Diseases that Harm Require Therapies that Harm Less

---Sir William Osler(1849-1919)
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ISMIVS Newsletter July & August, 2021
Newsletter 2021 July & August
2021年7月及8月简报
About Us 国际微无创医学会简介
The International Society of Minimally Invasive and Virtual Surgery (ISMIVS, previously known as International Society of Minimally Invasive and Noninvasive Medicine) was founded in July 2013 at the gala of the 1st Yangtze International Summit of Minimally Invasive and Noninvasive Medicine in Chongqing, China. ISMIVS envisions to accelerating the progress in minimally invasive and noninvasive medicine by promoting research, education, communication, and international collaboration.
国际微无创医学会(ISMIVS)是在 2013 年 7 月在中国重庆召开的第一届国际微无创医学长江高峰论坛上宣布成立的,旨在通过学术研究、教育、交流以及国际合作加快微无创医学的发展。
Become a member 注册成为会员 >
The Personality in the Medical Education World 医学教育界的大人物
From the 2020 July issue of our ISMIVS Newsletter, we would like to introduce some pioneers in the field of minimally-invasive and noninvasive medicine. They are not only prestigious in their field but also willing to share their experience and ideas with younger doctors, hence making a great contribution to medical education. This issue features Dr. Jianhua Wang from China, who is enaged in the Sino-African medical community.
从 2020 年 7 月刊开始,国际微无创医学会将为大家介绍微无创医学领域的一些领军人物。他们不仅在各自的领域享负盛名,而且非常乐意与年轻医生分享他们的经验、理念和想法,从而为医学教育做出了巨大的贡献。本期月刊要介绍的是来自中国的中非医学界人士王剑华医生。
Dr. Jianhua Wang, MD, urological surgeon
王剑华医生 医学博士 泌尿外科医生
Addis Ababa Silk Road General Hospital (ASGRH),Ethiopia埃塞俄比亚爱菲医院
Former Volunteer Doctor with the Chinese Medical Doctor Association (CMDA)原中国医师协会援非医生

In 2006, Dr. Jianhua Wang, a urological surgeon from Zhejiang, China, traveled to Ethiopia to serve as a volunteer for the Forum on China-Africa Cooperation (FOCAC) and stayed on to set up a diagnostic imaging centre after the end of the voluntary activity so as to provide better support to local patients for disease diagnosis.
Thai Medical Council (since 2021)
Best Practice & Research in Clinical Obstetrics and Gynecology (since 2021)
2006 年,来自中国浙江的泌尿外科医生王剑华前往埃塞俄比亚担任中非合作论坛(FOCAC)志愿者;活动结束后,为了更好地帮助埃塞当地病人诊断病情,王剑华留在当地建立了一家影像诊断中心。

In 2017, Dr. Wang established the Addis Ababa Silk Road General Hospital (ASGRH) in Ethiopia's capital Addis Ababa and acted as the Chairman. Since then, Dr. Wang and his medical team have been providing voluntary medical treatment to the Ethiopian people, donating medical equipment, training local doctors and nurses, and organizing local social charity events.
2017 年,王剑华医生在埃塞俄比亚首都亚的斯亚贝巴建立了埃塞俄比亚爱菲医院(Addis Ababa Silk Road General Hospital,ASGRH),并担任该院董事长。自此,王剑华医生与其团队长期为埃塞人民群众提供义务诊疗、捐助医疗设备、培训当地医生与护士,并组织本地性的社会慈善活动。

On 30 March 2020, ASRGH was designated as a Covid-19 hospital in Ethiopia. So far, 1,200 COVID-19 patients have been treated for free in this hospital, including 300 patients in serious condition, most of which have been discharged and returned home. ASRGH has administered more than 10,000 doses of COVID-19 vaccines to locals as well as Chinese people in Ethiopia. In this regard, the Chinese Embassy in Ethiopia issued a letter of appreciation to Dr. Wang through the Volunteer Doctor Working Committee of the Chinese Medical Doctor Association (CMDA) in July 2021 for leading his medical team at ASRGH to cooperate with the implementation of the COVID-19 vaccine injection and the management of side-effects.
2020 年 3 月 30 日,爱菲医院正式成为埃塞俄比亚的新冠肺炎救治定点医院,截止目前,共计义务收治新冠病人 1200 例,重症 300 例左右,其中大部分病人已经治愈出院回家。此外,爱菲医院义务为埃塞当地居民和在埃塞的中国人注射 1 万余剂疫苗。2021 年 7 月,中国驻埃塞大使馆通过中国医师协会志愿医生工作委员会发布了一封感谢信,感谢王剑华医生带领爱菲医院团队,配合实施新冠疫苗注射和不良反应的处理。

