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患者35岁,住院号1631,孕3产2,既往健康。平素月经规律,末次月经1989年1月10日,预产期为1989年10月17日,孕期经过正常。于住院前10天,无意中发现右下腹有一包块,超新生儿头大,无痛感。入院前24小时出现腹痛,逐渐加重,于1989年10月27日急诊转入我院。查体:T36℃,P88次/分,Bp17/12kPa,无贫血貌,子宫底平剑突,腹围110cm,宫高52cm,胎位为RSA,纵产式,臀先露,胎心128次/分,右下腹触及一实性包块,上界平脐,下界嵌入盆腔,包块与宫体间有凹陷状分界,但二者不能分开。阴道检查:宫口开大5.0cm,先露为足,未破膜,胎泡已形成,于后穹窿处可触及肿物下极阻碍先露部下降。B超检查证实为臀位,胎儿双顶径为9.6cm,盆腔内有巨大实质性肿物。在硬膜外麻醉下行急诊剖腹探查术及剖宫产术,术中见肿物来自子宫下段右前壁,部分向右阔韧带内生长呈哑铃形分叶状,上界达子宫体中下1/3,下界嵌
Patient 35 years old, hospitalization number 1631, pregnancy 3 3, past health. Normal menstrual regularity, the last menstrual January 10, 1989, the expected date of October 17, 1989, during pregnancy through the normal. 10 days before admission, inadvertently found a right lower quadrant with a mass of super-neonatal big head, no pain. 24 hours before admission abdominal pain, and gradually increased, in October 27, 1989 emergency department transferred to our hospital. Physical examination: T36 ℃, P88 beats / min, Bp17 / 12kPa, no anemia, uterine atypical kyphosis, abdominal circumference 110cm, uterine height 52cm, fetal position RSA, Points, the right lower abdomen touches a solid mass, the upper bound flat umbilical, the lower bound embedded in the pelvis, mass and the palace between the hollow-shaped demarcation, but the two can not be separated. Vaginal examination: cervix open large 5.0cm, first exposed enough, unbroken membrane, bubble has formed in the posterior fornix palpable tumor under the pole blocking the first dew drop. B-ultrasound confirmed breech, fetus biparietal diameter 9.6cm, a huge pelvic mass. Under epidural anesthesia underwent emergency laparotomy and cesarean section, intraoperative see tumor from the right anterior wall of the lower uterine segment, part of the right wide ligament growth within the dumbbell lobulate, the upper limit of the uterus 1 / 3, lower bound embedded