【镜·界】夏恩兰教授:宫腔镜!一眼清泉守子宫,数十春秋,仍倚梦前行!

作者:夏恩兰 单位: 来源:hysteroscopy newsletter 编者:
2018-3-23 阅读

宫腔镜诊疗时讯是由全球宫腔镜医师大会出版的非盈利性网络,是宫腔镜相关的国际性网站,旨在及时传递全球前沿、热点、实用的宫腔镜技术给每一位热衷于宫腔镜技术发展的医者或学者。目前已有148个国家的约40000位医生浏览了网页,来自32个国家的成员在Twitter注册。我国“宫腔镜之母”夏恩兰教授应大会主席邀请参加2019年第二届全球宫腔镜医师大会组委会,并接受了Hysteroscopy Newsletter的专栏访问。


(一)


Q:在中国宫镜技术是如何走出第一步的?


原文:How were the first steps of the Hysteroscopy in China?


A:林元英教授(图1)是我国著名妇产科林巧稚医生在协和医学院的同班同学。他在英国工作了许多年。1965年林教授在上海第一医院工作, 首先将宫腔镜介绍到中国。那年我作为访问医生在上海第一医院学习,参加了林教授的关于宫腔镜的研制和试用,获得成功。1990年,我继承林教授的遗愿,在阅读1987年英国医学杂志Adam Mago撰写的一篇宫腔镜子宫内膜切除术治疗异常子宫出血16例报道的论文后,在中国用前列腺电切镜成功地做了第一例TCRE术。开始我们只做TCRE代替子宫切除术。但术时会遇其他子宫内病变,如子宫平滑肌瘤、子宫内膜息肉、子宫纵隔、宫腔粘连和宫腔内异物。有趣的是,这5种子宫内病变宫腔镜术后会怀孕,明显改善了生殖预后。此后TCRM、TCRP、 TCRA、TCRS、TCRF等经典宫腔镜手术成为我国应用非常广泛的常规手术。


原文:Professor Lin Yuanying (Picture 1) is classmate of Lin Qiaozhi at Peking Union Medical College and worked in England for many years. In 1965 Professor Lin was working in the Shanghai first Hospital and introduced hysteroscopy to China firstly. As a visiting doctor I was learning in the Shanghai first hospital and took part in the manufacture and application of hysteroscopy with Professor Lin and get success. In 1990 I inherited Professor Lin’s unfulfilled wish, after reading a paper of AUB treated by transcervical resection of endometrium (TCRE) 16 cases reported in BMJ 1987 written by Adam Magos, trying to perform the first case of TCRE in China. From the beginning we just perform TCRE to instead hysterectomy. But at the same time will encounter and removed some other intrauterine lesions, such as leiomyoma, polyp, septum, IUAs and foreign bodies. It is interesting that after operation these five intrauterine lesions always got pregnant,improve reproductive significantly. Since then TCRM, TCRP, TCRA, TCRS, TCRF etc. classical hysteroscopic surgeries became routine operation and widely used in my country.


△林元英教授的照片


(二)


Q:在您的国家里,宫腔镜手术的例数有所增加吗?

原文:Is there an increase in the number of hysteroscopic procedures done in your country?


A:在中国,从1990年到2017年,宫腔镜手术的例数急剧增加。我们可以利用中国期刊上发表的论文数量来间接地表示宫腔镜手术数量的增加情况。


表1   发表论文的日期和数量


现在,在大城市里对有适应证者进行宫腔镜检查和手术已经成为常规程序。根据政府的要求,在中小城市,医院必须有宫腔镜的设备,并且应用,即使是社区或中医医院也不例外。


原文:In China the number of hysteroscopic procedures increased dramatically from 1990 t0 2017. We can use the number of published papers in Chinese Journals to express the increase in the number of hysteroscopic operations indirectly. (Table 1)


Table 1 The date and No. of published papers


Now the application of hysteroscopy in big cities has become a routine procedure for who indicated. In small and medium-sized cities according to the requirements of Government, the hospital must have equipment and application of hysteroscopy, even Community or Traditional Chinese medicine Hospital is no exception.


(三)


Q:你对与世界各地的宫腔镜医生保持联系的重要性有何看法?

原文:What are your reflections about the importance of keeping in touch with others hysteroscopists all over the world?


A:我很荣幸在这个时代成长和工作。我的国家前所未有的强大,有能力送我们出国交流知识和技术。保持与世界各地著名宫腔镜专家的联系,避免绕道而行。在我们每年一度的北京-国际宫腹腔镜与妇科微创技术研讨会议上,25年来邀请到国际知名的法国Bruhat MA, Wattiez A, Canis M;荷兰的Wamsteker K,Emanuel MH 和 de’ Block;美国的Rafael Valle, Franklin Loffer, Linda Bradly, Harry Rich教授;英国的TC Li, Peter O'Donovan教授;澳大利亚的Felix Wong, Peter Maher教授。日本的Baoliang Lin教授。意大利的Stefano Bettocchi, Malzoni M, Minelli L 教授。埃及的Shawki Osama教授;新加坡的Yap Li Kee教授;印度的Mangeshika教授;俄罗斯的Popov等教授讲学,演示手术,交换理念和经验,促进了妇科内镜,尤其是宫腔镜在中国的发展。

原文:I am much honored for grow and work in this era. My country unprecedented strong, has the ability to send us go abroad to exchange knowledge and technology. Keep in touch with famous hysteroscopists all over the world is very import for one grows up to avoid detour. Professor Bruhat MA, Wattiez A, Canis M, Nicolas Castaing in France, Wamsteker K, Emanuel MH and de’ Block from The Netherland, Rafael Valle, Franklin Loffer, Linda Bradly, Tommaso Falcone,Harry Rich in USA, TC Li, Peter O'Donovan in England, Jacques Donnez, Stephen Gordts in Belginm, Felix Wong, Peter Maher in Australia, Baoliang Lin in Japan. Stefano Bettocchi, Malzoni M, Minelli L from Italy, Shawki Osama from Egypt,Yap Li Kee from Singapore,Mangeshika from India,  Popov from Russia. They are well-known international recognized scholars who had attend the Annual Beijing-International Gynecological Endoscopy and Mini-invasive Surgery Symposium in 25 years to exchange their idea and experiences, promoted the development of gynecological endoscopy in China, especially the development of hysteroscopy technology.