Dr. Wang plans to establish a maternal and child health centre in Ethiopia in the future, which will contribute to providing quality medical care to investors, international organisations, NGOs, and local people in Ethiopia, and improving the health of African women through the application of advanced HIFU technology to treat benign and malignant tumours.
王剑华医生计划未来在埃塞俄比亚当地建立一所妇幼保健中心,应用先进的 HIFU 技术治疗良恶性肿瘤,为埃塞的投资者、国际组织、非政府组织和当地群众提供优质的医疗保障服务,从而提高非洲妇女的健康水平。

News 新闻
2021 APAGE-ISMIVS HIFU Series Webinars: HIFU and Fertility, Potential or Not? Episode 1
2021年国际微无创医学会(ISMIVS)与亚太妇产科内视镜暨微创治疗医学会(APAGE)联合会议
暨2021年高强度聚焦超声(HIFU)系列线上研讨会(AIH)——HIFU与生殖:潜力与否
第1期
"We deeply thank thousands of participants from Jordan, Vietnam, Japan, China, Turkey, Nepal, Indonesia, Europe, and the leading American countries for attending the event. It's always encouraging to receive positive feedback from our audience which is our motivation to hold the HIFU Webinar", a welcome speech from Prof. Chyi-Long Lee, the Chairman of Board of Trustees of APAGE, marks the official start of the once-a-year APAGE-ISMIVS HIFU Series Webinars. The first episode was held on July 22 with near 200 participants joining us online. We invited three excellent speakers to share the latest developments and their clinical experiences in the field of HIFU treatment and fertility.
“我们由衷感谢来自约旦、越南、日本、中国、土耳其、尼泊尔、印尼、欧洲以及美洲主要国家的数千名参会者,观众的热烈反响是我们举办高强度聚焦超声(HIFU)系列线上研讨会的源动力”, 亚太妇产科内视镜暨微创治疗医学会(APAGE)董事会主席李奇龙教授精彩的开场致辞拉开了 2021 年 HIFU 系列研讨会的序幕。本系列首期研讨会于 2021 年 7 月 22 日举行,吸引了近 200 位参与者。首期研讨会邀请到了 3 位顶尖专家,与大家分享 HIFU 治疗与生殖领域的最新进展和临床经验。
Dr. Selva (Sevellaraja Supermaniam), former President of APAGE, a Consultant Obstetrician and Gynecologist at Mahkota Medical Center, Melaka, Malaysia, who is involved in promoting HIFU technology and gynecological endoscopic surgery in Malaysia, shared the influence on fertility of the removal of non-cavity distorting (NCD) intramural fibroids. After showing the classifications of fibroids and demonstrating the pathophysiology that causes subfertility in patients with intramural (NCD) fibroids, Dr. Selva answered the questions on whether intramural (NCD) fibroids cause infertility and whether myomectomy improves pregnancy rates based on several papers. He concluded that myomectomy should not be the first-line treatment in patients with small intramural fibroids, and he provided five non-surgical alternatives including ulipristal acetate, GnRH agonist, atosiban, uterine artery embolisation (UAE), and HIFU, among which HIFU appears to be the most attractive option to shrink small intramural fibroids because it's a noninvasive technique with very few side effects.
APAGE 往届年会主席、马来西亚马六甲州仁爱医院妇产科顾问医师、马来西亚 HIFU 和妇科腔镜技术手术的积极推广者塞尔瓦(Sevellaraja Supermaniam)医生在本期研讨会中探讨了切除未引起宫腔变形的肌壁间子宫肌瘤(以下简称为“NCD肌壁间肌瘤”)对生育的影响。塞尔瓦医生介绍了子宫肌瘤的分型,并阐释了导致NCD肌壁间肌瘤患者不孕不育的病理生理学机制,随后引用数篇论文解答了NCD肌壁间肌瘤是否会造成不孕不育、子宫肌瘤剔除术能否提高妊娠率等问题。塞尔瓦医生总结道,子宫肌瘤剔除术不应作为肌壁间小肌瘤患者的首选治疗方式,并提供了5种非手术治疗方案,包括醋酸乌利司他、促性腺激素释放激素(GnRH)激动剂、阿托西班、子宫动脉栓塞术(UAE)和 HIFU 治疗。塞尔瓦医生认为 HIFU 治疗是缩小肌壁间小肌瘤的最佳选择,因为 HIFU 是一种无创技术,且副作用较少。
