Ceana Nezhat教授专访:全面系统性诊断子宫内膜异位症的重要性

作者:ding 单位:中国妇产科在线 来源:中国妇产科在线 编者:
2018-9-27 阅读

   


中国妇产科在线: 教授您好,在2018年北京妇科微创高峰论坛中您讲述了全面系统性诊断子宫内膜异位症的重要性,这对于降低子宫内膜异位症的复发有帮助吗?

 

Very good. Your question is excellent. The reason is, if we miss or don't find those subtle atypical lesions one would think it is recurrence, but it is not recurrence, it is missed diagnosis, or this is under treatment. That is why a systematic evaluation is important; it finds those small subtle lesions allowing us to take care of them because if the lesion is left behind, it will grow.

 

Ceana Nezhat教授:你的问题很好。如果我们没有找出那些突然的典型病变,那么我们会把它遗漏了。因此,再次发生子宫内膜异位症的时候,有些人认为是复发,但实际上并不是复发,只是之前诊断中错过的病变或者是未经治疗的病变。所以,这就是为什么需要进行系统性评估来找到那些小的突然病变,并且对它们进行适当的处理。因为如果放任不管,病变会继续发生发展。

 

中国妇产科在线:所以进行系统性诊断是减少复发的更好的途径?

 

Yes, especially in the younger individuals. I see a lot of young individuals, who have pain and bleeding, and it’s been ignored. And then, when you look at it and you catch it at the early stage, it makes them understand they have a condition that could stay with them. They no longer think it is in their head. The patient I showed you had small lesions in the inguinal area, she had cyclic pain on her groin and a CAT scan revealed she did not have a hernia but endometriosis caused irritation and inflammation.

 

Ceana Nezhat教授:是的,特别是年轻人。我看到很多年轻的人,他们有疼痛、出血的症状,但是都被忽视了。当你观察它并在早期阶段去查找时,该病灶会让你认为这种状况会一直存在。于是,他们便不再考虑这个问题了。我曾展示过一个病例,该病例患者在腹股沟区域有小的病灶,她有周期性疼痛的表现,经过CAT扫描检查后,医生说她没有疝气。是的,她没有疝气,只是子宫内膜异位造成刺激和炎症罢了。

 

中国妇产科在线:系统性筛查和评估对于不同阶段的子宫内膜异位症有不同的效果吗?

 

The staging of endometriosis, unfortunately, does not truly describe the invasiveness of the disease, specifically when it comes to pain. Current staging is for infertility assessment even though infertility does not always describe the severity of the disease. For example, an ovarian endometrioma is automatically staged higher than a 25px obstructed lesion on the ureter although the obstructed ureter, if left untreated, can result in irreversible kidney damage. We have yet to come up with appropriate classifications to address the extent of the disease correlating it to the patient’s symptoms.  Hopefully this will change.

 

Ceana Nezhat教授:不幸的是,子宫内膜异位的分期并不能真正描述疾病的侵袭性,特别是涉及到疼痛的时候。这个分期是基于不孕症来的,尽管不孕症并不能描述疾病的严重程度。例如,卵巢性子宫内膜异位症的分期通常自动高于阻塞尿管的一厘米的病灶,尽管尿管堵塞如果不治疗的话可能导致不可逆的损伤。目前,我们已经有了合适的分类来处理与患者疾病程度相关的症状,希望这能有所改变。

 

中国妇产科在线:您能介绍一下即将在美国丹佛举办的74届ASRM年会吗?

 

So, American Society of Reproductive Medicine was initially established as American Fertility Society. During the past 75 years, they have made significant progress in not only fertility, but in all aspects of reproductive health in women and men. The society is based on a very close collaboration between the gynecologist and urologist to address female and male fertility problems; for example, we’ve had children born with congenital abnormalities and this collaboration has helped surgical improvement. From the fertility point of view, we have accomplished a lot regarding hormonal problems, not only in the young aged individuals like persons with polycystic ovarian syndrome but also in the older people like postmenopausal women. So it covers all aspects of the reproductive part of the female, mainly, and some men.

 

Ceana Nezhat教授:在75年前,美国生殖医学协会最初是作为美国生育协会成立的。在75年中,我们取得了重大进展,不仅在生育,还在所有妇女和男性生殖健康方面。在协会里,妇科医生和泌尿科医生密切合作解决男女生育问题。例如,这类合作可以通过手术帮助先天畸形的孩子。从生育的角度来看,我们在激素的问题上已经取得了很多成果,无论是年轻患者的多囊卵巢综合征还是绝经后妇女。所以ASRM年会涵盖了女性生殖的方方面面以及一些男性问题。

 

中国妇产科在线:您对年会有什么期待吗?

 

Yes. The annual meeting is going to be another successful meeting not only from the scientific value, but internationally. American Society of Reproductive Medicine has the largest international participation. And we anticipate finding it very very productive with of course, a lot of learning opportunities like postgraduate courses. From the Society of Reproductive Surgeon, we have a very good didactic part covering different surgical aspects of reproductive surgery. We also have a hands-on course with training, and of course other areas like urology, will have hands-on courses also.

 

Ceana Nezhat教授:是的。此次年会将是另一个成功的会议,不仅从它的科学价值,还从国际角度。美国生殖医学协会拥有很高的国际参与度,我们期待它的引领。当然,会议提供了很多学习机会,比如研究生的课程。从生殖外科医生协会的角度,我们将在此次大会上分享涵盖不同的生殖手术方面的进展。我们也有课程、培训,当然,其他组织也有。

 

中国妇产科在线:未来几年您有与中国医学组织合作的计划吗?

 

Absolutely. As I mentioned, the Chinese surgical society in all specialties have progressed significantly and, from the technical point, they are doing a very good job. I have seen a lot of research coming out from the PhD levels on the scientific part, specifically, I have seen it on endometriosis and also on cancer, a lot of research coming up. So, this collaboration we are anticipating being in more putting courses, hands on courses, and working. Personally, I always have at least one or two visiting Chinese fellows in my center each year. Of course Professor Duan has come for a visit. This year so far, I have had three from China, and they stay anywhere between three to six months.

 

Very good, and I am very pleased to see our collaboration is improving and progressing very rapidly.

 

Ceana Nezhat教授:当然。正如我提到的,中国在医学各个专业领域进步显著。从技术角度,他们做得很好。我见过很多博士学位水平的论文研究。具体地说,我也看到了大量的子宫内膜异位症和癌症方面的研究。接下来的合作应该会更多的放在课程方面。在个人工作方面,我每年至少会邀请一到两个中国医生到我的中心交流。段华教授有去过,今年,我有三个来自中国的医生,他们通常会待三到六个月。我很高兴看到合作进展如此迅速。

 

Thank you very much, it has been a pleasure.

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