your doctor may prescribe pills to be taken continuously, with no breaks for a menstrual period, or progestin-only therapy. Progestin-only therapy can also be given by injection. Endometriosis symptoms may return after you stop taking the pills.治疗-曼月乐(Treatment-Mirena)曼月乐是通过缓释左炔诺孕酮(20ug/d)抑制子宫内膜的激素宫内避孕系统;左炔诺孕酮缓释不仅可实现避孕目的,对于缓解痛经、减少月经量均有明显效果,也是治疗子宫内膜异位症的有效手段。Manurin inhibits the hormone intrauterine contraceptive system of the endometrium by releasing levonorgestrel(20ug/d). The sustained release of levonorgestrel is not only effective in preventing pregnancy, but also effective in relieving dysmenorrhea and reducing menstrual flow.治疗-其他内分泌干预方案(Treatment-Other Hormone Therapies)根据现有理论,可以通过药物模拟更年期状态,以摆脱子宫内膜异位症的症状,抑制子宫内膜异位症发展。GnRH agonists(促性腺激素释放激素激动剂,商品名如醋酸亮丙瑞林、那法瑞林和诺雷德),可以阻止女性雌孕激素的产生。但它们会产生一过性潮热、阴道干涩、疲劳、情绪变化和骨质流失等不良反应。也可以通过促性腺激素抑制剂(合成雄激素,达那唑)来拮抗雌激素。此药物的副作用可能包括体重增加,乳房缩小,粉刺,面部毛发增多,声音男性化和情绪变化,并有可能对子代出生缺陷造成影响。These drugs mimic menopause, getting rid of periods along with endometriosis symptoms. GnRH agonists, such as Lupron, Synarel, and Zoladex, block female hormones from being made. They can cause hot flashes, vaginal dryness, fatigue, mood changes, and bone loss. Danocrine works mainly by lowering estrogen. Side effects can include weight gain, smaller breasts, acne, facial hair, voice and mood changes, and birth defects.治疗:手术切除(Treatment: Excision)通过腹腔镜检查,医生可以分离可见的粘连,并切除子宫内膜异位增生病灶。大多数女性都能有很快效缓解疼痛。然而,没有有效预防复发的治疗措施,手术一年后,大约45%的女性会出现症状。随着时间的推移,症状复发的可能性会持续升高。因此术前-术中-术后的激素疗法及综合预防措施需要跟进,以期改善结果。During a laparoscopy, the surgeon may remove visible endometrial growths or adhesions. Most women have immediate pain relief. A year after the surgery, though, about 45% of women will have a return of symptoms. The likelihood of symptoms returning rises over time. Hormone therapy started soon after surgery may improve the outcome.治疗-开放手术(Treatment-Open Surgery)Severe cases of endometriosis may require laparotomy, or open abdominal surgery, to remove growths, or a hysterectomy -- removal of the uterus and possibly all or part of the ovaries. 严重的子宫内膜异位症可能需要进行经腹手术,必要时需切除子宫,部分或全部卵巢组织,甚至还需要切除部分直肠。治疗-中药内服(Treatment - internal medicine)早在距今2000多年前的中医学古籍《黄帝内经》和稍后的古医籍《金匮要略》最早记载了痛经(症瘕)的症状表现及,并制定了多首治疗症瘕和痛经的著名方剂。内异症的主要病机是瘀血蓄积少腹、阻滞冲任而引起气血失调,胞宫胞络功能失常,治疗以活血化瘀为基本治则,常用药物有桃仁、红花、丹参、赤芍、三棱、莪术、蒲黄、五灵脂、延胡索、乳香、没药、土鳖虫、香附等。As early as 2000 years ago, the ancient Chinese medical book《Huangdi neijing》and later the ancient medical book《Synopsis of golden chamber》first recorded symptoms of dysmenorrhea, and formulated a number of famous prescriptions for the treatment ofabdominal mass and dysmenorrhea.The main pathogenesis of endometriosis is the accumulation of stagnant blood and less abdomen, blockage and impingement, resulting in the imbalance of qi and blood, and the dysfunction of cytokines.The treatment is based on promoting blood circulation and removing blood stasis, and the commonly used drugs include peach kernel, safflower, salvia miltiorrhiza, red peony root, three rhizome, zedoary rhizome, pu huang, wuling lipids, yanhusuo, frankincense, myrrh, woodworm, and perfume.治疗-中医外治(Treatment - TCM external treatment)具有中医特色的外治诸法如:中药保留灌肠、针刺法、灸法、穴贴压法、中药贴敷法,可以发挥活血散瘀、消瘕止痛、软坚散结之功效,治疗子宫内膜异位症不仅具有理论支持,拥有令人满意的疗效,对于手术后恢复和预防复发都有很大价值。The methods of external treatment are as follows: retention enema of traditional Chinese medicine, acupuncture, moxibustion, acupoint pressure and Chinese medicine application。