tag:blogger.com,1999:blog-66313013249533363072024-03-14T13:12:11.922+08:00魏君卉醫師 婦科微創手術台南柳營奇美醫院婦產科 魏君卉醫師 婦科微創手術魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.comBlogger124125tag:blogger.com,1999:blog-6631301324953336307.post-72838305770958360262024-03-01T00:08:00.006+08:002024-03-01T00:08:41.904+08:00[圖解] 骨盆子宮脫垂要手術,怎麼辦? <p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space-collapse: preserve;">早上的門診答應病人和家屬,晚上要把這則漫畫放上來。忙了一天,來兌現我的承諾。</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">當病人因為疾病需要考慮拿掉子宮時,最常見的問題之一就是:</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">" <span style="font-family: inherit;"><a style="color: #385898; cursor: pointer; font-family: inherit;" tabindex="-1"></a></span>聽說拿掉子宮後,會空掉,器官沒有支撐會下垂,請問是真的嗎?"</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">答案是: 完全不是真的! (笑)</div><span><a name='more'></a></span><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">子宮沒有支撐器官的功能,反而和其他器官(像是膀胱、直腸)一起接受骨盆肌肉的支撐。骨盆就像一張吊床,器官則是水果,通通躺在吊床上。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">當水果很重,給吊床施加的壓力超過吊床可以承受的範圍,吊床就會慢慢變鬆,導致水果們下陷。這些壓力,包含體重很重、慢性咳嗽,自然產等等....</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">有時候,則是吊床用久了,自然的退化變鬆。像是老化,就是這樣子。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">*</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">所以,醫師要做的,是增加吊床的強度。其中比較常見的是利用人工網膜,從陰道或腹部做修補固定。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">我這裡主要的途徑是從腹部做手術,可以利用腹腔鏡或達文西等微創的方式來執行。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">和陰道網膜相比,可以利用一次手術,同時處裡子宮或卵巢的病灶和脫垂問題,算一魚兩吃。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">有需求的人,還是得到門診諮詢喔。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHGCxPTG3MAJtnkHnEouslDB6y4jvmJERYCEHr5i494mPOD2SdARgFtgSg9fmfNQ6FzFyo9ydpk8sDXhg-L2EP9iLG06mYomMshkDs5lQpOq43u3mlI0nlCsrfMQ6EYwegr6mJ9qioV1xqsXF9arjcFMO_xVG6h7IZnhEwpCsk5xYWLJ9RnGUw8-75Q_c/s3750/%E9%AA%A8%E7%9B%86%E8%84%AB%E5%9E%82_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2500" data-original-width="3750" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHGCxPTG3MAJtnkHnEouslDB6y4jvmJERYCEHr5i494mPOD2SdARgFtgSg9fmfNQ6FzFyo9ydpk8sDXhg-L2EP9iLG06mYomMshkDs5lQpOq43u3mlI0nlCsrfMQ6EYwegr6mJ9qioV1xqsXF9arjcFMO_xVG6h7IZnhEwpCsk5xYWLJ9RnGUw8-75Q_c/w640-h426/%E9%AA%A8%E7%9B%86%E8%84%AB%E5%9E%82_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" width="640" /></a></div><div class="separator" style="clear: both; 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margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6ycFYYKb9uEi3XDKC7bxcpVbjLYjQr3eI-64ceaysnd5-ccQ-RpVv9p419x65MB6vKL4xNgZATZPZVu2aE64gYb85GNROshJ7u19Sz4aIiHIVV7lcwGAekpuJnieoEiQv48f-wqKh4CS6-LmnZmBgYoRcc-eEm-iZzFAC79W4FBJFPPsR25-AH1wpSSc/w640-h640/%E9%AA%A8%E7%9B%86%E8%84%AB%E5%9E%82-03.jpg" width="640" /></a></div><br />魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-49626828704112091232024-01-22T20:07:00.007+08:002024-03-01T00:02:26.076+08:00[圖解] 用白色小藥丸打擊子宮內膜異位症,談談異位寧(Visanne)<p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space-collapse: preserve;">及早診斷,對症下藥"是子宮內膜異位症治療的準則。</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><a style="color: #385898; cursor: pointer; font-family: inherit;" tabindex="-1"></a></span>因此,如何替病人選擇藥物,用藥後月經會不會來,有哪些可能副作用等問題,每個門診我都得講不只一遍啊。