Prof. Lian Zhang, Secretary-General of ISMIVS, Director of Chongqing Haifu Hospital and a Chief Editorial Board Member of International Journal of Hyperthermia, gave a speech themed on Pregnancy Outcomes of Patients with Uterine Fibroids or Adenomyosis after HIFU Treatment. He first introduced the working principles and application of HIFU treatment, then he presented pre-and post- HIFU MRI images of some cases with uterine fibroids and adenomyosis. Prof. Zhang Lian mentioned that 293 patients with uterine fibroids and 31 patients with adenomyosis that had been treated with HIFU in Chongqing Haifu Hospital got pregnant and delivered babies after HIFU treatment, and no complications occurred during their pregnancy or delivery. Based on the particular elaboration of several cases he has treated, Prof. Zhang Lian concluded that HIFU treatment was an effective way to help patients who suffered from infertility due to uterine fibroids or adenomyosis, and required more researches to theoretically prove its effectiveness on pregnancy.
国际微无创医学会(ISMIVS)秘书长、重庆海扶医院院长、《国际热疗学杂志》(International Journal of Hyperthermia)主编成员张炼教授,在会上作了“HIFU治疗子宫肌瘤或子宫腺肌病的生育结果”的专题演讲。张炼教授首先介绍了 HIFU 治疗的工作原理和临床应用情况,然后对比了子宫肌瘤患者及子宫腺肌病患者进行 HIFU 治疗前和治疗后的 MRI 影像。张炼教授提到在重庆海扶医院接受 HIFU 治疗的患者当中,已有293位子宫肌瘤患者和31位子宫腺肌病患者HIFU术后怀孕并分娩,并且其妊娠和分娩过程中未出现任何并发症。张炼教授详尽地展示了数例病例的治疗过程和治疗结果,并总结道,对于因子宫肌瘤或子宫腺肌病而不孕不育的患者来说,HIFU 是一种有效的治疗方式,但还需要通过更多的研究从理论上证明其对妊娠的有效性。
Prof. Felix Wong, the Conjoint Professor of the University of New South Wales and Chairman of CA-AMIGO, shared his experience in setting up Hong Kong HIFU Center and some surgery videos of HIFU treatment. With advanced equipment and customized services, Hong Kong HIFU Center has treated 240+ cases in total since September 2019. Prof. Felix Wong also looked back on the development of gynecological surgery from opening surgery to advanced laparoscopic surgery and robotic surgery, and then to focused ultrasound surgery.
新南威尔士大学客座教授、中国及亚太地区微创妇科肿瘤协会(CA-AMIGO)主席黄胡信教授在此次研讨会上分享了他建立香港 HIFU 中心的珍贵经验,并为大家讲解了他在该中心开展HIFU治疗的手术视频。香港 HIFU 中心拥有先进的医疗设备、提供个性化的患者服务,自 2019 年 9 月至今,该中心的总治疗量已超过240例。黄胡信教授还回顾了妇科手术的发展历程:从传统的开刀手术到先进的腹腔镜手术和机器人手术、再到如今的聚焦超声手术。
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2021 APAGE-ISMIVS HIFU Series Webinars: HIFU and Fertility, Potential or Not? Episode 2
2021年国际微无创医学会(ISMIVS)与亚太妇产科内视镜暨微创治疗医学会(APAGE)联合会议
暨2021年高强度聚焦超声(HIFU)系列线上研讨会(AIH)——HIFU与生殖:潜力与否
第2期
With the warm response from our audience after 2021 APAGE-ISMIVS HIFU Series Webinars–Episode 1, the Episode 2 started off as scheduled on August 26, 2021. The mission of HIFU Webinars is to facilitate academic interactions in the new field of noninvasive surgery and promote the technology and education exchange among doctors from different countries and regions.
2021 年 APAGE-ISMIVS 联合会议暨高强度聚焦超声(HIFU)线上系列研讨会第 1 期获得了参与者的一致好评,在此良好的观众基础上,第 2 期 HIFU 线上研讨会于 8 月 26 日如期举行。HIFU 系列研讨会旨在促进微无创这一新兴医学领域的学术交流,为来自不同国家和地区的专家学者搭建技术研究与科学教育的一体化平台。
Chairs of this webinar, Prof. Osamu Tsutsumi, Director of SANNO Hospital, Japan, and Prof. Angela Aguilar, President of Philippine Society of Reproductive Medicine, first gave a short introduction to our four guests and a sincere appreciation for all the participants. Then, Prof. Philippe Descamps from Angers University Hospital delivered his welcoming speech, during which he said that HIFU was a noninvasive and non-drug therapy requiring no radiation and operation for uterine fibroids and adenomyosis, playing an important role for rebuilding women's wellness.