It can exert the functions of promoting blood circulation and removing blood stasis, relieving pain, as well as resolving hard lump.It's very valuable for recovery and preventing relapseafter surgery。子宫内膜异位症与妊娠(Getting Pregnant With Endometriosis)大多患有子宫内膜异位症的女性在妊娠结局影响不大。但是中度至重度子宫内膜异位的女性的怀孕率显著低于正常水平,需要通过腹腔镜手术提高自然生育率。如果手术评估自然受孕困难,体外受精是一种选择,精子和卵子结合在实验室中产生的胚胎被植入子宫。Many women with endometriosis don't have trouble getting pregnant. But laparoscopic surgery can improve the pregnancy rate of women who have moderate to severe endometriosis. In vitro fertilization is an option if infertility persists. The sperm and egg are combined in a lab and the resulting embryo is implanted into the uterus.子宫内膜异位的应对(Coping With Endometriosis)虽然没有办法防止子宫内膜异位症,但你可以选择生活方式来帮助你感觉更好。经常锻炼可以通过改善你的血液流动和促进内啡肽来缓解疼痛,这是身体的天然止痛药。针灸、瑜伽、按摩和冥想也可以帮助改善负面情绪并缓解症状。Although there is no way to prevent endometriosis, you can make lifestyle choices that will help you feel better. Regular exercise may help relieve pain by improving your blood flow and boosting endorphins, the body's natural pain relievers. Acupuncture, yoga, massage, and meditation also may help Improve negative emotionsand ease symptoms.子宫内膜异位症的自然终结?(An End to Endometriosis?)对大多数女性来说,子宫内膜异位症随着绝经期的消退而逐渐消退。一些女性在怀孕期间发现子宫内膜异位消退了。在某些情况下,症状可能会消失。大约有三分之一的患有轻微子宫内膜异位症的女性会发现她们的症状会自行解决。如果是这样,你真该好好庆祝下!For most women, endometriosis recedes with menopause. Some women findrelief from endometriosis during pregnancy. In some cases, symptoms may simply go away. About one-third of women with mild endometriosis will find that their symptoms resolve on their own.If so, you should celebrate!
妊娠第28周:到目前为止,你的宝宝从顶臀径大约有25cm长,体重超过1000g——大约相当于一个南瓜大小。他或她可以做各种各样的事情——眨眼、咳嗽、打嗝,甚至可能在做梦!婴儿正在进入分娩所需的位置(胎方位),每天都在接近分娩。如果他/她仍是臀部朝下,先不要惊慌,此时仍然有机会转变为头位。由现在起,建议你怀孕期间需要每两周去一次产科门诊。你可以和你的妇产科医生讨论的胎位的事情,你也会遇到更多的和你一样的孕妇,相互聊聊经历也是不错的。By now your baby measures about 10 inches long from the top of the head to the rump and weighs more than 2 pounds — about as large as a squash. He or she can do all sorts of things — blink, cough, hiccup, and possibly even dream! Baby is moving into position for childbirth, which is getting closer every day. If he or she is facing rump first, don't panic. There's still time to move into a headfirst position. That's something you can discuss with your ob-gyn, who you'll be seeing more of now, with visits about once every 2 weeks during a normal pregnancy.妊娠第29周:婴儿的生长速度飞快,而且由于子宫里的空间更小,胎儿每一个动作都会让你感同身受。随着婴儿的骨骼和肌肉变得越来越强壮,有时肘部和膝盖的动作会非常强烈。从肺到大脑等等,婴儿身体的其他部分也在发育。随着神经细胞连接的建立,大脑正在产生更多的皱褶,这些皱褶正是记忆的开始。此时婴儿声音、光线和触觉的感官反应越来越有显著了。Baby is growing at a rapid rate, and because there's less room in the womb, you should be able to feel just about every movement. Some of those elbow and knee jabs will be pretty intense as baby's bones and muscles get stronger. Every other part of baby's body is maturing too, from lungs to brain. That brain is developing more wrinkles as nerve cell connections are established. Baby's senses are also becoming more aware of sound, light, and touch.妊娠第30周:这周,你的宝宝顶臀径长度约为28cm,并将其大小接近1.5kg——大约相当于一只小烤鸡的大小。宝宝长大了,肚子也在变大,身体的重心也在发生变化。重心的变化可能会让你感到不舒服,也会很尴尬,例如不自主的漏尿。你可能会注意到你的脚也在肿胀,同时你的骶髂关节在为分娩而变得松弛。此时的你,去买一双更大更舒适的鞋子可能是个很好的选择。This week your baby measures about 11 inches long from the top of the head to the rump, and tips the scales at nearly 3 pounds — about the size of a small roasting chicken. As your baby grows, your belly is growing to match. That can be uncomfortable, and awkward, as your center of balance shifts. You might notice your feet expanding too, as your joints loosen up in preparation for labor. If that's the case, a shopping trip for a bigger pair of shoes may be in order.