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1.Screening
1.1.Inclusion Criteria

Inclusion criteria

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1.2.Exclusion Criteria

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刘义彬

Date

2022-05-17 yyyy-mm-dd

2.Baseline
2.1.Medical History

24 小时

Average times of menstrual onset a year

14.9 次/年

Menarche time

13 岁(years)

Average menstrual cycle

24.5 天(days)

The time of last Menstruation

2022-04-28 年、月、日(yyyy-mm-dd)

The time of menstrual onset before the last one

不详 年、月、日(yyyy-mm-dd)

Disease or surgery name

Date of the confirmation or the surgery

-- 年/月/日(yyyy-mm-dd)

Date

2022-5-17 yyyy-mm-dd

2.2.General information

Date of signing the informed consent

2022-05-09

Date of birth

1982-003-24 yyyy-mm-dd

Age

40 Years

Education background

Middle school

Occupation

Other

Other (Description)

自由

2.3.Physical examination

Vulva

Not examined

Description in detail for abnormal

Vagina

Normal

Description in detail for abnormal

Uterine neck

Normal

Description in detail for abnormal

Corpus uteri

Normal

Description in detail for abnormal

Adnexa uteri

Left side

Not examined

Description in detail for abnormal

可触及5*5cm包块

Right side

Normal

Description in detail for abnormal

Weight

71 kg

Hight

1650 mm

Systolic pressure (SP)

147 mmHg

Diastolic pressure

100 mmHg

Temperature

36.4 degree Celsius

Pulse rate

88 次/分

Breath frequency

22 次/分

Doctor signature

刘义彬

Date

2022-05-09 yyyy-mm-dd

2.4.Blood Routine Tests

WBC

12.3 ×109 /L

NEUT%

88.3 %

LY%

7.2 %

MONO%

4.4

RBC

4.36 ×10^12 /L

HGB

128 g/L

PLT

395 ×10^9 /L

Researcher signature

刘义彬

Date

2022-05-09 yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

pH value

未查

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

UBG

NIT

Date of test

未查 yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

11.8 U/L

AST

10.3 U/L

GGT/γ-GT

14 U/L

ALP

65 U/L

TBIL

16.6 μmol/L

DBIL

5.1 μmol/L

IBIL

11.5 μmol/L

ALB

43.8 g/L

UA

179 umol/L

UREA

1.8 mmol/L

TC

-- mmol/L

Cr

43 umol/L

TG

-- mmol/L

HDL

-- mmol/L

LDL

-- mmol/L

CK

-- U/L

CK-MB

-- U/L

LDH

-- U/L

K

3.79 mmol/L

Na

137.4 mmol/L

Cl

104.4 mmol/L

Ca

2.28 mmol/L

Glu

-- mmol/L

Date

2022-05-09 yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

11.7

Thrombin time (TT)

15.2

Activated partial thromboplastin time (APTT)

28.2

Fibrinogen (FIB)

2.11 g/L

Date of examination

2022-05-09 yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

Negative

HCV

Negative

Negtive

Negative

Date of test

2022-05-09 yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

2022-05-09 (yyyy-mm-dd)

LAC

0.56 mmol/L

SBE

-1.2 mmol/l

HCO3

23 mmol/l

SO2

99

PCO2

35.3 mmHg

P02

120 mmHg

PH

7.431

2.10.D-dimer Test

0.05

2.11.HCG Test

-- mIU/mL

Urine HCG

Not detected

2.12.Visual Analogue Scale

Pain Visual Analogue Score

Very pain

2.13.Image Examinations

11

4.21*4.23*3.96 cm*cm*cm

--

4.7*5.3*2.9 cm

左2.9*2.06 右1.96*0.85 cm

Date of examination

2022-05-09 yyyy-mm-dd

Abdomen CT examination

Abnormal with clinical significance

Description in detail for abnormal

子宫后方囊状影,考虑附件来源可能,周围伴渗出且积液较多

Date of examination

2022-05-09 yyyy-mm-dd

--

2.14.Other Tests
3.In the process of the treatment
3.1.Treatment Record

左输卵管系膜囊肿

5*5 cm

2520 °

excision

刘义彬

2022-05-09

4.Follow-up
4.1.Physical examination

BG Puncture site

No

Temperature

36.8

Systolic pressure (SP)

-- mmHg

Diastolic pressure (DP)

-- mmHg

Heart Rate, HR

80 次/分

Blood pressure

-- mmHg

4.2.Blood Routine Test

WBC

13.7 ×109 /L

NEUT%

76.14 %

LY%

17.39 %

MONO%

5.29

RBC

3.5 ×10^12 /L

HGB

117 g/L

PLT

204 ×10^9 /L

Date

2022-05-10 yyyy-mm-dd

4.3.D-dimer test

D-dimer

D-dimer

0.1

Date of test

2022-5-11 yyyy-mm-dd

4.4.Visual Analogue Scale

Pain Visual Analogue Score

5.Management system of participants

sample collection

Collected

Volume

1 ml

Time of collection

2022-05-09 yyyy-mm-dd-hh-min.

Label Number of the sample

20220509005

6.ADR/ADE management system

Is there any adverse event?

No

Severity

Within 30 minites or not?

Begin time at

年/月/日(yyyy-mm-dd)

Time of stop

年/月/日(yyyy-mm-dd)