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">甚至....甚至....也會有用藥一陣子的病人問我月經的事,真的是會講到口渴(喝飲料)</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">這次漫畫介紹的是可長期使用,副作用相對小的藥物異位寧(Dienogest)。另一個藥物佑汝(Gestrinone),雄性化副作用比較明顯,我相對比較少用。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">漫畫主要是服務我的門診病人,所以這次就已介紹異位寧為主。<span><a name='more'></a></span></div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;"><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">搭上直播主題,成功督促我這拖稿王把子宮內膜異位症用藥 " 異位寧" 的漫畫生出來。以後,大家就掃QR code回家自己看。忘記了,就再看一次。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">看看我以後飲料可不可以買中杯就好。(笑)</div></div></div><div class="separator" style="clear: both; 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text-align: center;"><br /></div><br /><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-62354157707030721722024-01-16T19:19:00.003+08:002024-01-22T19:41:01.572+08:00[圖解] 什麼是自然孔腹腔鏡 <p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space-collapse: preserve;">今日開自然孔腹腔鏡全子宮切除手術。病人因為嚴重的腺肌症,經期爆血因此選擇手術治療。</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">早上開刀,下午五點忙完去看她,病人看起來精神好氣色好。不得不說這種手術除了醫生比較辛苦(笑),風險得仔細評估並不是所有狀況我都願意開之外,真的還不錯。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><a style="color: #385898; cursor: pointer; font-family: inherit;" tabindex="-1"></a></span>自然孔手術其實是單孔手術的變形,可以用腹腔鏡做,困難一點的則可以搭配達文西會更安全。<span><a name='more'></a></span></div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">不過,自然孔手術條件限制我認為還是蠻多的,在手術之前醫師得想更多事情。有些太困難的刀,我會建議使用單孔(或雙孔),甚至腹部達文西手術去處理。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">畢竟,手術安全才是最重要的。盲目追求無傷口,卻把自己置於險境,實在不值得啊。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; 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text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-87729805830072268542023-12-07T17:10:00.004+08:002023-12-07T17:13:47.285+08:00[圖解] 微創手術常用自費耗材,全解密! <p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space-collapse: preserve;">手術自費耗材一直以來,是病人非常好奇,但又無門路可理解的東西。</span></p><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space-collapse: preserve;"><br /></span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">我一直認為,說明這些耗材的價值是為了讓手術更順暢安全,病人就能理解為何醫師會用。當醫師能拿到好用的器械,手術順了,心情順了,病人就安全了。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="color: #050505; font-family: inherit;"><span style="font-family: inherit;"><a style="color: #385898; cursor: pointer; font-family: inherit;" tabindex="-1"></a></span>昨日(112/12/06)的直播,特別就這塊做的詳細的說明。有興趣的朋友請進社團去聽。
入社連結請點:
<br /></div><div dir="auto" style="font-family: inherit;"><a href="https://www.facebook.com/groups/1266018690650943">魏君卉醫師的婦科相談室 | Facebook</a><span style="color: #050505;">