妊娠第31周:你每周的增加体重大约是900g,你的宝宝也会胖起来。为了让你的身体准备好分娩,腹部可能已经开始出现Braxton Hicks收缩(无痛性宫缩)了。这些“预热”性质的收缩可以持续30秒到2分钟。如果宫缩变得更强烈或更稠密,请联系你的医生,以鉴别你是否真正的临产。婴儿的肺仍在发育阶段,如果孩子现在出世,他或她需要呼吸机的帮助才能呼吸。You're putting on about a pound a week, and your baby is plumping up too. To get your body ready for labor, you may be starting to have Braxton Hicks contractions. These "practice" contractions can last from 30 seconds to 2 minutes. If contractions get more intense or closer together, call your doctor to make sure you're not in labor for real. Baby's lungs are still developing, and he or she would need the help of a ventilator to breathe if you gave birth right now.妊娠第32周:你的宝宝,将近3.5kg,就像一个哈密瓜,压在你的肚子上!你的子宫里已经没有多少空间了,但是你的小包袱仍然会在那里极尽所能的扭动、蠕动,尽管可能没有以前那么有力。宝宝正在为他或她的外貌施展最后的妆容:胎毛正在脱落,毛发也只会保留在那些点睛的地方——睫毛、眉毛和头。Your baby, at almost 4 pounds, is like a cantaloupe weighing down your belly! There isn't much room left in your uterus, but somehow your little bundle will still manage to wriggle and squirm around in there, though maybe not as forcefully as before. Your baby is making final preparations for his or her appearance. The fine covering of body hair called lanugo is falling off, and hair only remains where it's meant to be — on the eyelashes, eyebrows, and head.妊娠第33周:这周,你的宝宝的身体继续变得更加饱满,而妈妈的骨盆则需要支撑着它产生的更大压力。此时唯一仍保持柔软的骨头是宝宝的颅骨,以便适当压缩来适应产道。婴儿的颅骨,在出生后最初的几年中,仍然会有一些柔软的地方(囟门),让大脑得以生长。与此同时,你的腰围越来越大,会让你感觉更不舒服,从胃灼热到痔疮都可能会有。别担心——再熬过几个星期就可以了!This week your baby's body continues to plump up, while the bones underneath harden to support it. The only bones that will stay soft are inside your baby's skull, which will need to compress slightly to fit through the birth canal. There will still be soft spots in your baby's skull throughout the first few years, to allow the brain to grow. Meanwhile, your growing girth is making you more uncomfortable, with afflictions ranging from heartburn to hemorrhoids. Don't worry — only a few more weeks to go!妊娠第34周:现在你的宝宝顶臀径超过30cm,重2250g------大约相当于一个大菠萝的大小。大多数主要的器官(消化系统、呼吸系统和神经系统)几乎都能自主工作。宝宝可能已经处于头位朝下,他/她已经准备好了!此时子宫里的空间更加局促,如果你看到一个不合时宜肘部或膝盖从你的腹部突出来,请不要感到惊讶。Right now your baby measures more than 12 inches from the top of the head to the rump, and weighs 5 pounds — about the size of a large pineapple. Most of the major organs — digestive, respiratory, and nervous systems — are almost able to work on their own. Your baby may already be in the head-down position, ready for delivery! Space in your uterus is tight these days, so don't be surprised if you see an errant elbow or knee poking out from your belly.妊娠第35周:你的子宫里可能没有多少空间了,你的宝宝体重将近2500g,而且开始了更迅速的增长。在接下来的几个星期里,你的宝宝每周会增加450g或更多的体重。婴儿也会在你的盆骨中沉降下来——这个动作被称为“衔接”。这对你的肺来说是个好消息(呼吸现在应该变得更容易了);但是对你的膀胱来说是个坏消息,它将会感觉到更大的压力,因此,你可能会在厕所里花上更多的时间。There may not be much room left in your uterus, with your baby weighing in at nearly 5 1/2 pounds, but now the serious growth begins. For the next few weeks, your baby will put on 1/2 pound or more a week. Baby is also settling into position lower in your pelvis for delivery – this movement is called "lightening." That's good news for your lungs — breathing should get easier now — but bad news for your bladder, which will start to feel more pressure. As a result, you'll be spending even more time in the bathroom.妊娠第36周:再过几天,你的宝宝就会被认为是足月儿了。体重大约2700(大约相当于一个蜜瓜的大小),孩子的身体已经准备好出生了。在这9个月的旅程中,被称为“胎脂”的蜡状白色物质,覆盖了他或她的大部分身体。婴儿吞下胎脂,会形成黑绿色的胎粪,这些胎粪在婴儿的第一块尿不湿中便该找到。