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子宫肌瘤分碎术受医生质疑或致癌症扩散

更新时间:2013-12-19 20:33:14 来源:华尔街日报中文网 作者:佚名

Doctors Eye Cancer Risk In Uterine Procedure
子宫肌瘤分碎术受医生质疑或致癌症扩散

An increasingly popular method of removing common uterine growths is coming under assault by some doctors worried about the risk of spreading a potentially deadly cancer.

一种越来越流行的去除子宫肿瘤的方法受到部分医生质疑,医生们担忧这会引发可能致命的癌症扩散风险。

Brigham and Women's Hospital, a prominent Boston medical center, said Tuesday it plans to impose new limits on the procedure, called morcellation. And Massachusetts General Hospital said it expects to change what it tells women about possible risks from the technique. The Harvard University-affiliated hospitals said they believe the dangers remain very small.

波士顿知名医疗中心布里格姆妇女医院(Brigham and Women's Hospital)周二表示,其计划对这种名为分碎术的操作实施新的限制。麻省总医院(Massachusetts General Hospital)说,其预期将改变向妇女告知关于这项技术风险的内容。哈佛大学附属医院说,他们认为相关危险仍然很小。

The changes come as four Boston-area doctors have submitted a draft article to the New England Journal of Medicine calling for a moratorium on the procedure, which involves using a power tool to grind up fibroids-growths in the uterus-or the uterus itself so the pieces can be removed through small incisions used in minimally invasive surgery.

这一变化是由于四位波士顿地区的医生向《新英格兰医学杂志》(New England Journal of Medicine)提交一篇文章草稿,呼吁暂停这项操作。这项操作包括使用一个电动工具碎解子宫肌瘤或是子宫本身,以便碎片可以从用于微创手术的小切口中清理出来。

The article says a much higher number of women than previously thought have undetected cancer in the fibroids, and that grinding the growths can inadvertently disperse cancerous material in the abdomen, in some cases tripling the odds of death within five years. The article is under peer review, a standard procedure by medical journals.

文章说,子宫肌瘤中的癌症未被检测出的情况比人们此前认为的更多,将肿瘤碎解会在无意中使癌症物质散布在腹腔,在一些情况下会导致五年内死亡机率增加两倍。这篇文章正在进行同行评议,这是医疗期刊的标准程序。

Other doctors said the procedure shouldn't be halted, but that women should be better informed about the risks.

其他医生说,这类操作不应被暂停,但应更详尽地向患者告知风险。

The American Congress of Obstetricians and Gynecologists said it still considers the procedure very low risk. The physician group doesn't offer guidelines on what doctors should tell patients about morcellation and said it has no immediate plans to do so.

美国妇产科医生协会(The American Congress of Obstetricians and Gynecologists)称,其仍认为这项操作的风险极低。这个医师组织没有就医生应当如何向患者解释分碎术提供指导意见,同时表示其并无关于此事的近期规划。

Nearly 500,000 hysterectomies were performed in the U.S. in 2010, and about 55,000, or 11% of them, involved morcellation, according to the ACOG. Estimates from doctors at Columbia University Medical Center and Northwestern University put the figure at closer to 80,000 annually.

据美国妇产科医生协会的数据,2010年美国实施了近50万例子宫切除术,其中约5.5万例涉及分碎术,占比为11%。哥伦比亚大学医学中心(Columbia University Medical Center)和西北大学(Northwestern University)的医生估计,每年涉及分碎术的手术接近8万例。

Women leery of morcellation have other choices, including traditional open abdominal surgery or a vaginal hysterectomy.

对分碎术心存怀疑的妇女还有其他选择,包括传统的开腹手术或阴道子宫切除术。

Concerns about the method have circulated among doctors over the past few years. The latest discussion was sparked by an unusually vocal campaign by a Boston cardiothoracic surgeon, Hooman Noorchashm. His wife, Amy Reed, also a physician, was told by one of her doctors in October that her rare uterine cancer may have been spread by the procedure, according to a Wall Street Journal review of her medical records.

过去几年,医生中也流传著有关这一方法的担忧。引发这轮最新讨论的是波士顿心胸外科医生诺查什姆(Hooman Noorchashm)发起的极度激烈的宣传活动。他的妻子里德(Amy Reed)也是一名医师。《华尔街日报》审阅了她的病历,其中显示,里德的一位医生在今年10月告诉她,她所患的罕见子宫癌可能是因这项操作而扩散。

Dr. Reed, a 40-year-old mother of six and anesthesiologist at Beth Israel Deaconess Medical Center in Boston, has handled some of the hospital's most sensitive cases, including treating the surviving alleged Boston Marathon bomber for injuries sustained during his capture in April.

40岁的里德有六个孩子,是波士顿贝斯以色列女执事医疗中心(Beth Israel Deaconess Medical Center)的麻醉医师,曾经处理过该医院一些最敏感的病例,包括为被指控的波士顿爆炸案嫌犯治疗其在今年4月被捕时所受的伤。

Dr. Noorchashm, a surgeon at Brigham and Women's, has been circulating petitions online calling for an immediate moratorium on morcellation and seeking support for his campaign from doctors around the country. His work prompted the review by the four doctors who wrote the article, who include a family friend and Dr. Reed's oncologist.

诺查什姆是布里格姆妇女医院的外科医师,他一直在网上传播请愿书,呼吁立即暂停分碎术,并寻求全国医生对其行动的支持。他的呼吁促使撰写上述文章的四位医生对相关手术的风险进行评估,其中包括他们夫妇的一位朋友以及里德的肿瘤医师。

Mincing fibroids and the uterus have become more common over the past 10 years, a spokesman for ACOG said. Makers of the surgical tool used, known as a morcellator, include Johnson & Johnson.

美国妇产科医生协会的一位发言人说,过去10年中,切碎子宫肌瘤与子宫的做法已经更为常见。这种手术所用的工具名为组织粉碎器,其生产商包括强生公司(Johnson & Johnson)。

A J&J spokesman said morcellation is an effective surgical option in many cases, and that the company's training and product labels identify known risks. Among the risks on a current label is that the morcellator 'may lead to dissemination of malignant tissue.'

一位强生发言人说,分碎术在很多情况下都是有效的手术选择,该公司的培训以及产品标签都确定了已知风险。当前的标签上列出的风险之一是,组织粉碎器“可能导致恶性组织的散布”。

Most of the time, the process is successful and leads to a shorter hospital stay, smaller scars and quicker recovery, doctors say. 'It has revolutionized our ability to care for women,' said Magdy Milad, chief of gynecologic surgery at Northwestern University Feinberg School of Medicine.

医生们说,大多数情况下,这项手术都是成功的,并令患者住院时间缩短、伤口更小、恢复更快。西北大学费恩伯格医学院(Northwestern University Feinberg School of Medicine)妇产科手术负责人米拉德(Magdy Milad)说,这项手术彻底改变了我们关爱女性的能力。

Experts estimate 20% to 40% of women over age 35 will develop fibroids, which usually are benign. They are the most common reason for hysterectomies, with women ages 40 to 44 the most likely candidates.

据专家预计,年龄在35岁以上的妇女中,有20%至40%会患子宫肌瘤,通常为良性。子宫肌瘤是最常见的子宫切除原因,年龄在40至44岁的妇女最有可能患子宫肌瘤。

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