本期研讨会的会议总主席 Osamu Tsutsumi 教授(日本山王医院院长)和联合主席 Angela Aguilar 教授(菲律宾生殖医学会会长)首先介绍了受邀参与此次会议的四位嘉宾,并表达了对所有参会人员的感谢。随后,来自法国昂热大学医院的菲利普•德刚(Philippe Descamps)教授开场致辞,表示高强度聚焦超声是一种无创、非药物、无辐射、不开刀治疗子宫肌瘤和子宫腺肌症的新技术,对改善女性健康有重要作用。
Prof. Chii-Ruey Tzeng, Founder of Taipei Fertility Center (TFC) and President of Taiwan Endometriosis Society, shared current challenges and treatment options of uterine myoma and adenomyosis in fertility management. Prof. Tzeng first analyzed the mechanisms linking different types of uterine fibroids and infertility, and provided corresponding management strategies. And he explained why patients with adenomyosis were not easy to be cured due to CISD2 (a longevity gene), then further compared IVF outcome of 10 adenomyosis cases after GnRHa treatment. Prof. Tzeng concluded that segmental IVF approach and adenomyomectomy should be considered for patients who were poor responders to long-term GnRHa long-term regulation with a treatment diagram of ART in adenomyosis.
亚太生殖医学会第七届会长、台湾子宫内膜异位症学会理事长曾啟瑞教授介绍了以生育调节为目的的子宫肌瘤和子宫腺肌症治疗的难点和痛点,以及现有的多种治疗手段。曾啟瑞教授首先分析了不同种类子宫肌瘤导致不孕不育的原理,并分享了对应的治疗方案。随后,阐释了子宫腺肌症由于 CISD2 (一种调控哺乳动物寿命长短的基因)的作用而难以根治的原因,并对比了 10 例子宫腺肌症患者经过促性腺激素释放激素(GnRHa)治疗后的体外受精结果。最后,向大家展示了子宫腺肌病不孕症的辅助生殖技术诊治流程图,并总结道,对于GnRHa治疗后效果不明显或是有较大不良反应的子宫腺肌症患者,应考虑采用分段体外受精法和腺肌瘤切除术。
Dr. Jordi Rodriguez from Mutua Terrassa University Hospital, Spain, gave a speech themed on HIFU and Fertility. He introduced the working principle of ultrasound ablation and two goals of HIFU treatment for fertile women with uterine fibroids, including the inactivation of fibroid tissues and shrinkage of fibroids with gradual restoration of uterus structure. After that, he compared the pregnancy rate of patients with uterine fibroids underwent laparotomy, laparoscopic surgery and USgHIFU therapy. Based on his clinical experience of treating uterine fibroids and adenomyosis, Dr. Jordi Rodriguez concluded that USgHIFU therapy was an effective and safe technology, and that it seemed to be the first-line therapeutic option for women due to its noninvasive nature.
来自西班牙特拉萨大学医院的 Jordi Rodriguez 教授以“HIFU 与生殖”为主题,分享了超声消融的基本原理,以及HIFU 治疗患有子宫肌瘤的育龄女性的两大目标:一是让肌瘤组织失活;二是缩小肌瘤,使子宫结构逐渐恢复正常。此外,他还对比了子宫肌瘤患者接受剖腹手术、腹腔镜手术和超声引导 HIFU(USgHIFU)治疗术后的生育率。Jordi Rodriguez 医生结合其治疗子宫肌瘤和子宫腺肌症的临床经验,总结道,超声引导 HIFU 治疗安全有效,其特有的无创性也让它成为众多女性患者的首选治疗方案。
Dr. Wei-Chun Chen shared his clinical experience using HIFU technology to treat uterine fibroids and adenomyosis in Chang Gung Memorial Hospital of Linkou, and elaborated on the whole process of HIFU treatment with HIFU treatment videos. He ended his lecture with some tips of HIFU treatment for uterine fibroids and adenomyosis, such as using concentrated high-dose energy strategy for myoma treatment and considering average low-dose energy strategy for adenomyosis treatment.
陈威君医生则分享了他在林口长庚纪念医院利用 HIFU 技术治疗子宫肌瘤和子宫腺肌病的临床经验。在展示手术视频的同时,陈医生详细讲解了 HIFU 治疗的手术过程。在讲座的最后,陈医生跟大家分享了 HIFU 治疗子宫肌瘤和子宫腺肌症的操作技巧,比如使用较高能量治疗子宫肌瘤,使用较低且平均的能量治疗子宫腺肌症等。
Watch the HIFU Series Webinars on our Youtube:
点击观看HIFU系列研讨会:
Webinars - YouTube