从现在开始直到你临产,每周都该去见你的产科医生。In just a few days, your baby will be considered full-term. At almost 6 pounds — about the size of a honeydew melon — your child's body is just about ready for birth. The waxy, white substance called vernix caseosa that covered much of his or her body during this 9-month journey has dissolved. Baby has swallowed this and other substances, which will form the blackish-green meconium bowel movements you'll find in baby's first diapers. From now until the end of your pregnancy, you'll see your ob-gyn at least once a week.妊娠第37周:你的宝宝足月了,重量约3000g,差不多是一个小的保龄球!婴儿自己也正在为分娩做准备,在几周的时间内——或者在这其中的任何一天,他/她的脑袋在你的骨盆中移动,这过程被称为“下降”。此时婴儿的免疫系统功能也启动了,并将在出生后继续发挥作用。建议你采取母乳喂养,这会更好的激发婴儿的免疫系统。Your pregnancy is now full-term, and your baby is just about full-sized. At a weight of 6 1/2 pounds, it's like you're carrying around a small bowling ball! Baby is getting ready for labor, which could be a couple of weeks away — or any day now! His or her head is moving into position in your pelvis, which is called "engaged." Baby's immune system is also arming up, and will keep developing after birth. If you breastfeed, you'll boost baby's immune system even more.妊娠第38周:冲刺阶段!婴儿现在体重超过了3000g。大部分的重量是厚厚的脂肪,这将有助于他或她适应外面世界的温度。宝宝的成长速度已经放缓了,但是器官正常运转更加顺畅。大脑已经开始掌控整个身体的功能——从呼吸到心率调节。机体反应也很活跃(包括抓握和吮吸),这表现为宝宝在出生后不久就能抓住你的手指并放在胸前(握持反应、拥抱反应)。You're in the home stretch! Baby now weighs more than 6 1/2 pounds. Much of that weight is a layer of fat, which will help keep him or her warm in the outside world. Your baby's growth has slowed down, but the organs should all be working now. The brain has started to control the functions of the entire body — from breathing to regulating the heart rate. Reflexes are also active — including the grasping and sucking that allow baby to grab your hand and latch on to a breast soon after birth.妊娠第39周:你的宝宝在你的肚子里就像一个小西瓜,你能感觉到每一份重量。你可能已经准备好了告别胃灼热、背痛和厕所依赖症,并准备好迎接你的宝宝!你不用再等太久了,婴儿随时都可能出生。当你的身体准备分娩时,你可能会注意到更多的Braxton Hicks收缩。如果他们变得更有规律和强烈,是时候联系您的产科医生了。At just over 7 pounds, your baby is like a little watermelon in your belly — and you can feel every ounce. You're probably more than ready to be done with the heartburn, backaches, and constant bathroom visits and ready to meet your baby already! You won't have to wait much longer. Baby could be born any day now. You may notice more Braxton Hicks contractions as your body prepares for labor. If they get more regular and intense, it's time to call the doctor.妊娠第40周:在这一周,你终于可以看一看你在过去的九个月里一直怀着的那个蠕动的小包袱了!然而,小调皮往往不配合时间表,准点靠岸。如果你的孩子仍决定在你的子宫里停留,在预产期前,和你的医生谈谈诱发分娩,也就是所谓的引产。新生儿的体型会有所不同,平均每个宝宝的体重是3200g,顶臀径是50cm。总之届时该恭喜你,终于有了自己的宝宝。This is the week when you should finally get to meet the squirmy little bundle you've been carrying around for the last 9 months! However, often babies don't cooperate and arrive on schedule. If yours decides to stick around in your womb past your due date, talk to your doctor about whether he or she will cause you to go into labor, also known as inducing. Your baby is now full-sized. Although newborn sizes can vary, the average baby weighs 7 pounds, and measures 20 inches long from the top of the head to the rump.生育是女性最伟大的奉献,也是女性体质发生重大变化的关键节点,产后百病诱生,欢迎继续了解下一章节产后诸症。姚志韬医师浙江省中医院妇科 主治医师浙江省中医院 医务部 副部长浙江省数理医学会盆腔整合医学学会 青年委员兼学会秘书浙江省抗癌协会妇科肿瘤分会青年委员浙江省中医院盆腔肿瘤中心秘书浙江省中医盆腔肿瘤MDT秘书本文系姚志韬医生授权好大夫在线(www.haodf.com)发布,未经授权请勿转载。