</span></div><div dir="auto" style="color: #050505; font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;">簡而言之:</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">1) 傷口撐開器: 單孔腹腔鏡/ 自然孔腹腔鏡與部分的達文西手術我都會用。簡易版容易破。一破,氣壓不穩手術視野不穩我心情也會不穩(笑)。如果有預算就買進階版,上蓋透明,檢體出入方便且不容易破,好用。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">2) 進階電燒: 能燒、能夾、也能剪。大大增快手術效率,減少出血,值得。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">3) 倒鉤縫線: 能讓縫合更順利,尤其正在出血時。</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">檢體袋: 避免要拿掉的腫瘤屑屑汙染妳乾淨的肚子,有些東西就跟前男友一樣,能清多乾淨就斷多乾淨。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space-collapse: preserve;"><div dir="auto" style="font-family: inherit;">4) 防沾黏: 牌子真的太多。看個案狀況挑選使用。放進去不用再拿出來會自己吸收喔。</div><span><a name='more'></a></span><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOU-Ee81Oxp4YLk-dggQKA8yZXoSBeKL_XBEAgWPJ9rxDCmXpTJtzGRvHKByeL6xl5p0mLCttyqXBScBWOKLNPmbc3rVKz7ESNd0NtJWcYOEMNzhVKCjhzpJzwk1M6QgJ4SX_owwhX3_2Q3nFTqEQ08uZW6lZx9UoWGEhcC2DMNkJk-xv1DyGctCA9OKY/s3750/%E7%9B%B8%E8%AB%87%E5%AE%A4-%E8%87%AA%E8%B2%BB%E9%86%AB%E6%9D%90_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2500" data-original-width="3750" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOU-Ee81Oxp4YLk-dggQKA8yZXoSBeKL_XBEAgWPJ9rxDCmXpTJtzGRvHKByeL6xl5p0mLCttyqXBScBWOKLNPmbc3rVKz7ESNd0NtJWcYOEMNzhVKCjhzpJzwk1M6QgJ4SX_owwhX3_2Q3nFTqEQ08uZW6lZx9UoWGEhcC2DMNkJk-xv1DyGctCA9OKY/w640-h426/%E7%9B%B8%E8%AB%87%E5%AE%A4-%E8%87%AA%E8%B2%BB%E9%86%AB%E6%9D%90_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" width="640" /></a></div><div class="separator" style="clear: both; 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margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="3751" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPS5Z8lUghxj-w5Tmcgp3d_X0XxrPLw7SPNu_cgceRuh3QdZbGrS0zLMADuA87QgOxDnuQ_Fn_apcWM7KV-8Tg_nYGLI4wbtJNajaSRlUd3mLxjEFHmHSQFzEgi4BVGjTUz0QFZoJ8ZE61xJYDfeG4ytRDAJcpB7qjgAcd6ZwPCB-4njnNypmnG5Vam1Q/w640-h426/%E7%9B%B8%E8%AB%87%E5%AE%A4-%E8%87%AA%E8%B2%BB%E9%86%AB%E6%9D%90-04.jpg" width="640" /></a></div></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTJlEIxbQ6AKNUaP_K4nmUKT8ZFTPeYSKCOkljlyfkigfj-JnRHGVBBbbmY90xTvH9iK3UZbhNenbVczJzBWrN-1BRAmhAjvd_drt7KSw-VWYUhJv7n2f86raqa615P8sIECxhrTxdfXYS0bz7Qpw00oDwZmH17TtyGiIVKYL2lxtYtvpimy0j6dCMRMY/s3751/%E7%9B%B8%E8%AB%87%E5%AE%A4-%E8%87%AA%E8%B2%BB%E9%86%AB%E6%9D%90-05.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="3751" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTJlEIxbQ6AKNUaP_K4nmUKT8ZFTPeYSKCOkljlyfkigfj-JnRHGVBBbbmY90xTvH9iK3UZbhNenbVczJzBWrN-1BRAmhAjvd_drt7KSw-VWYUhJv7n2f86raqa615P8sIECxhrTxdfXYS0bz7Qpw00oDwZmH17TtyGiIVKYL2lxtYtvpimy0j6dCMRMY/w640-h426/%E7%9B%B8%E8%AB%87%E5%AE%A4-%E8%87%AA%E8%B2%BB%E9%86%AB%E6%9D%90-05.jpg" width="640" /></a></div><br /><div> <a href="https://obgyndrwei.blogspot.com/p/blog-page_7.html">返回圖解婦產首頁</a></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-55739096083028462862023-08-10T17:50:00.001+08:002023-08-10T17:50:24.775+08:00[圖解] 2023年更新 : 次全子宮切除手術,留子宮頸也不沾黏。<p>先前的圖解婦產,有提到若選擇次全子宮切除(就是留下子宮頸),需考慮腸道沾黏這個議題。</p><p>有許多前輩不喜歡這個手術,就是因為沾黏這件事。</p><p>不過,其實只要手術時多縫合腹膜,就能降低沾黏發生。只是腹腔鏡手術縫合較傳統開腹手術困難、耗時且需要熟練的技術。</p><p>幸虧現在有達文西機器手臂,由於器械轉彎靈活,能輔助腹腔鏡做很好的縫合。因此只要接受達文西手術次全子宮切除的病人,我都會將腹膜完整的縫合。</p><p>至於選擇單孔腹腔鏡的病人,因為目前我已經很熟悉縫合技巧,只要條件允許,我也會盡量做到。</p><p>如果對手術圖片有興趣的朋友,請點<a href="https://obgyndrwei.blogspot.com/2023/07/blog-post.html" target="_blank">次全子宮切除達文西連結</a>,就可以看到手術實際圖片。