Notice通知
APAGE-ISMIVS HIFU Series Webinars 2021: HIFU and Fertility, Potential or Not?
2021年国际微无创医学会(ISMIVS)与亚太妇产科内视镜暨微创治疗医学会(APAGE)联合会议
暨2021年高强度聚焦超声(HIFU)系列线上研讨会(AIH)
To foster academic exchanges in the new field of minimally invasive and noninvasive surgeries and deliver scientific and educational dialogues across continents, the Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy (APAGE) and the International Society of Minimally Invasive and Virtual Surgery (ISMIVS) have been co-organizing APAGE - ISMIVS HIFU (AIH) Webinar Series 2021, which is themed on HIFU and Fertility, Potential or Not? and consists of 4 episodes starting from July to December, 2021.
为促进微无创手术领域的学术交流,国际微无创医学会(ISMIVS)联合亚太妇产科内视镜暨微创治疗医学会(APAGE)将于 2021 年 7 月至 12 月举办 4 场高强度聚焦超声(HIFU)线上系列研讨会。来自世界各地的医学专家将围绕“HIFU 与生殖:潜力与否”的主题为大家带来一场科学与教育的盛宴。

Follow us on Facebook and get free registration for the following episodes:
关注我们的Facebook账号,免费注册本系列研讨会:
International Society of Minimally Invasive and Virtual Surgery | Facebook
Looking forward to seeing you!
期待您的参与!
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ISMIVS launching its online training program
国际微无创医学会培训课程上线中
The International Society of Minimally Invasive and Virtual Surgery is pleased to announce the availability of a series of online training courses on the clinical application of noninvasive focused ultrasound therapy. A variety of courses related with ultrasound-guided high intensity focused ultrasound (HIFU) ablation of uterine fibroids will enlighten doctors about the physics and biological effect of HIFU, case screening, clinical protocol, anesthesia plan, nursing care, etc. In the meantime, more courses on focused ultrasound therapy of other diseases will be uploaded in the future, please follow us on www.ismivs.org for what you are interested in.
国际微无创医学会很高兴向大家宣布:我们的线上培训课程开始正式上线。课程将涵盖超声引导的高强度聚焦超声(HIFU)消融子宫肌瘤的物理学基础和生物学效应、病例筛选、临床方案、麻醉方案以及临床护理等。同时更多聚焦超声无创治疗其他疾病的课程将陆续上线,欲了解更多,请关注我们的官方网站 www.ismivs.org
The training courses are accessible only to part of ISMIVS members.
培训课程仅向部分国际微无创医学会会员开放。
Training Course Introduction: Techniques for Understanding MR Images and Its Clinical Application in HIFU Ablation
培训课程介绍:盆腔 MRI 阅片技巧及在聚焦超声消融治疗中的临床应用
MRI reading skills mainly introduce four aspects: 1. Understand the characteristics of MRI images; 2. Familiar with normal MRI anatomy; 3. Master the typical MRI performance of various diseases; 4. Combined with clinical data and other image inspections. MRI displays clear, realistic, no radiation, is not affected by fracture, hence MRI has been widely used in clinical practice.
MRI 阅片技巧主要介绍四个方面:1. 了解 MRI 图像的特点;2. 熟悉正常的 MRI 解剖;3. 掌握各种疾病的 MRI 典型表现;4. 结合临床资料及其它影像检查综合分析。MRI 优点在于解剖结构显示清晰、逼真,没有辐射,不受骨伪影影响,因此,已广泛应用于临床。
Become a member >
申请成为会员 >
To apply for the training courses,
please contact the ISMIVS Secretariat
jennyzhang@isminim.org
申请线上课程学习,
请联系国际微无创医学会秘书处
jennyzhang@isminim.org