妊娠第13周:希望你已经安然度过了你的晨吐期。现在的你,应该开始适量增重。不久你的朋友和同事就会注意到你的小肚子了!宝宝现在生长得很快,比例也更加协调——现在大脑袋和身体的比例减小至三分之一。胎盘的形成,提供了稳定的营养来源,并自动清除代谢产物,帮助你的宝宝成长。如果来的是个女宝宝,惊喜的是,这时候她的卵巢已经充满了成千上万的卵子。Hopefully you're over any morning sickness you had. Now, you should be putting on weight. It won't be long before friends and co-workers start to notice your baby bump! Your baby is growing quickly now and is getting more proportional – now the head makes up only 1/3 of your baby's body. Helping your baby grow is the placenta, which is serving up a steady supply of nutrients and disposing of wastes. If you're having a girl, her ovaries are already filled with hundreds of thousands of eggs.妊娠第14周:你的宝宝顶臀径大约有10cm长,重约100g——大概也就是小桃子的大小。就像桃子,他或她的身体被柔软的胎毛覆盖着,它们就像一件小外套,在子宫里提供温暖。当然别担心——这件漂亮的毛皮大衣应该在你的预产期前消失。这时候宝宝也发育出了自己的私人标志,他或她正在设计自己的指纹。兴许,这时候的宝宝,已经在嘴唇里印下了指纹的印痕。Your baby is right around 4 inches long from the top of the head to the rump and weighs about 31/2 ounces — roughly the size of a small peach. Like a peach, his or her body is covered with soft hairs. These are called lanugo, and they're like a little coat providing warmth in the womb. Don't worry — this fine covering of fur should be gone by your due date. Baby is also becoming an individual! He or she is developing fingerprints, including on the thumb, which might have already found its way into baby's mouth.妊娠第15周:很明显,你的宝宝的身体里发生了什么变化。婴儿的皮肤太薄了,薄到你可以看穿它!仔细观察,你就能看到一个由细血管形成的网络。婴儿的肌肉变得越来越强壮,他或她正在通过四处走动,做拳头,尝试不同的面部表情来测试他们。在你下一次的产检中,你的医生应该为你提供一个筛查检测来检查唐氏综合症和其他染色体问题。It's very clear what's going on right now inside your baby's body. Baby's skin is so thin you can see right through it! Look closely, and you'll be able to see a network of fine blood vessels forming. Baby's muscles are getting stronger, and he or she is testing them out by moving around, making fists, and trying out different facial expressions. At one of your next visits, your doctor should offer you a quad screening test to check for Down syndrome and other chromosome problems.妊娠第16周:到目前为止,你的宝宝从头顶到臀部有将近13cm长,重约110g——大约相当于一个小苹果的大小。你现在可能正享受着“怀孕的光辉”,备受家人照顾。如果你的脸颊看起来很红,很健康,那是因为你的血容量增加了,这为你的宝宝提供了充足的营养!但这种额外的血液流动也有一些不利之处,包括鼻出血和下肢静脉曲张。咨询下你的医生,应该能找到求解决这些问题的建议。By now, your baby is nearly 5 inches long from the top of the head to the rump and weighs close to 4 ounces — about the size of a small apple. And you're probably enjoying a "pregnancy glow" right now. If your cheeks look flushed and healthy, it's because your blood volume has increased to supply your growing baby! There are also some downsides to this extra blood flow, including nosebleeds and bigger leg veins. Ask your doctor for tips to deal with these issues.妊娠第17周:所有的系统的发育几乎都是宝宝在成长过程中的一种尝试。肺部在羊水中呼吸,血液在循环系统中周而复始,肾脏正在过滤尿液。宝宝的外表正在改变,头发、眉毛和睫毛都在变长。你的身体也在变化,现在最可能的麻烦是衬衫上的扣子,因为你的乳房已经长大了,开始为喂养宝宝做准备。All systems are a go — or nearly there — inside your growing baby. The lungs are breathing in amniotic fluid. Blood is pumping around the circulatory system. The kidneys are filtering urine. Your baby's looks are changing, as hair, eyebrows, and eyelashes grow in. Your body is changing, too. You might have trouble buttoning your blouse now, because your breasts have grown in preparation to feed your baby. Some women get a full cup size bigger.妊娠第18周:你是否第一次感到了宝宝的运动?可能是这样的,因为婴儿从头顶到臀部有14cm长,重约140g。这大约相当于一个Apple 7的大小,大到可以在每次翻转便能引起腹壁的振动。开始和你的孩子说话吧,他或她的耳朵已经发育得足以听到你的声音!在接下来的一两周内,你可以预约三维超声第一次看到婴儿的样子。