医学汉英翻译记忆库27(5000条)

ChineseEnglish他们发现如果不能从组织学上除外自然流产，髙达40%的异位妊娠诊断错误。Theyfoundthatthepresumptivediagnosisofectopicpregnancyisinaccurateinnearly40percentofcaseswithouthistologicexclusionofaspontaneouspregnancyloss.然而,尚缺乏有效的评价子宫内膜取样的时机和方式的研究。Nevertheless,theneedandmethodofendometrialsamplingmustcarefullybeweighedagainstthelimitedrisksofmethotrexate.有研究Pipelle活检是否可作为刮宫术的替代,发现其取得绒毛的敏感性为30%-63%(Barnhart,2003b;Ries,2000)。Pipellebiopsywasstudiedasanalternativetocurettageandfoundinferior,withsensitivityofobtainingvillirangingfrom30to63percent(Barnhart,2003b;Ries,2000).与此对比，用刮宫取得组织的冷冻切片确定妊娠产物的准确性要超过90%(Barak，2005；Spandorfer,1996)。Bycomparison,frozensectionofcurettagefragmentstoidentifyproductsofconceptionisaccurateinover90percentofcases(Barak,2005;Spandorfer,1996).新的血清标志物NovelSerumMarkers有一些小规模的研究来评价新的、诊断异位妊娠的标志物。Anumberofsmallstudieshavebeendonetoevaluatetheutilityofnovelmarkerstodetectectopicpregnancy.Daniel等（1999)发现血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)的浓度〉200pg/L可以用来鉴别诊断异位妊娠和正常或死亡的宫内妊娠，其敏感性、特异性和阳性预测值分别为60%、90%和86%。Danielandassociates(1999)foundthatvascularendothelialgrowthfactor(VEGF)inconcentrations200pg/mLcoulddifferentiatebetweenanectopicandanormalorarresteduterinepregnancywithasensitivity,specificity,andpositivepredictivevalueof60,90,and86percent,respectively.此外，还有学者研究癌抗原125(cancerantigen125，CA125)、血清肌酸激酶和胎儿纤维连接蛋白浓度作为异位妊娠的标志物（NeSS1998;Predanic,2000)。Inaddition,cancerantigen125(CA125),serumcreatinekinase,andfetalfibronectinconcentrationshavebeeninvestigated(Ness,1998;Predanic,2000).近日，质谱为基础的蛋白质组学技术也被用来确定正常妊娠和它的一些疾病（尚卡尔，2005年）的生化蓝图。Recently,massspectrometry-basedproteomictechniqueshavealsobeenusedtodeterminethebiochemicalblueprintofnormalpregnancyandsomeofitsdisorders(Shankar,2005).诊断评价总结SummaryofDiagnosticEvaluation临床医生在只有50%的自然流产患者的妊娠产物中发现绒毛，另外有30%的绒毛被病理科医生发现。Chorionicvilliinspecimensfromwomenwiththediagnosisofspontaneousabortionwereidentifiedclinicallyinonlyhalfofcasesandbythepathologistinanother30percent.因此,剩下的20%的患者仍然有异位妊娠的可能性(Lindahl,1986)。Thusin20percentofwomen,anectopicpregnancywasstillaconsideration(Lindahl,1986).诊断性腹腔镜仍然是诊断异位妊娠的金标准（图7-9，彩图7-3)。Confirmationbydiagnosticlaparoscopyremainsthegoldstandardfordiagnosisofectopicpregnancy(Fig.7-9).应用现有的高敏感性的诊断手段，异位妊娠完全可以在术前得到诊断。Thatsaid,withsensitivediagnosticmodalitiesavailable,ectopicpregnancycantypicallybediagnosedpriortosurgery.图7-9腹腔镜图像FIGURE7-9Laparoscopicphotograph.用钝型的拨棒暴露一个蓝色、增大的输卵管壶腹部。Thebluntprobeelevatesablue,distendedlefttubalampulla.(由KevinDoody博士提供）(CourtesyofDr.KevinDoody.)应用规范的循证医学的方法可以帮助异位妊娠的诊断。