Tech Update 微无创技术新进展
Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on Postoperative Pain Reduction: A Randomized Pilot Study
对比经阴道自然腔道内镜手术(vNOTES)与单孔腹腔镜子宫切除术(LESS)的术后疼痛减轻:一项随机试验研究
This study aims to evaluate postoperative pain and safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy compared to laparoendoscopic single-site (LESS) hysterectomy for benign uterine disease. 26 patients were randomized and allocated to vNOTES group (n = 13) and LESS group (n = 13).
本研究旨在对比评估经阴道自然腔道内镜手术(vNOTES)与单孔腹腔镜子宫切除术(LESS)治疗子宫良性疾病的术后疼痛和安全性。26例患者被随机分到 vNOTES 组和 LESS 组,每组各13例患者。

This study concluded that vNOTES hysterectomy could be safely performed for benign uterine disease requiring hysterectomy. However, vNOTES hysterectomy might be associated with higher postoperative vaginal pain intensity compared to LESS hysterectomy.
该研究得出结论:vNOTES子宫切除术可以安全地用于需要子宫切除术的子宫良性疾病的治疗。然而,与 LESS 子宫切除术相比,vNOTES 子宫切除术的术后阴道疼痛强度更高。
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High-intensity focused ultrasound versus uterine artery embolization for patients with retained placenta accreta
高强度聚焦超声(HIFU)与子宫动脉栓塞(UAE)治疗植入性胎盘滞留的对比
In order to compare the safety and clinical effectiveness of high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) for retained placenta accreta, a retrospective analysis was performed on 94 women who underwent HIFU (n=63) or UAE (n=31) followed by hysteroscopic resection for retained placenta accreta by the Third Xiangya Hospital of Central South University, China.
为了比较高强度聚焦超声 (HIFU) 和子宫动脉栓塞 (UAE) 治疗胎盘滞留植入的安全性和临床有效性,中国中南大学湘雅三医院对 94 名植入性胎盘滞留患者进行回顾性分析,其中63例接受 HIFU 治疗、31例接受 UAE 治疗,随后均行宫腔镜切除术切除滞留的植入性胎盘。
The baseline characteristics, including age, gravidity, parity, previous cesarean section rate, previous curettage rate, previous intrauterine adhesions rate, and delivery mode, were similar between the two groups. Vaginal bleeding was the major complaint in patients with retained placenta accreta. The number of hysteroscopy sessions, amount of intraoperative blood loss, and the length of hospital stays were also similar between the groups. No further hysterectomy was needed in either group. 两组的基线特征相似,包括年龄、妊娠情况、产次、既往剖宫产率、既往刮宫率、既往宫腔粘连率和分娩方式。阴道出血是植入性胎盘滞留患者的主要主诉。两组间宫腔镜检查次数、术中失血量和住院时间也相似。两组均不需要进一步的子宫切除术。
This study showed that both HIFU and UAE combined with hysteroscopic resection seemed to be safe and effective procedures in cases of retained placenta accreta.
这项研究表明,HIFU 和 UAE 联合宫腔镜切除术治疗胎盘滞留植入似乎安全有效。
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International Guidelines on Gynaecological Endoscopy  国际妇科腔镜指南
Gynecological Endoscopic Society of Malaysia Statement and Recommendations on Gynecological Laparoscopic Surgery during COVID-19 Pandemic
马来西亚妇科内镜学会(GESM)关于新冠肺炎大流行期间妇科腹腔镜手术的声明和建议