虽然这时候已经能通过超声分辨男孩还是女孩——当然,根据我们国家的法律,这是不被允许的,哈哈,听天由命吧!Are you feeling the first flutters of movement? You might be, because baby is now 5 1/2 inches long from the top of the head to the rump and weighs about 5 ounces. That's about the size of a small cell phone and big enough to cause a stir with every roll. Start talking to your baby. His or her ears are developed enough to hear you! In the next week or two, you'll get to see what baby looks like during your first pregnancy ultrasound. You can also learn whether you're having a boy or girl — that is if you want to know!妊娠第19周:环绕和保护你的宝宝的羊水也会影响到他或她娇嫩的皮肤,在婴儿的身体涂上一层蜡状的白色物质,叫做胎脂。它应该在出生之前会消失,除非你的宝宝早产了。当宝宝的头发长出来的时候,你可能会注意到你自己的头发也变厚了。这是因为你正常的头发脱落周期已经变慢了。请享受你浓密的毛发,只要不去染发!(有花堪折直须折,扎起你的麻花辫,等到生完宝宝,这一头靓丽的头发就该还回去一些)The amniotic fluid that surrounds and protects your baby can also irritate his or her delicate skin. That's why baby's body is now coated with a waxy, white substance called vernix caseosa. It should be gone before birth, unless your baby is born early. Under the skin, a layer of fat is forming to provide warmth. As baby's hair grows in, you might notice your own hair getting thicker. This is because your normal hair shedding cycle has slowed down. Enjoy your thick mane while it lasts!妊娠第20周:你已经孕期过半了!在大约20周的时间里,你可能已经通过影像见过了你的宝宝。而在摇篮里,婴儿可以听到并可能对声音做出反应。对他或她说话或唱歌吧——即使只是哼哼——这样你的宝宝就能熟悉你的声音了。目前的婴儿的顶臀径是16.5cm,重约300g——大致相当于一个小香蕉的长度。你和你的孩子将会一起成长,你每周增长的体重大约会在700g左右。You're halfway through your pregnancy! In about 20 weeks, you'll get to meet your baby for the very first time. Inside you, baby can hear and may respond to sounds. Talk or sing — even if you can't carry a tune — so your baby can get familiar with your voice. By now, baby measures 6 1/2 inches from the top of the head to the rump and weighs about 11 ounces — roughly the size of a small banana. Your baby will keep growing, and so will you. Expect to gain about 1/2 pound a week from here on out.妊娠第21周:在你的肚子里更多变化正在发生!婴儿的牙龈里萌发了牙芽;肠道开始产生胎粪(这是一种黏糊糊的、看起来油状的代谢物);眼球可能会出现快速眼动;骨髓增加了血红细胞的产生为婴儿的身体提供氧气。朋友和同事应该已经对你的肚子评头论足了,并祝贺你即将到来!A lot is going on under the surface of your tummy! Tiny tooth buds are popping up in baby's gums. The intestines are starting to produce meconium, the sticky, tarry-looking waste that you'll see in baby's first few dirty diapers. Rapid eye movements may occur. And the bone marrow is ramping up its production of red blood cells, which will soon deliver oxygen to baby's body. Friends and co-workers should already be commenting on your growing belly, and congratulating you on your upcoming arrival!妊娠第22周:这周你的宝宝快500g重了,顶臀径大约是20cm!在你的宝宝体内形成了各种各样的系统,包括会给他或她的器官发号指令的各种激素系统,触觉、嗅闻和各种各样的感觉体验的神经系统。婴儿的性器官现在也在发育,男孩的睾丸已经开始下降;在女孩的子宫、卵巢和阴道也移位到正常位置上。This week your baby is almost 1 pound and 8 inches long from the top of the head to the rump! All sorts of systems are forming inside your baby, including hormones that will give his or her organs the commands they need to operate, and the nerves baby needs to touch, smell, and experience all sorts of other sensations. Baby's sex organs are also developing now. In boys, the testes have started to descend. In girls, the uterus, ovaries, and vagina are where they should be.妊娠第23周:你的宝宝已经超过了500g,而且几乎已经发育到足以在子宫外存活。但你还有几个月的时间把他/她含在腹中。现在是婴儿在世界上真正开始实践和感知的时候了。肺部开始尝试着通过吸入羊水,来为呼吸运动作准备,还生产了一种叫做表面活性剂的物质,让肺部发生膨胀。婴儿的大脑正在创造思维的联系——并与你进行交流。Your baby has passed the 1-pound mark and is almost developed enough to survive outside the womb, but you've still got a few more months to go. Now it's time for baby to practice for life out in the world. The lungs continue to get ready to breathe by inhaling amniotic fluid. They're also producing a substance called surfactant, which will allow the lungs to inflate. Baby's brain is making the connections needed to think — and negotiate with you some day!