</p><span><a name='more'></a></span><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMvCcuAlGcFSYxV9ol8cVy2eoK3-PPYLKOHFAK_n0NBIWHwv9OD11Mh-U7ksAR__Qd7uN0UQsrYqdZ9dFzbRKk-MmHLGKAIsWL3V2Tx9MYPsDSn0CCyV02lkvvXk--CHeLlXK8WRD_3nWTMHiEgmbvFaHJY8kk88DNG2QIKH0nKMF3Fa1DZ2pEvC-h_MM/s3750/%E9%AD%8F%E9%86%AB%E5%B8%ABlevel%20up_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2500" data-original-width="3750" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMvCcuAlGcFSYxV9ol8cVy2eoK3-PPYLKOHFAK_n0NBIWHwv9OD11Mh-U7ksAR__Qd7uN0UQsrYqdZ9dFzbRKk-MmHLGKAIsWL3V2Tx9MYPsDSn0CCyV02lkvvXk--CHeLlXK8WRD_3nWTMHiEgmbvFaHJY8kk88DNG2QIKH0nKMF3Fa1DZ2pEvC-h_MM/w640-h426/%E9%AD%8F%E9%86%AB%E5%B8%ABlevel%20up_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" width="640" /></a></div><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMMVPq1-nktXPnTMW9Lb_rniF9FZD9WKdZBudljPygdUFwA2MNjq6tYoBivtjVWMQvGnc2nNAH2GZkQV4f6FVDKlD1xH6CVE_3hWuGnqAsEd7OGQ9Cb3WxTz_jHPA-opWvMrOFTvB0xarWEh7TS40IkPM7RijDfD5pqaCNMJpIwXc7Q3Coq2jeW5qfl48/s2501/%E9%AD%8F%E9%86%AB%E5%B8%ABlevel%20up-02.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMMVPq1-nktXPnTMW9Lb_rniF9FZD9WKdZBudljPygdUFwA2MNjq6tYoBivtjVWMQvGnc2nNAH2GZkQV4f6FVDKlD1xH6CVE_3hWuGnqAsEd7OGQ9Cb3WxTz_jHPA-opWvMrOFTvB0xarWEh7TS40IkPM7RijDfD5pqaCNMJpIwXc7Q3Coq2jeW5qfl48/w640-h640/%E9%AD%8F%E9%86%AB%E5%B8%ABlevel%20up-02.jpg" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggkVcJoGIpHV5KS4hsSkmP12mZ-vfwkd6L7Z2ANEBiAQ881qOhGzWOU6w12_S5b2BXrnBoBIp9AcIjIp70HMsyCjhJNyvoxzypTspBopwMh2OoAObndN1oWAPn7jXo2JSGpAD_VZk1lu1I5HW2qWFSP4wG4vLHq6qW-KnMcLix0eqiMNyka_7C3O5Z5Ww/s2501/%E9%AD%8F%E9%86%AB%E5%B8%ABlevel%20up-03.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggkVcJoGIpHV5KS4hsSkmP12mZ-vfwkd6L7Z2ANEBiAQ881qOhGzWOU6w12_S5b2BXrnBoBIp9AcIjIp70HMsyCjhJNyvoxzypTspBopwMh2OoAObndN1oWAPn7jXo2JSGpAD_VZk1lu1I5HW2qWFSP4wG4vLHq6qW-KnMcLix0eqiMNyka_7C3O5Z5Ww/w640-h640/%E9%AD%8F%E9%86%AB%E5%B8%ABlevel%20up-03.jpg" width="640" /></a></div><p>回 <a href="https://obgyndrwei.blogspot.com/p/blog-page_7.html" target="_blank">圖解婦產首頁</a></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-26083473156034851482023-07-26T21:45:00.003+08:002023-07-26T21:45:39.674+08:00[ 達文西手術] 次全子宮切除手術<p>45歲的王小姐,因為子宮腺肌症每次月經來量都很多,選擇接受手術摘除子宮。還記得她選擇達文西手術時,特別提醒我: 魏醫師,你的達文西手術分享中沒有次全子宮切除喔!</p><p>今日她回診,看到她的笑容,我當下就決定今晚得把這事情給辦了</p><p>**</p><p>選擇手術時,若討論要拿子宮,是否留子宮頸經常是許多病人在乎的事。</p><p>如何選,我們直接講結論: </p><p>留子宮頸的大前提 : 子宮頸得是健康的。這就像考試六十分,這點要先滿足,才能留。<span></span></p><a name='more'></a><p></p><p>至於好處主要有三點:</p><p>1) 手術較簡單 ,在困難的個案中能降低傷害輸尿管的機會 。如果你的手術很困難,我甚至會主動跟妳提是否留子宮頸保平安。</p><p>2) 性生活較快恢復,平均2周後可以恢復性生活 。(其實不會痛後就可以了,這算是保守的估計)</p><p>3) 骨盆結構完整,減少日後脫垂的機會。但,骨盆脫垂這件事情成因很多,大家有興趣要點進圖解婦產看漫畫了解一下。</p><p>延伸圖解婦產閱讀: <a href="http://obgyndrwei.blogspot.com/2021/03/2.html#more" target="_blank">聽人家說,拿子宮腸子會脫垂?</a></p><p>**</p><p>2023年之後,我做次全子宮切除已經習慣把子宮頸粗粗的面整個關好,還給骨盆一個光滑面。因此腸道沾黏的機會比之前降低。</p><p>所以如果妳選擇的是次全子宮切除,別太擔心沾黏,只要滿足子宮頸健康這個前提,就ok啦。</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEganLyBg6kU0dMspZTB7SduMHkzsyEKm6DDYh0Xfn2FbR9gI4GXctxEtFsu8JOmUFrxk9VIXn-ES0Rfh2xYh5RCEuGKXhGWPoG6p8aKaqA-XMxVDPUOTfK1DIs4qfOlt--j7Hylo6wtoXZVC5ZON6a7OKzBGfmgViBeeZC9aUVKsb5q1Yfv3lMXby3bxBk/s1920/2%20(3).