Gynecological Endoscopic Society of Malaysia (GESM) guidelines and recommendations on gynecological laparoscopic surgery during COVID-19 outbreak in Malaysia were presented in Nov 2020 Issue 4 of Gynecology and Minimally Invasive Therapy (GMIT), the official journal of APAGE. Specific recommendations for laparoscopic surgery:
亚太妇产科内视镜暨微创治疗医学会官方杂志《妇科与微创治疗》2020年第4期11月刊发表了马来西亚妇科内镜学会(GESM)关于马拉西亚新冠肺炎大流行期间妇科腹腔镜手术的指南和建议。对腔镜手术的具体建议如下:

1.For asymptomatic patients who were negative for COVID-19 in their viral swab test, the laparoscopic procedures should be encouraged as with usual practice.
2.During intubation and extubation, all healthcare workers (HCWs) should vacate the operating room until the anesthetist has prepared the patient.
3.In view of the pandemic with limited resources and time, the procedure should involve only a privileged and an experienced anesthetist, surgeon, and their assistants.
4.Ensure supporting staffs are highly trained and that effective equipment are readily available for safe and efficient surgery.
5.Avoid obese patients with high comorbidities, especially patients with sleep apneas, chronic lung disease, and metabolic disorders.
6.If there is a need to use a uterine manipulator, ensure that thorough cleaning and protection of perineum from contamination before, during, and postoperative is performed. May consider bowel preparation before all laparoscopic procedures.
7.Beware of the high risk of explosive dispersion of bodily fluid with specimen removal (both abdominally and vaginally).
8.It is also recommended that CO2 leakage is minimized to reduce the much “feared” AGP. This will also shorten the surgical procedure as the operating field is always “opened.”
1.对于病毒拭子检测结果为 COVID-19 阴性的无症状患者,腹腔镜手术应作为常规做法进行。
2.在插管和拔管期间,所有医护人员都应离开手术室,直到麻醉师为患者做好准备。
3.鉴于新冠肺炎大流行期间资源和时间有限,腹腔镜手术应仅涉及经验丰富的特许麻醉师、外科医生及其助手。
4.确保手术支持人员训练有素、有效设备可随时获得以进行安全有效的手术。
5.避免患有高合并症的肥胖患者,尤其是患有睡眠呼吸暂停、慢性肺病和代谢紊乱患者。
6.如果需要使用举宫器,请确保术前、术中和术后会阴的彻底清洁和保护,以免受污染。可考虑在所有腹腔镜手术前进行肠道准备。
7.谨防(经腹部和经阴道)取出标本时体液爆炸性扩散的高风险。
8.还建议尽量减少二氧化碳泄漏,以减少“令人恐惧”的气溶胶产生。这也将缩短手术过程,因为手术区域始终是“开放的(暴露在外的)”。

In general, there is no scientific basis of shunning laparoscopic approach in surgical intervention. Ultimately, the guiding principles would be of reducing the anesthetic and surgical duration, the availability of full protective gear for HCWs during the surgery and the status of the patient. It is mandatory for viral swab tests to be done within the shortest window period possible, for all cases planned for surgery.
总的来说,在手术干预中避免腹腔镜进入路径并没有科学依据。 指导原则最终还是减少麻醉和手术时间、在手术期间为医护人员提供全套防护装备以及依据患者状况。 对于所有计划进行手术的患者,必须在尽可能短的窗口期内进行病毒拭子检测。
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