妊娠第24周:你的宝宝现在体重超过500g,从顶臀径几乎有30cm长——伸展出来的大小相当于一个大型的热狗。你的宝宝现在已经初步具备了生存能力——这意味着如果分娩必须进行,婴儿可以在呼吸机的帮助下存活下来。在过去的几周里,婴儿的皮肤像李子干一样皱起了皱纹。但是,随着皮下脂肪堆积,这些皱纹就会被填满并抚平。指甲开始覆盖指尖。当你的腹部膨胀时,你可能会注意到腹部的拉伸痕迹,这些应该在产后就会消失,当然有些就留下了怀孕的痕迹(妊娠纹)。从现在到28周,产科医生建议进行葡萄糖筛选测试来检查妊娠期糖尿病。Your baby now weighs more than a pound and extends almost a foot long from the top of the head to the rump — stretched out that's about as big as a jumbo ballpark hotdog. Your baby has now reached viability – meaning that the baby would most likely survive with the help of a ventilator if delivery had to take place. In weeks past, baby's skin was as wrinkled as a prune. But those wrinkles are filling in and smoothing out as fat builds up underneath. Fingernails are present. As your own belly expands, you may notice stretch marks forming across your abdomen. These should fade after you deliver. Between now and week 28, your doctor should give you a glucose screening test to check for gestational diabetes.妊娠第25周:你的宝宝正在变大——体重大约是700g——大约是西兰花的大小。当你的宝宝的皮肤从透明到致密的时候,进入你宝宝体内神奇世界的窗口正在关闭(之前医学家可以通过羊膜镜偷窥宝宝的身体变化)。然而,婴儿的心跳正变得越来越清晰。如果你的伴侣把耳朵贴在你的肚子上,那是一种微弱而快速的bah-boom,bah-boom,大到可能足够在腹部就能听到。偶尔,你可能还会感到宝宝一两声轻微的打嗝。Your baby is getting bigger — weighing in at a pound-and-a-half — about the size of a head of broccoli. The window into the amazing world inside your baby is closing, as his or her skin goes from see-through to cloudy. Yet baby's heartbeat is becoming clearer. If your partner puts an ear against your belly, a faint and fast bah-boom, bah-boom may be strong enough to hear. You might also feel a gentle hiccup or two emanating from your belly.妊娠第26周:你的宝宝是900g重。此时他或她的体重与推荐你每天喝的牛奶量差不多,为了宝宝,你需要每日摄入1200毫克的钙。自从你的宝宝的眼皮形成后,他们将会第一次打开,露出蓝颜色的眼睛。不要太执着于颜色——它可能在生命的最初几个月里慢慢发生变化。通过羊膜镜,除了宝宝外观,子宫里没有太多的东西可以看到了。但是如果在你的腹部照射一束光,你的宝宝可能会出现一阵运动反应。Your baby is a 2-pound bundle of joy. He or she weighs about the same as the quart of milk you drink from daily to get your recommended 1,200 mg of calcium. For the first time since your baby's eyelids formed, they've opened, revealing bluish-colored eyes. Don't get too attached to the color — it might change in the first few months of life. There isn't much to see inside your uterus, but if you shine a light on your abdomen, your baby might react with a flurry of movement.本文系姚志韬医生授权好大夫在线(www.haodf.com)发布,未经授权请勿转载。
“月经“”的名称起源《脉经·卷二·平人迎神门气口前后脉第二》公元3世纪 西晋·王叔和“月经”一词首见于此:“左手关上脉阴虚者,足厥阴经也。病苦胁下坚,寒热,腹满,不欲饮食,腹胀,悒悒不乐,妇人月经不利,腰腹痛。在古医籍中,除“月经”一词外,根据月经一月一至、按时而下的特点,尚有用“月事”、“月水”、“月信”、“月潮”、“月汛”等讳饰;根据月经的颜色、性状特点,用“红脉”、“血经”、“月水”、“经水”、“天癸”等讳饰; 《诸病源候论》作为中医的病因病理学专著,对于月经的描述除沿用了“月经”“天癸”及“经血”等经典名称外,还出现了“月浣”“月候”等新名称,表意更加形象具体。不论中外,古人认为月经是不洁之物,又有用“衅”、“婵变”讳饰。由于月经涉及女性生殖器官,且古人认为女性月经期间所排出的血液为不洁的象征,《 本草纲目》中就有“女人入月,恶液腥秽,故君子远之,为其不洁,能损阳生病也”的记载。《圣经·旧约》中写道:女人行经,必污秽七天;凡摸她的,必不洁净到晚上。女人在污秽之中,凡她所躺的物件,都为不洁净,所坐的物件,也都不洁净;在女人的床上,或在她坐的物上,若有其他物件,一人摸了,也必不洁净到晚上。布哈里圣训 第一部:第一卷:经期篇وقولاللهتعالى{ويسألونكعنالمحيضقلهوأذى}إلىقوله{ويحبالمتطهرين 译文:安拉说:“他们问你月经的(律例),你说:‘月经是有害的,故在经期你们应当离开妻子,不要与他们交接,直到她们清洁。当她们洗净的时候,你们可以在真主所命你们的部位与她们交接。’真主的确喜爱悔罪的人,的确喜爱洁净的人。古罗马学者老普林尼在著作《自然史》中这样写:女人的经血会使新酒变酸、使麦子枯萎,杀死蜜蜂、腐蚀铁和铜,让空气中充满恶心的味道,如果狗尝了经血就会疯掉,被这些狗咬上一口,就像被患狂犬病的狗咬了一样。近现代对月经的污名化行为方式月经的称谓国内常用"大姨妈"、“老朋友”、“见红”、“坏(好)事儿”;国外有“鲨鱼周(SharkWeek)”、“血腥玛丽(BloodyMary)”、“女人事(LadyBusiness)”···经期恶俗在印度广袤的乡村地区,“月经隔离”不但更为普遍,条件也更为恶劣。在荒山野岭,常常会出现一些被称为“月经小屋”(Gaokor)的简陋棚屋,一般由木头和红砖搭成,糊上水泥,没有门窗。来月经的女性被迫离开家人,隔离在此。屋内没有床铺,只能睡在硬地板上,碰到雨季,茅草屋顶还会漏雨,地面也会积水。奥斯卡最佳纪录短片《研究月经的男人》《月事革命》月经,阴中之阴,作为女性生理特征,在妇科医生眼里,只是突出代表了生殖繁衍功能的需求。对于月经的羞涩感,是母系社会衰落后的父权思维文化引导的结果。