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEganLyBg6kU0dMspZTB7SduMHkzsyEKm6DDYh0Xfn2FbR9gI4GXctxEtFsu8JOmUFrxk9VIXn-ES0Rfh2xYh5RCEuGKXhGWPoG6p8aKaqA-XMxVDPUOTfK1DIs4qfOlt--j7Hylo6wtoXZVC5ZON6a7OKzBGfmgViBeeZC9aUVKsb5q1Yfv3lMXby3bxBk/w640-h360/2%20(3).BMP" width="640" /></a></div><div style="text-align: center;">Fig.1 長腺瘤的子宮</div><div><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKTDy3Q9527Mqo1K-D6xsjp1Agh_LvMZeaptUBAZ30u82q2k-lM5eROQ3jnX9VnAg207t6pyiETVy5Jrwt750gf6GBWxXNUCHQRiD_QvUpd61z71CEpZcSB89nXRV0LGNKrHwHc55Wqw6OPQHqsI2JV1RemW3VrKhBxEwSJjIHJopuNBMGww7mDUr0vZ4/s1280/2%20(11).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKTDy3Q9527Mqo1K-D6xsjp1Agh_LvMZeaptUBAZ30u82q2k-lM5eROQ3jnX9VnAg207t6pyiETVy5Jrwt750gf6GBWxXNUCHQRiD_QvUpd61z71CEpZcSB89nXRV0LGNKrHwHc55Wqw6OPQHqsI2JV1RemW3VrKhBxEwSJjIHJopuNBMGww7mDUr0vZ4/w640-h360/2%20(11).BMP" width="640" /></a></div><div style="text-align: center;">Fig.2 大部分子宮已經切除,留下中間白色粗粗的面就是子宮頸。</div><div><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKKW2ZpDY5eWvaOOEyiyRLV5hgeUc4JTq_eD9M0baZI6GsNaQ2NVxf6SMB5s3LOcWrBiAN8Pz1oKFYK7fhAGBsT9pksa4MD_rJUZEmdWMtx826OV2g9yGsMkGqFKRZG6p0evVdDqIKeUOt8AnYykh6WpDIFP8-B6T_Uo8vsy79lyuYKodJM_vNoUpirkY/s1280/2%20(15).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKKW2ZpDY5eWvaOOEyiyRLV5hgeUc4JTq_eD9M0baZI6GsNaQ2NVxf6SMB5s3LOcWrBiAN8Pz1oKFYK7fhAGBsT9pksa4MD_rJUZEmdWMtx826OV2g9yGsMkGqFKRZG6p0evVdDqIKeUOt8AnYykh6WpDIFP8-B6T_Uo8vsy79lyuYKodJM_vNoUpirkY/w640-h360/2%20(15).BMP" width="640" /></a></div><p style="text-align: center;">Fig.3 把腹膜關好,雙側卵巢也固定好。骨盆結構完整,表面光滑,腸道沾黏的機率降低。</p><p><br /></p><p><br /></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-83356793341667345462023-04-17T19:35:00.001+08:002023-04-17T19:38:48.312+08:00[ 達文西手術 ] 巨大前子宮頸肌瘤切除手術<p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">子宮頸肌瘤,是所有肌瘤類型中最難處理的一種,尤其是前子宮頸。</span></p><p>原因是前子宮頸旁邊有許多重要的結構,包含膀胱、子宮動脈、輸尿管。這些構造的位子會因為肌瘤而移動,需要找出來、分清楚,手術才能安全下庄。</p><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">*</span></p><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">記得剛開始做達文西時,我還不夠有信心,還因此拒絕了一個類似的病人。</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">隨著經驗的累積,現在已經可以處理。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><a style="color: #385898; cursor: pointer; font-family: inherit;" tabindex="-1"></a></span>整個開刀過程中,由於有機器人放大的視覺與靈活的手臂,以往用腹腔鏡開,會很艱難的膀胱與肌瘤分離,被很輕鬆的克服掉。</div><span><a name='more'></a></span><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">我倒覺得最有挑戰性,也最需要注意的,是注意不要傷到子宮頸兩側的子宮動脈。由於子宮頸肌瘤,也是從小開始長的(廢話),所以會把子宮動脈往外推,至於推到哪就不確定,分離的時候要很小心。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">否則弄破,那出血可是夠受啊。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">另外一個挑戰,是子宮頸要削多深。因為從子宮頸長出來,基本上正常組織所剩不多,肌瘤底部與子宮頸界線也沒有非常明顯,在這裡花了一點時間。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">不過結果還是達到我對自己的期待。沒有什麼出血(100cc),沒有併發症,縫合起來也挺美觀。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">越開,越覺得很難的刀,用機器人開好處實在太大!</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">希望自己能有機會,繼續開下去。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">**</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4U73gswYPasybmNpI6BxP89pCoQ0Ti_rhYniSoLnP3-w19ecTtuf2RiLF9IfkzzKpDLjmt2O2RqT6_0h9NkvgL9f4RYX51yumwgwnIv5QGjS4bL2BNG9WAg8SbxeLQwOk9QwnqzK8xcAO5ayaWsV-CHSHTVioUCLEQHy2XRR4OKjKIaY5adBm_pLU/s1280/1%20(13).