△与世界各地宫腔镜专家合影


(四)


Q:在宫腔镜手术中,课程和培训有何重要性?

原文:How important are courses and training “hands on” in hysteroscopy? 


A:宫、腹腔镜的学习是完全不同的。1)  宫腔镜手术与传统剖腹手术,阴式手术或腹腔镜手术是完全不相同手术。2)只要有剖腹手术的基础,了解腹腔镜设备和仪器的使用,看简单的腹腔镜手术的视频,医生就可以独立进行相同的腹腔镜手术。但是这样学习宫腔镜就不行了。因为在画面上看不到视频判断不了光源的瓦数、景深、膨宫压力和流速、电切模式和功率。3)并发症不同,腹腔镜手术的并发症与开腹手术相似,宫腔镜的并发症与经尿道前列腺电切术相似,如TURP综合征、静脉空气栓塞等。因此,学习宫腔镜检查必须经过专业培训。“手把手”教学是最好的培训方式。自1992年以来,我中心举办了66期宫腔镜“手把手”培训班,在模型上练习宫腔镜技术。2000年,我们中心荣幸地被荷兰国际宫腔镜培训学校任命为国际宫腔镜培训中心亚洲分中心。培训医生3000余名。在中国大多数宫腔镜医生是从我中心培养出来的。

原文:Learning hysteroscopy is completely different with laparoscopy. 1) Hysteroscopy surgery is completely different from the traditional laparotomy, vaginal operation  or laparoscopic surgery. 2) As long as there is the basis of the laparotomy, understand the usage of laparoscopic equipment and instrument, watching video of simple laparoscopic surgery, operator can be performing the same surgery independently. But studying hysteroscopy cannot, because of the operator can’t understand the parameters of the video such as light wattage, depth of field (DOF), fluid pressure and velocity, electrical current intensity and the electric cutting model. 3) Complication is different. Complications of laparoscopy are similar with laparotomy and complications of hysteroscopy are similar with transurethral resection of prostate, such as TURP Syndrome, venous air embolism.  Therefore, learning hysteroscopy must go through professional training. “hands on”is the best way to learn. Since 1992, my Center had held 66 classes of Hysteroscopic "hand-on" Training Workshops to practice hysteroscopic skill on the model. In 2000 the Centre was honored named International Hysteroscopic Training Center of Asia by International Training School Netherlands, more than 3000 Doctors were training in total. In China most Hystroscopist were cultivated from my center.

 

△手把手教学


△亚洲宫腔镜培训中心签约仪式


(五)


Q:宫腔镜的发展达到极限了吗?

原文:Has the hysteroscopy reached it limits? 


A:宫腔镜检查从来没有达到极限! 不要认为宫腔镜仅可诊治宫腔内疾病,宫腔镜还可以治疗宫颈疾病,例如宫腔镜切除子宫颈病变(TCRC)治疗宫颈上皮内瘤变(CIN)比冷刀锥形切除术(CKC) 有预防CKC术后导致宫颈机能不全的优点。宫腔镜手术是治疗剖宫产切口憩室 (PCSD) 的首选术式。宫腔镜切除子宫腺肌病或子宫壁囊肿均有良好效果,值得进一步研究。

原文:Hysteroscopy never reached the limits!Don't think that the hysteroscopy only can diagnosis and treat intrauterine lesions, but also can manage cervical diseases, such as transcervical resection of cervix (TCRC) to treat cervical intraepithelial neoplasia (CIN) which is better than cold knife conization (CKC) for prevent cervical incompetence. Hysteroscopic surgery is the first choice treatment of post cesarean scar diverticular (PCSD). Hysteroscopic resection for adenomyosis or cyst of uterine wall has good effect, is worth further study.


(六)


Q:你对刚开始从事宫腔镜手术的年轻妇科医生有什么建议吗?

原文:Do you have any advice for the young gynaecologists who are starting in the world of minimally invasive surgery?


A:年轻的医生是幸运的一代,赶上了应用宫腔镜,改变了妇科疾病的诊断和治疗理念及诊治方法,是里程碑式的进步。宫腔镜技术微创、有效,似乎很容易。但年轻的医生不要认为这很简单。不完整的手术或不安全的操作治疗效果不好。不谨慎的处理可能导致致命的并发症。宫腔镜医生应学习和熟练地掌握腹腔镜,因为有时我们需要腹腔镜的帮助处理宫腔镜的并发症,例如子宫穿孔,或疑难病例的诊断,就像斜隔子宫。

原文:Young doctors are fortunate generation, caught up with hysteroscopy, it is milestone progress. Hysteroscopy changed the concept of diagnosis and treatment for gynecological diseases. Hysteroscopy minimally invasive, effective, seem to be very easy, but young doctors don't thought it is simple. Incomplete surgery or unsafe operation cannot get good outcome. None careful handling can lead to fatal complications. Hysteroscopist have to study and handled laparoscopy skillfully because sometimes we need laparoscopy when encountered complication just like uterine perforation or difficult diagnosis just like Robert’s uterus. 


本文译自www.hysteroscopy.info


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