Useofanevidence-basedalgorithmwillfacilitateidentificationofanectopicpregnancy.经过适当的临床评价后，所有生育年龄的可疑异位妊娠的患者均应检查尿hCG。Afterappropriateclinicalevaluation,allreproductive-agedwomenwithanysuspicionofpregnancyshouldbetestedusingasensitiveurine-hCGassay.如果结果为阳性、超声检查不能证实为宫内妊娠、没有急性腹腔内出血的征象，应该怀疑异位妊娠的存在，然后进一步进行如图7-10所示的检查。Followingpositivetesting,ifanintrauterinepregnancyisnotconfirmedbysonography,nosignsofacuteintra-abdominalhemorrhagearepresent,andanectopicgestationissuspected,thenanevaluationsuchastheonedepictedbythealgorithminFigure7-10maybeused.Gracia等（2001)进行了一项研究来发现6种评价手段先后顺序如何才能更有效地发现异位妊娠以及减少对宫内妊娠的干扰。Graciaandcolleagues(2001)performedadecisionanalysisofsixdiagnosticstrategiestoevaluatewhichsequenceoftestswasmostefficientinyieldingthefewestmissedectopicpregnanciesandinterrupteduterinepregnancies.他们发现在孕早期腹痛或阴道出血的患者最佳的检査手段为TVS。TheyfoundthebeststrategytobeTVSforallwomenwithfirst-trimesterpainorbleeding.如果结果不能明确诊断，然后应测定血清hCG水平。Iffindingsarenotdiagnostic,thenserum-hCGlevelsaremeasured.应用这种检查策略，只有1%的潜在宫内妊娠受到干扰，并且没有异位妊娠漏诊，确诊的平均时间为1.5天。Usingthisstrategy,only1percentofallpotentialuterinepregnancieswereinterrupted,noectopicpregnanciesweremissed,andtheaveragetimetodiagnosiswas1.5days.由于超声检查发现官内妊娠的总体敏感性低于93％(由于陈旧的超声设备、无经验的超声医师、患者肥胖或不适、解剖改变）。他们建议先测定血清hCG水平，在超过警戒水平的患者进行超声检査。Intheeventthatoverallsensitivityofavailablesonographyfordetectinguterinepregnancyislessthan93percentbecauseofoldersonographicequipment,aninexperiencedsonographer,patientobesityordiscomfort,ordistortedanatomytheyrecommendmeasurementofserum-hCGlevelsfirst,reservingsonographicexaminationforthosewomenwithlevelsabovethediscriminatoryzone.图7-10异位妊娠的诊断步骤FIGURE7-10Algorithmofectopicpregnancyevaluation.-hCG=-人绒毛膜促性腺激素，D＆C=刮宫术;IUP=宫内妊娠;TVS=阴道超声。-hCG=-humanchorionicgonadotropin;D&C=dilatationandcurettage;IUP=intrauterinepregnancy;TVS=transvaginalsonography.在血液动力学稳定的阴道出血妇女，如果血清hCG2000IU/L并且超声检查没有发现宫内妊娠，那么诊断为可疑完全流产。Ahemodynamicallystablewomanwithvaginalbleeding,aserum-hCGlevel2,000IU/L,andnosonographicevidenceforauterinepregnancyisagoodcandidateforexpectantmanagementofpresumedcompleteabortion.24-48小时内重复测量血清hCG水平来明确其变化趋势（Condous，2005)。Serum-hCGlevelsarerepeatedin24to48hourstoelicitthetrendofchange(Condous,2005).如果其下降值2天小于20%或7天小于60%，可以除外完全流产，应该怀疑滋养层组织的持续存在，可能为不全流产或异位妊娠(Barnhart,2004a)。Iftherateofdeclineislessthan20percentat2daysor60percentat7days,thencompletedspontaneousabortionisexcluded,andpersistenceoftrophoblastictissuefromeitheranincompletemiscarriageoranectopicpregnancymustbeassumed(Barnhart,2004a).缺少临床干预的输卵管妊娠可能会发生输