妇产科研究生英语题.doc

妇产科学专业研究生专业英语考试题Introduction Endometriosis represents a common gynecological condition reaching 5%-15% of childbearing age women and up to 3%-5% of post-menopausal women. The number of women with endometriosis is estimated to be seven million in the USA, being one of the main causes for gynecological hospitalization in industrialized countries. This disease is defined by the presence of stromal and/ or endometrial glandular epithelium implants in extra-uterine location4, possibly compromising several sites, including ovaries, peritoneum, uterosacral ligaments, retrocervical area, rectovaginal septum, rectum/sigmoid, terminal ileum, vermiform appendix, urinary bladder, and ureters. Some patients with endometriosis are asymptomatic; however, most of them have clinical complaints in different intensities, with the main ones being dysmenorrhea, chronic pelvic pain, infertility, deep dyspareunia, cyclic bowel and urinary symptoms, such as pain or bleeding on defecation or urination during the menstrual period. Among other factors, occasional nonspecificity of the clinical picture and the noncorrelation between symptoms and disease severity can explain the delay in endometriosis diagnosis. A number of aspects of the disease are still study targets, with the search of the etiopathogenesis standing out, considering that if the reason for the endometriosis focus development is understood, directing efforts to improve diagnosis and treatment will be possible. Two main etiopathogenic hypothesis lines of thought have been cited for almost one century: coelomic metaplasia theory, where mesothelium turns into endometrial tissue; retrograde menstruation theory, postulating the implant of endometrial cells from menstrual blood reflux through the Fallopian tubes into the abdominal cavity15, occurring under the influence of a favorable hormone environment and immunological factors which would not clear the cells out of the inappropriate site. Koninckx and Martin, in 1992, divided this disease into three distinct conditions: peritoneal, ovarian, and rectovaginal septum endometriosis, with the last one being called deep infiltrating endometriosis. In the first case, patients with peritoneal implants would be included; in the second case, the well-known ovarian cysts, typical of the disease; and in the third case, the infiltrating endometriosis affecting retrocervical and paracervical areas, in addition to gastrointestinal and genitourinary tracts. Although the typical symptoms of endometriosis are well-known, they might be poorly specific or be related to the involvement sites of the disease foci. Patients can experience pelvic pain, infertility, cyclic intestinal and/or urinary changes and this may not be an endometriosis case. Non-invasive endometriosis diagnosis via laboratory methods has no satisfactory results, but despite definitive diagnosis depends on surgical methods to obtain the material and disease histological confirmation, imaging methods have significantly progressed over last years, with high accuracy levels for deep endometriosis cases. Over the last years, much has been studied about the immunological factors in endometriosis pathogenesis and many abnormalities have been found, with the main mechanism assessed being additional to the retrograde menstruation theory. For some reason that is uncertain at the moment, endometrial cells that enter the abdominal cavity would not be cleared and, thus, they would be allowed to implant and the disease would be developed. 子宫内膜异位症是一种常见妇科疾病，育龄妇女发病率达到5% -15%的，绝经后妇女达3% -5% 。美国有7万人子宫内膜异位症，成为在工业化国家妇科病人住院一个主要的原因。本病是指存在的间质和/或子宫内膜腺上皮细胞植入子宫外部位，可能种植的几个地点，包括卵巢，腹膜，子宫骶韧带，子宫颈后的地区，直肠阴道隔，直肠、乙状结肠，末端回肠，盲肠，膀胱，和输尿管。一些患者的子宫内膜异位症是无症状的；然而，他们大多临床上有不同程度的不适，其主要表现是月经困难，慢性盆腔疼痛，不孕，深部性交疼痛，肠道和泌尿系统症状，如疼痛或出血，在月经期排便或排尿痛或出血。除其他因素外，偶尔的非特异性的临床影像以及症状与疾病的严重程度不相关，可以解释延误子宫内膜异位症的诊断。疾病的发病机理多样性研究仍然是焦点，认为如果子宫内膜异位症的发病原因清楚了，改善诊断和治疗将成为可能。近一个世纪两个主要发病机理假说已被引用：体腔上皮化生学说，间皮转变成子宫内膜组织；经血逆流学说，假定的混入子宫内膜细胞经血逆流通过输卵管进入腹腔，在一个良好的激素环境和免疫因素作用下，不能在不恰当的位置辨明细胞。Koninckx和Martin，1992，分为三个不同的类型：这种疾病的腹膜，卵巢，和直肠阴道隔子宫内膜异位症，后者被称为深浸润子宫内膜异位症。第一种情况包括腹膜种植的患者；第二种情况，常说的卵巢囊肿，典型病变；第三种情况下，浸润宫颈旁和后部的区域，除外胃肠道和泌尿道。虽然典型症状的子宫内膜异位症是众所周知的，他们可能是不典型的或与疾病好发部位不相关的。患者能盆腔疼痛，不孕，肠蠕动和/或排尿的变化