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4U73gswYPasybmNpI6BxP89pCoQ0Ti_rhYniSoLnP3-w19ecTtuf2RiLF9IfkzzKpDLjmt2O2RqT6_0h9NkvgL9f4RYX51yumwgwnIv5QGjS4bL2BNG9WAg8SbxeLQwOk9QwnqzK8xcAO5ayaWsV-CHSHTVioUCLEQHy2XRR4OKjKIaY5adBm_pLU/w640-h360/1%20(13).BMP" width="640" /></a></div><br /><div style="text-align: center;"><b>Fig.1 坐在子宮正上方的巨大子宮肌瘤。大約9公分。</b></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5tsNjLTUwOyUvtWH6hhnmtivUAqQitrPl0hWXeG2WBJfGEVfLhKw1zwuigybuaHy34mRKnRVmNCtZT5sefGRHmsNMvGsS8BOfUMDK1GKzieSR7CsNs2AqVsQk35DTX6cWvX-UcUiZwm5kq30eqOfVLleVvJ4LlWVKUThFOJZULw1rkXhVz4xumwbv/s1280/1%20(14).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5tsNjLTUwOyUvtWH6hhnmtivUAqQitrPl0hWXeG2WBJfGEVfLhKw1zwuigybuaHy34mRKnRVmNCtZT5sefGRHmsNMvGsS8BOfUMDK1GKzieSR7CsNs2AqVsQk35DTX6cWvX-UcUiZwm5kq30eqOfVLleVvJ4LlWVKUThFOJZULw1rkXhVz4xumwbv/w640-h360/1%20(14).BMP" width="640" /></a></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /></div><div style="text-align: center;"><b>Fig.2 找到膀胱和肌瘤的界線。從這裡下手。</b></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8j2va1djtkX88Dfw5jyDs310JbidmwrhavumFRxvN3bK1NiCNk5fldXbjAVW7uPYV5PDXXtfkq_Wp1igQ--reWQ1eXHu8R6zipD-sst1hCq8ur790tDvpxrVk6ckspFsQdjD1f0M-1pSQEiq0z5fN8VPK8od7FPF08XCIppc30IbwOjZG2icZh3oZ/s1280/1%20(17).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8j2va1djtkX88Dfw5jyDs310JbidmwrhavumFRxvN3bK1NiCNk5fldXbjAVW7uPYV5PDXXtfkq_Wp1igQ--reWQ1eXHu8R6zipD-sst1hCq8ur790tDvpxrVk6ckspFsQdjD1f0M-1pSQEiq0z5fN8VPK8od7FPF08XCIppc30IbwOjZG2icZh3oZ/w640-h360/1%20(17).BMP" width="640" /></a></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /></div><div style="text-align: center;"><b>Fig.3 腹膜一打開,二氧化碳幫忙將空間撐出來。</b></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; text-align: center; white-space: pre-wrap;"><b>把膀胱和肌瘤慢慢地、細緻的分開。這個過程好療癒啊。</b></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div style="text-align: center;"><span face=""Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif" style="color: #050505; font-size: 15px; white-space: pre-wrap;"><br /></span></div><div class="separator" style="clear: both; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; text-align: center; white-space: pre-wrap;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy5eMQ3F9RlWx0JXg7LVUg9GNCUJCAs0C4kh0uudqpq0q72qkuWz7FgpNorrgPdYgVb09EpCISZJe4wB9JdwQhtCTEWzgm-W2_sSWozTEI5CkdupINgVsfyTzTgS_XSG_1MhlwGOMkFxWGQBkLsVrLnTFpuP3h88t0rckiumEaHvAG5wyeR-KEZDuu/s1280/1%20(24).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy5eMQ3F9RlWx0JXg7LVUg9GNCUJCAs0C4kh0uudqpq0q72qkuWz7FgpNorrgPdYgVb09EpCISZJe4wB9JdwQhtCTEWzgm-W2_sSWozTEI5CkdupINgVsfyTzTgS_XSG_1MhlwGOMkFxWGQBkLsVrLnTFpuP3h88t0rckiumEaHvAG5wyeR-KEZDuu/w640-h360/1%20(24).BMP" width="640" /></a></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; margin: 0.5em 0px 0px; overflow-wrap: break-word;"><br /></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; margin: 0.5em 0px 0px; overflow-wrap: break-word; text-align: center;"><b>Fig.4子宮頸的位置,稍微看的到了。