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妊娠期甲状腺功能异常和自身抗体阳性可作为妊娠并发症和母体日后发生甲状腺疾病的预测因子
妊娠能够预示妇女未来的健康状况,因其对机体各器官系统的功能都是很大的考验.妊娠期间,母体的甲状腺功能可出现某些改变.如果机体不能适应这些生理变化,则可产生甲状腺功能异常,特别于甲状腺抗体阳性者.在妊娠期间,甲状腺功能异常和(或)自身抗体阳性较为常见,一般认为这对母体和胎儿健康可产生不良影响,并与胎盘早剥、妊娠糖尿病、妊娠高血压和先兆子痫等妊娠并发症有关,但尚未得到全面证实.对这些并发症所作的研究表明,研究对象、甲状腺功能异常的定义以及背景因素的差别可能是结果不一致的原因.
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BACKGROUND:?At?the?time?of?diagnosis,?most?patients?with?gallbladder? cancer? are? in? advanced? stage? and? the? cancer? is?unresectable.?Long-term?survivors?are?usually?seen?in?a?small?number? of? patients? with? incidental? gallbladder? cancer.? This?study?aimed?to?identify?preoperative?predictors?of?incidental?gallbladder?cancer?in?elderly?patients.
METHODS:?A?total?of?4014?patients?of?more?than?44?years?old?who?had?undergone?cholecystectomy?at?our?department?from?January?2000?to?December?2010?were?retrospectively?reviewed.?Univariate?and?multivariate?modalities?were?used?to?identify?the?predictive?factors?of?incidental?gallbladder?cancer.
RESULTS:?Twenty-nine? of? the? 4014? patients? who? had? under-gone? cholecystectomy? for? benign? gallbladder? diseases? were?histologically?diagnosed?as?having?incidental?gallbladder?can-cer.?Multivariate?analysis?identified?that?elevated?carbohydrate?antigen? 19-9? combined? with? carcinoembryonic? antigen? and/or? carbohydrate? antigen? 125? (P=0.045),? a? gallbladder? polyp?greater?than?or?equal?to?1.2?cm?(P=0.043)?and?focal?gallblad-der?wall?thickening?of?more?than?or?equal?to?5?mm?(P=0.002)?were?predictive?factors?of?incidental?gallbladder?cancer.
CONCLUSION:?Cholecystectomy? is? suggested? for? patients?with?these?predictive?factors?and?intraoperative?frozen?section?should?be?considered?to?rule?out?carcinoma.