《血证论》问:而女子何以必行经。男子何以不行经。答曰。经血者。血之余也。夫新生旧除。天地自然之理。故月有盈亏。海有朝汐。女子之血。除旧生新。是满则溢。盈必亏之道。女子每月。则行经一度。盖所以泄血之余也。血主阴而下行。所以从下泄。而为经血也。至于男子。虽无经可验。然亦必泄其余。男子以气为主。气主阳而上行。故血余不从下泄。而随气上行。循冲任脉。上绕唇颐。生为髭须。是髭须者。即所以泄血之余也。所以女子有月信。上遂无髭须。男子有髭须。下遂无月信。所主不同。升降各异。只此分别而已矣。气血之余,男子为须,女子为经,虬髯之美,众人称道,经信之难,岂可忽视。顺应时代,解放思想,坦荡面对“月经”,才是现代女性权利的真实体现。六十四卦(学习):屯卦———水雷屯,坎上震下象曰:风刮乱丝不见头,颠三倒四犯忧愁,慢从款来左顺遂,急促反惹不自由。这个卦是异卦(下震上坎)相叠,震为雷,喻动;坎为雨,喻险。雷雨交加,险象丛生,环境恶劣。万物始生,充满艰难险阻,然而顺时应运,必欣欣向荣。中药(学习):当归性味味甘、辛,性温。归经 归肝、心、脾经。功效 补血活血,调经止痛,润肠通便。主治 用于血虚萎黄,眩晕心悸,月经不调,经闭痛经,虚寒腹痛,风湿痹痛,跌扑损伤,痈疽疮疡,肠燥便秘。酒当归活血通经。用于经闭痛经,风湿痹痛,跌扑损伤。《本草正》:“当归,其味甘而重,故专能补血,其气轻而辛,故又能行血,补中有动,行中有补,诚血中之气药,亦血中之圣药也。”“大约佐之以补则补,故能养荣养血,补气生精,安五脏,强形体,益神志,凡有形虚损之病,无所不宜。佐之以攻则通,故能祛痛通便,利筋骨,治拘挛、瘫痪、燥、涩等证。《本草新编》当归,味甘辛,气温,可升可降,阳中之阴,无毒。虽有上下之分,而补血则一。东垣谓尾破血者,误。入心、脾、肝三脏。但其性甚动,入之补气药中则补气,入之补血药中则补血,入之升提药中则提气,入之降逐药中则逐血也。而且用之寒则寒,用之热则热,无定功也。功虽无定,然要不可谓非君药。如痢疾也,非君之以当归,则肠中之积秽不能去;如跌伤也,非君之以当归,则骨中之瘀血不能消;大便燥结,非君之以当归,则硬粪不能下;产后亏损,非君之以当归,则血晕不能除。肝中血燥,当归少用,难以解纷;心中血枯,当归少用,难以润泽;脾中血干,当归少用,难以滋养。是当归必宜多用,而后可以成功也。倘畏其过滑而不敢多用,则功用薄而迟矣。不良反应:如畏其滑肠,则佐之白术、山药之味,何不可者。或疑当归滑肠,产妇血燥,自是相宜。然产妇亦有素常肠滑者,产后亦可用当归乎?曰∶产后不用当归补血,实无第二味可以相代。即平素滑肠,时当产后,肠亦不滑,正不必顾忌也。
乳腺肿瘤兼内异,囊肿复发疼痛剧尿管压迫粘连密,手术困难西药忌不抛弃且不放弃,中医外治显神奇囊肿缩小疼痛消,巩固战果尚可期子宫内膜异位症(endometriosis,EMT)简称内异症,是指具有生长功能的子宫内膜组织(腺体和间质)出现在子宫腔及宫体肌层以外的部位,异位内膜可侵犯全身任何部位,但绝大多数位于盆腔脏器和壁腹膜,以卵巢(巧克力囊肿,简称巧囊)、宫骶韧带最常见。主要表现为逐渐加重的继发性痛经。子宫内膜异位虽然属于良性病变,但具有恶性肿瘤的转移和种植能力,且易复发,严重影响女性的生殖健康和生活质量。案例故事,始于一个新的希望一名满怀期待的中年女性来到衢州中医医院妇产科就诊。她三年前因乳腺癌做了手术和化疗,两年前因为双侧巧克力囊肿破裂,急诊进行腹腔镜囊肿剥离术。由于顾虑乳腺癌病史禁忌,患者没有接受异位症维持治疗药物,不久囊肿便复发了,除了典型的痛经、盆底疼痛症状外,还有严重的性交痛和腰部胀痛。听说最近衢州中医院妇产科来了抗子宫内膜异位症的新药(地诺孕素),她满怀希望前来就诊。首诊宋燕医师,仔细评估了病人情况,发现巧克力囊肿虽然不算大(53cm),但坚实的固定在盆腔侧方,压迫了输尿管,并引起一侧肾脏积水,这就解释了她的临床表现。病情是明了啦,但该怎么治疗,却仍然是个棘手问题:药物保守Vs乳腺癌禁忌手术治疗Vs输尿管损伤防护一系列困难摆在面前,先请示浙江省中医院驻衢州中医院姚志韬主任和邱淑芬主任、中医妇科童桔英主任等,开展一个小型的盆腔疑难疾病多学科MDT,面对盆腔疑难疾病,这已经成为工作常规。l“影像提示肿瘤固定,输尿管周围组织水肿,局部结构有点混杂,是个难题”。l“肿瘤指标轻度偏高,可能和内异症活动性有关。”l“手术有指征,但是输尿管损伤风险较高,确实要谨慎啊”。l“地诺孕素是目前子宫内膜异位症保守治疗的高效药物,但其药物说明书禁用于乳腺癌等激素依赖性肿瘤,原则上这一类药物都不能作为保守治疗的推荐方案”。l“子宫内膜异位症、乳腺恶性肿瘤,都是典型的情志相关疾病(统称郁证),中药疏肝解郁,清热解毒,散瘀消癥,可能疗效是慢了点,但确实有效。”l“不抛弃不放弃,也不纠结不犹豫,要不我们医师自己也得焦虑耗成内异症。可以先试试红藤汤中药保留灌肠外治,对盆腔水肿和瘀血吸收能起到很好的作用,期待较快的达到治疗效果。患者有恶性肿瘤病史,也要兼顾内异恶变风险,又有输尿管压迫,引起了肾脏积水,后期如果反复症状性发作或指标异常,便需考虑手术治疗”。一个月后。。。。。。疼痛好转,VAS评分6分降低至VAS平分1分,无夫妻生活疼痛中断。阴道超声:囊肿大小从5.54.8cm逐步缩小至3.22.6cm,2.31.9cm。肾脏超声:输尿管扩张1.28cm降至正常。“开心点,巩固治疗,定期监测,也许我们的武功不需要用在你的身上。”“我们需要掌握核武器,但最好不用核武器”,这是来自一个妇科手术医师的嘱托和自省。后记子宫内膜异位症属于女性高发疾病,是典型的情志相关疾病,也是时间依赖性疾病,与情绪、饮食、作息及外部环境等相关,与月经周期相关,与宫腔操作相关,随着女性年龄增长呈渐进趋势。减少子宫内膜异位症相关危害,重在管理,重在预防,重在减轻和消除疼痛、促进和保护生育能力、降低和减少复发、警惕和早期发现恶变,提高患者的生命质量。子宫内膜管理:减少子宫内膜损伤,减少不必要的人工流产,剖宫产等医源性结构损伤;规律月经周期,维护子宫内膜的定期剥脱。疼痛管理:70%~80%的患者有不同程度的盆腔疼痛,包括痛经、慢性盆腔痛、性交痛、肛门坠痛、排便痛、疼痛过敏以及中枢性疼痛等。根据不同年龄阶段和疼痛评分(VAS0-4分,5-7分,8-10分)、内异包块大小采取不同的药物干预(口服避孕药、高效孕激素、曼月乐、地诺孕素、GnRH-a、中药)、手术干预等原则化个体化治疗。情志管理:女子以肝为先天,主动或被动的情绪失常,可导致气机错乱,呈气滞、寒凝、血瘀、痰湿等辨证型别。家庭和睦,工作顺心,睡眠充足,饮食平衡,是内异症患者的生活基础。出现早期症状,自我调解困难,借助中医调经解郁,也能取得良好成效。性生活管理:严重的子宫内膜异位症可以引起性交痛,性生活障碍。而不满意的夫妻生活,或会导致进一步的情志异常,加重郁证状态。缓解子宫内膜异位症症状,改善性生活质量,有助于子宫内膜异位症治疗及家庭生活美满。微创手术治疗合并盆腔包块直径≥4cm或不孕或药物治疗无效者,应手术治疗。内异症以良性为主,手术属于计划性择期或限期类别,中西结合的围术期管理,是子宫内膜异位症手术治疗的理想流程。小贴士:中药保留灌肠技术l灌肠疗法又称直肠给药法,是在继承中医传统的直肠给药方法的基础上,结合现代的灌肠技术和中医辨证论治发展起来的一种独特的疗法。l拟好灌肠的方剂并采用煎制灌肠液中药,液量100ml,温度控制在39-40度,将灌肠液装入输液瓶中。根据病情安排体位,取左侧卧位。挂灌肠器于架上,液面高于肛门,润滑导管后从肛门插入25-30cm保留灌肠,缓慢滴入药液,并尽量保留药液不溢出(0.5-2h或更长时间)。如:浙江省中医院妇产科复方大血藤灌肠院内制剂请关注姚志韬主任与衢州中医医院妇产科“”让微创更微创真实案例”科普续集让微创更微创--良性肿瘤宫外孕,单孔腔镜无痕迹让微创更微创---巧囊复发无良方中药灌肠入厅堂让微创更微创--宫腔疾病发病多,免麻免扩先诊断让微创更微创--术前术后服中药,中西结合更无伤让微创更微创--腔镜小孔细操作,恶性肿瘤也微创让微创更微创--肿瘤扩散需开腹,先期治疗不慌张让微创更微创--恶性肿瘤后续管,基因检测帮上忙让微创更微创--肿瘤复发无良方,盆腔团队共商量(备注:科普可学习,得病需就医,世态万万千,诊治忌雷同)