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病历翻译(中英作品展示)

2011,患者因为眼部外伤致右眼球凸出,眼睑肿胀,当地医院CT提示右眶肿瘤,考虑为血管瘤。

2011-03-15,患者于中国人民武装警察部队总医院行全麻下右眶肿瘤切除术,术后病理提示脉管瘤。术后恢复良好,眼球回退至基本正常。

2011-08,患者突发出现有眼球突出,经2月余右眼突出逐渐消失。

2011年底,患者再次出现右眼球突出并缓慢自行消退。

2012-11,患者再次出现右眼球突出,逐渐加重,无好转迹象。

2013-03-21,患者于全麻下行右眶内外联合开眶眼眶血肿清除+血管畸形栓塞术+眼眶内壁减压术,手术过程顺利。

2013-03-21,患者突然出现眼球突出,眶压增高,考虑为术后急性框内出血,经保守治疗后无明显好转。

2013-03-28,患者于全麻下行右眼皮肤切口拆线+睑裂缝线拆线+右眶穿刺抽液治疗,治疗过程顺利,穿刺抽液后眼球回退明显,框压明显降低。针对眼球突出、框压增高等框内出血、渗血的症状,给予止血、消肿及支持治疗后,病情基本稳定。考虑患者畸形血管供血丰富,与视神经关系密切,再次手术风险较大,为保护视力及眼部功能,密切观察,暂不手术治疗。



2011: The patient had an eye injury, causing right-sided exophthalmos and eyelid swelling. CT scan at the local hospital indicated right orbital tumor, suggestive of hemangioma.

3/15/2011: Under general anesthesia, the patient underwent resection of the right orbital tumor at General Hospital of Armed Police Forces. Postoperative pathology study indicated vascular tumor. Postoperative recovery was good. The eyeball grossly returned to normal position.

8/2011: The patient suddenly presented with exophthalmos which gradually disappeared more than 2 months later.

In late 2011, the patient presented with right-sided exophthalmos again which gradually disappeared spontaneously.

11/2012: The patient presented with right-sided exophthalmos again which worsened gradually and there was no sign of improvement.

3/21/2013: Under general anesthesia, the patient underwent right orbital hematoma resection via combined medial and lateral orbitotomy + embolization for vascular malformation + decompression of orbital medial wall, with uneventful process. On the same day, the patient suddenly presented with exophthalmos and increased orbital pressure, suggestive of postoperative acute intra-orbital hemorrhage which was not improved by conservative treatment.

3/28/2013: Under general anesthesia, the patient underwent stitches removal of right ocular skin incision + palpebral fissure suture removal + puncture and drainage of right orbit, with uneventful process. After that, the exophthalmos was improved and the orbital pressure decreased markedly. For exophthalmos, increased orbital pressure, intra-orbital hemorrhage and blood oozing, the patient was given hemostasis therapy, detumescence and other supportive treatments. The condition was grossly stable. Since the malformed vessel had abundant blood supply and close connection with optic nerve, a second surgery would have high risk. Therefore, to protect the vision and ocular function, she only received close follow-up and no surgical treatment was performed.