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各位醫師同好
對於腹腔鏡以及內視鏡操作有興趣的專家們
可以考慮這個月底IRCAD 的課程喔!!
我可以幫您介紹報名有優待!
我接了這個任務 雖然只是胃鏡實際操作指導
我會很認真準備的,
當然更重要的是還有許多專家精彩的演講以及手術展演
也希望未來 STRETTA, ARMS, ARMA等內視鏡手術
可以納入這樣像IRCAD國際型的課程之中
Laparoscopic & Endoscopic Hybrid Upper GI Workshop
https://www.ircadtaiwan.com/en-us/course.php
Kita cuti makeup dulu ya..Alhamdulillah selesai da laparoscopic surgery pagi td.
Let's leave our makeup first.. Thank God, the surgery was finished this morning.Translated
< 子宮內膜異位症與不孕 >
各位好
小弟威廉氏後人 – 李毅評醫師
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5/28是世界經期衛生日
原因只是因為
最標準的月經是
每28天來一次，一次來5天。
所以訂在5/28。
我個人是覺得蠻幽默的
-
說到經期衛生日
大家直覺就會聯想到的就是經痛
說到經痛，就不能不提到子宮內膜異位症。
-
子宮內膜異位症是一個非常常見的疾病，
發生率大約在10% - 15%左右。
-
子宮內膜異位症經常有很明顯的症狀：
80%的人會經痛
20%的人形成卵巢腫瘤，也就是巧克力囊腫。
-
子宮內膜異位症，
顧名思義，
就是說子宮內膜跑到不該有內膜的地方去了。
所以才叫做「異位」。
-
正常的子宮內膜，
應該乖乖地待在子宮腔內，
然後隨著每個月的賀爾蒙變化增生剝落。
-
不過，當這些子宮內膜出現在其他部位，
如腹膜、骨盆底、腸道、膀胱、輸尿管等地方的時候，
每個月的週期性出血
以及出血引起的發炎
就會形成嚴重的症狀。
-
今天主要不是要跟大家介紹子宮內膜異位症
如果大家真的有興趣
可以去看我在世界經期健康日的採訪內容
http://www.healthnews.com.tw/news/article/46302
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除了經痛、性交痛、巧克力囊腫、卵巢癌之外
子宮內膜異位症
最大的問題是這個病跟不孕症實在關係太密切了
-
子宮內膜異位症跟不孕症有著非常緊密的關聯性。
30%-50%的子宮內膜異位症患者，有不孕症問題；
30%-50%的不孕症患者，有子宮內膜異位症的問題。
-
針對子宮內膜異位症造成的不孕症患者，
第一步必須先仔細評估患者夫妻，
排除是否仍有其他問題，
如精蟲活動力、輸卵管不通等等問題。
-
如果是子宮內膜異位症且有經痛問題的不孕症患者，
接受第一次手術確實有機會改善不孕症的情形。
未手術組的一年自然懷孕率為34%，
而手術組的一年自然懷孕率為57%。
-
但是，
如果是復發型的子宮內膜異位症，
反覆手術反而會嚴重的傷害卵巢，
進一步導致卵巢早期衰竭。
-
根據統計，
反覆的子宮內膜異位症手術，
會讓未來的懷孕率下降44%。
造成卵巢功能的嚴重惡化。
-
每一次的巧克力囊腫手術
AMH會下降至本來的65%
而且這樣的傷害是無法恢復的
-
因此，多次的手術已經逐漸被摒棄，
最多一次的手術，
以及後續藥物治療為主的治療方針，
才是目前美國生殖醫學會提供的準則。
-
我曾經治療過一位患者，
37歲的小筠
年輕時，
因為反覆的巧克力囊腫接受腹腔鏡手術。
手術後卵巢功能嚴重惡化，
接近更年期邊緣。
AMH只剩0.38，
大約跟43歲的卵巢功能接近。
-
飽受卵巢早衰折磨的她，
接受了我的微試管的療程。
共經過6次取卵，
蒐集到6顆品質中等的胚胎。
3顆D3，3顆D2。
最後，
巧手一伸，
乾坤一擲
順利獲得一對龍鳳胎，
目前雙寶健康狀況都很良好
應該都快過一歲生日了呢
-
參考資料：
1. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2014
2. The effect of second-line surgery on reproductive performance of women with recurrent endometriosis: a systematic review. Acta Obstet Gynecol Scand. 2009;88(10):1074.
3. Comparison of Anti-Mullerian Hormone Level in Non-Endometriotic Benign Ovarian Cyst Before and After Laparoscopic Cystectomy. Iran J Reprod Med. 2015 Mar;13(3):149-54
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“她總是笑笑地跟我說：人家都是集點換鍋子，我是集胚換孩子！”
“不知道每一次的笑容後面，又有多少眼淚呢？”
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~威廉氏後人 李毅評醫師~
臉書蒐尋 : 威廉氏後人 李毅評醫師
粉絲專頁 : https://www.facebook.com/mrwilliams999
網誌連結 : https://mrwilliams999.blogspot.tw
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under the knife
14th Feb 2017
After my photo shoot with Mariel, I dragged Azmi and kids to visit 7 month old Muhammad Adib who is suffering from hirschprung disease.
Hirschsprung's (HIRSH-sproongz) disease is a condition that affects the large intestine (colon) and causes problems with passing stool. The condition is present at birth (congenital) as a result of missing nerve cells in the muscles of the baby's colon.
A newborn who has Hirschsprung's disease usually can't have a bowel movement in the days after birth. In mild cases, the condition might not be detected until later in childhood.
Surgery to bypass the part of the colon that has no nerve cells treats Hirschsprung's disease. The lining of the diseased part of the colon is stripped away, and normal colon is pulled through the colon from the inside and attached to the anus. This is usually done using minimally invasive (laparoscopic) methods, operating through the anus.
We wanted to help this family because they didn't have enough money to pay the hospital at Temerloh for the surgery done on baby Adib. Puan Shafiqa had to quit her job to look after baby Adib full time at the hospital (he has not left the hospital since birth) and her husband took a job at the Pasar Borong so he can get daily wages (instead of monthly) to constantly buy baby diapers and his special formula milk. I wanted to be sure this was an authentic case before viralising this story to reach out to the public for donations. Adib was asleep when we came over and he's such a strong strong lad.
If you have change to spare, here's Puan Shafiqa's maybank account number to help her family out for the meantime. (They weren't eligible for bantuan even though her husband earns less than RM1500 a month).
Maybank Noor Shafiqa Suhada: 154044930753
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