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张某,50岁,住院号48905。阴道流血近50天,多时达月经量,无腹痛,亦未就医。于1983年3月1日晨4时许出现排便困难,持续时间约半小时,突然由阴道脱出一肿物,疼痛难忍,出血增多共约400ml6小时后来院就诊。既往足月正常分娩2次,末产24年前。宫内置环多年未查。患精神分裂症史,问诊检查均不甚合作,病史大部分由爱人叙述。查体:T36.5℃,P70次/分,Bp100/60mmHg。面色苍白,痛苦面容。意识清,心肺正常。腹部软,下腹部有压痛。阴道外口脱出一手拳大圆形肿物,紫红色,表面光滑有少量渗血,弹性硬,表面未见输卵管开口处。内诊及双合诊见:肿物完全脱出于阴道外口,蒂粗直径为4cm,呈圆柱形长约10cm,上端达盆底水平,触不到宫颈,也触不到子宫体。向膀胱内注入氯化钠液后行B 超检查,耻骨联合下显示正常大的子宫。宫内有节育器反射,双侧附件显示不清。化验:Hb85g/L,WBC13×10~9/L。初步诊断:①粘膜下子宫肌瘤(伴急性脱出),②失血性贫血,③合并子宫内翻?
Zhang, 50 years old, hospital number 48905. Vaginal bleeding nearly 50 days, up to menstruation, no abdominal pain, nor medical treatment. At 4:00 on March 1, 1983 at about 4 pm when defecation difficulties occurred, the duration of about half an hour, suddenly a prolapse from the vagina pain, unbearable pain, increased bleeding about 400ml 6 hours later to hospital. Past full-term normal delivery 2 times, 24 years ago, the end of the last. Palace built ring for many years did not check. Suffering from schizophrenia, medical examination are not very cooperative, most of the history described by the lover. Physical examination: T36.5 ℃, P70 beats / min, Bp100 / 60mmHg. Pale, painful face. Consciousness, normal heart and lung. Abdomen soft, tenderness in the lower abdomen. Vaginal mouth prolapse big hand round fistula, purple, smooth surface with a small amount of oozing, elastic hard, the surface no tubal openings. Internal consultation and double co-clinic see: The tumor completely out of the vaginal orifice, pedicle diameter of 4cm, was cylindrical about 10cm, the upper reaches of the pelvic floor level, touch the cervix, but also touch the uterus. Into the bladder after the injection of sodium chloride B ultrasound examination, the pubic symphysis showed normal large uterus. Intrauterine IUD reflex, bilateral attachment is not clear. Laboratory: Hb85g / L, WBC13 × 10 ~ 9 / L. Preliminary diagnosis: ① submucosal uterine fibroids (with acute prolapse), ② hemorrhagic anemia, ③ combined with intrauterine inversion?