</b></div><br /><div class="separator" style="clear: both; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; text-align: center; white-space: pre-wrap;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJevR5FdJUMzLCT8snMrdBOeyIuMvItsIgaPoBR1DSwXlyHA_ZNgJqngdO_8ogAef2G4x0-XfqiHiVbyOTYSgs2W3lKN-P7rT3XkMpfwoouXoLcFhF26dft4SafLBnUfxEFpyJ4I_GQx4jT932PpCUAW38TxcF49N0ylM3soUstFIXazsF4bt8K7TI/s1280/1%20(30).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJevR5FdJUMzLCT8snMrdBOeyIuMvItsIgaPoBR1DSwXlyHA_ZNgJqngdO_8ogAef2G4x0-XfqiHiVbyOTYSgs2W3lKN-P7rT3XkMpfwoouXoLcFhF26dft4SafLBnUfxEFpyJ4I_GQx4jT932PpCUAW38TxcF49N0ylM3soUstFIXazsF4bt8K7TI/w640-h360/1%20(30).BMP" width="640" /></a></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; margin: 0.5em 0px 0px; overflow-wrap: break-word;"><br /></div><div style="text-align: center;"><b>Fig.5 把肌瘤從底部削掉,只留下一點點連接子宮頸的部分 (大概3mm),為了縫合。</b></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; margin: 0.5em 0px 0px; overflow-wrap: break-word; text-align: center;"><b>否則前子宮頸幾乎要消失了。</b></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; margin: 0.5em 0px 0px; overflow-wrap: break-word;"><br /><div class="separator" style="clear: both; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; text-align: center; white-space: pre-wrap;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibWODkruZeLqE0Bu1N-sb89GqVFO_bVgYeI9nBsFoaT-XeY1g_Ip0J6PRvRpXyCvWDOE0FFI6SLLNJNr0Fni4Yd3f7Hs3CRil5fLpx7K1Byd22GzU4BM0ONIylTIwKEtV7eY8EuxqeYt01t4qav-9r06h0UMzABgOo56FPvT0YINSWK75jeNLyUuSb/s1280/1%20(35).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibWODkruZeLqE0Bu1N-sb89GqVFO_bVgYeI9nBsFoaT-XeY1g_Ip0J6PRvRpXyCvWDOE0FFI6SLLNJNr0Fni4Yd3f7Hs3CRil5fLpx7K1Byd22GzU4BM0ONIylTIwKEtV7eY8EuxqeYt01t4qav-9r06h0UMzABgOo56FPvT0YINSWK75jeNLyUuSb/w640-h360/1%20(35).BMP" width="640" /><div class="separator" style="clear: both; text-align: center;"><br /></div></a></div><div style="text-align: center;"><b>Fig.6 子宮頸縫好的樣子。後面留下的光滑腹膜表面,是原來肌瘤的位置。</b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIDC69AEdJMhx3BM8tkiQzQ46jdWVqhICAR3JJYh4jpmarqG8llQQj3JhtC4f0AZJsBT-pDZG9c-AavIZQA1mC9839HSwYbsl5FmrVAZfk3vqGYM2bmJGoMzQ7XlL2VYfahCe1vbt7u_y1tWd_JLy_l0dMTZjFERClgBGmptl1yl0G85dF-PqjmE0q/s1280/1%20(1).BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIDC69AEdJMhx3BM8tkiQzQ46jdWVqhICAR3JJYh4jpmarqG8llQQj3JhtC4f0AZJsBT-pDZG9c-AavIZQA1mC9839HSwYbsl5FmrVAZfk3vqGYM2bmJGoMzQ7XlL2VYfahCe1vbt7u_y1tWd_JLy_l0dMTZjFERClgBGmptl1yl0G85dF-PqjmE0q/w640-h360/1%20(1).BMP" width="640" /></a></div><br /><b>Fig.7 可以看到完整子宮、兩側卵巢和輸卵管。真美呀。</b></div><div dir="auto" style="color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-64894755759766324122023-03-20T16:13:00.003+08:002023-03-20T16:48:09.597+08:00[ 子宮鏡手術 ] 子宮外孕手術 (子宮角)<p>子宮外孕大家都有聽過。</p><p>光聽名稱,會以為就是胚胎長在子宮外面,很單純。</p><p>不過,事情沒有那麼簡單。還是有兩種狀況,明明胚胎著床在子宮內,但因著床的地點肌肉層較薄( 為了讓病人容易理解,我都稱風水不好) ,懷孕早期就可能把子宮撐破。</p><p>這兩個風水不好的子宮內地點,分別是 1) 剖腹產疤痕處 2) 子宮角靠近輸卵管的地方。<span></span></p><a name='more'></a><p></p><p>*</p><p>上週五,就在我終於看完夜診,心想好不容易可以洗洗睡時,急診打電話過來。</p><p>" 魏醫師,病人從台北轉下來,診斷子宮角懷孕,想麻煩妳處理。" 聽到這個內容,內心不禁哀嚎。</p><p>這種外孕手術不太好做,沒搞好,孕婦會血流成河。</p><p>不開刀只打針也不是不行。打針可用MTX,是一種阻止胚胎繼續生長的藥,常用在子宮外孕治療。但打針,沒保證能成功阻止胚胎長大。</p><p>網路醫學文獻隨便查,打完針,子宮一樣被撐破者有多。</p><p>看一看,和病人及家屬討論好,決定用硬式子宮鏡小心處理。如果真的子宮破掉,得轉成腹腔鏡手術。