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女性生殖道出血的鉴别诊断

Author
Andrew M Kaunitz, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG
Translators
陈蔚琳, 副主任医师，副教授

引言

生殖区域观察到异常出血的女性就诊时通常主诉阴道出血。临床医生常将出血归因于子宫来源，但出血也可能由下生殖道(外阴、阴道、宫颈)或上生殖道(宫体、输卵管、卵巢)的任何解剖部位的疾病引起。出血也可能源自非妇科部位，例如尿道、膀胱、肛门或其他肠道部位。下表列出了生殖道出血的鉴别诊断(表 1)。生殖道出血的鉴别诊断随不同的年龄组而异(表 2)。

女性生殖道出血的鉴别诊断的概述将总结在此。对有异常子宫出血(abnormal uterine bleeding, AUB)女性的评估将单独讨论。(参见“非妊娠育龄期女性异常子宫出血的评估”和“妊娠女性阴道出血的病因与评估概述”和“绝经后子宫出血”)

卵巢出血

卵巢出血很少表现为阴道出血。卵巢出血最有可能发现为腹腔内的。少见情况下，卵巢包块、创伤或感染引起的出血可能通过输卵管并延伸至下生殖道。

卵巢癌 — 阴道出血是卵巢癌的少见表现[1,2]。(参见“上皮性卵巢癌、输卵管癌及腹膜癌的临床特征和诊断”，关于‘其他症状’一节)

输卵管出血

与卵巢出血相似，输卵管出血可能很少会通过子宫而表现为阴道出血。但是此情况少见，且大多数输卵管出血被发现为腹腔内的。输卵管出血的病因包括输卵管妊娠、肿瘤性疾病、创伤和感染。

                                                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-13.
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