</p><p>*</p><p>" 魏醫師,台北的醫師特別交代這個手術不能隨便做,因為有風險。" 邊檢查,病人邊跟我說。</p><p>" 所以我就拿妳的簡歷給他看。他看完後說,這個應該可以。" 聽到這裡,真的是莞爾。</p><p>雖然不知道是哪位台北的前輩,但我任務達成了。特此報告。</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ7-8rjJd0TDcQTd7y-5LCB-e2naZ04XnV5kEDnn1L0gOul2H1XceCGq7_jBM-GLb7Otx4MOk5s_ZYzx-2oF0277mmISAlJR80rUa7FoAU6RL2Pp7pwSWBbY3_OEuvueO18j0kXoJwPN8JyAaUFNNWX8jE_tLaJU14JDGspF3nbdB7reH23-DWZd7R/s1280/corneal%20pregnancy_RSC.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ7-8rjJd0TDcQTd7y-5LCB-e2naZ04XnV5kEDnn1L0gOul2H1XceCGq7_jBM-GLb7Otx4MOk5s_ZYzx-2oF0277mmISAlJR80rUa7FoAU6RL2Pp7pwSWBbY3_OEuvueO18j0kXoJwPN8JyAaUFNNWX8jE_tLaJU14JDGspF3nbdB7reH23-DWZd7R/w640-h360/corneal%20pregnancy_RSC.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="347" src="https://www.youtube.com/embed/Xc0DZi15KLg" width="565" youtube-src-id="Xc0DZi15KLg"></iframe></div><div><br /></div>利用子宮鏡慢慢把懷孕組織和正常子宮肌肉層分開。其中遇到血管就先止血,保持手術視野盡量不血乎乎。<div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIvjtnUBQMHlUUvyrF45HeU6xUu3sIXtm7KFq42iDRdkKEi8soFEk2CRY8rpYJUEQgzmUevZGZpyLOe7EJKXHWkAIyUjilKval_wNoJqf9Q1Xg66o4yRJ1H6WMTj99_vESE2mFfNjeNMfU1rb5e72yxypVNl8rslJEoYm0yk60UfD_xmWDZaWs_2BO/s1280/corneal%20pregnancy_RSC2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIvjtnUBQMHlUUvyrF45HeU6xUu3sIXtm7KFq42iDRdkKEi8soFEk2CRY8rpYJUEQgzmUevZGZpyLOe7EJKXHWkAIyUjilKval_wNoJqf9Q1Xg66o4yRJ1H6WMTj99_vESE2mFfNjeNMfU1rb5e72yxypVNl8rslJEoYm0yk60UfD_xmWDZaWs_2BO/w640-h360/corneal%20pregnancy_RSC2.jpg" width="640" /></a></div><br /><div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p><br /></p><p><br /></p></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-26653112953713917492023-01-03T20:30:00.002+08:002023-01-03T20:33:02.112+08:00[ 達文西手術 ] 子宮內膜異位合併嚴重沾黏手術 <p>子宮內膜異位症,決定手術需要非常謹慎。除了每次手術對組織都是傷害外,另一個原因就是: 每次手術造成的沾粘,都會讓下次手術難度升高。(但拜託,該吃藥就吃藥,該開刀就開刀,逃避只會更糟糕喔)</p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">這次,是病人第三次因為子宮內膜異位症開刀。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">子宮內膜異位症再次手術,需要提高警覺,這點只要是婦產科醫師都知道。因此,當病人第二次因為痛,被家人送到急診時,當時遇到的醫師無法保證可以處理。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">「如果真的黏的太厲害,只能先做緊急處理,然後直接把肚子關起來。<span style="font-family: inherit;">」病人轉述。</span></div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">所幸,第二次的刀還是有開成,不過從此少了右邊卵巢。</span></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">所以,當她的左邊卵巢巧克力囊腫一直長大,用藥控制效果也不彰,逼得我得開始考慮手術時,光想,就頭皮發麻。</div><span></span><span><a name='more'></a></span><div dir="auto" style="font-family: inherit;">*</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">開達文西手術前,我習慣做術前解釋。這麼做,除了讓外面等待的家屬,能夠對手術難度與時間有個底,對於手術施行的我,心理壓力也會降低。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">「腸子沾黏非常嚴重,骨盆完全釘死,妳先去買杯飲料和一個便當吃,我得慢慢開。」達文西術前解釋時,我對病人的妹妹說。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">「沒關係,醫生,妳就慢慢做。」</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;"><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">長達六小時的馬拉松手術。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">把大腸所有的沾黏都分開,無論是黏在骨盆側邊還是卵巢上又或者子宮上的,通通分開,完全free 。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">左側卵巢輸卵管,費了九牛二虎之力終於摘除。12公分卵巢腫瘤,黏死釘牢啊。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">最精彩的是子宮,做到完全切除。輸尿管則被完整分離至靠近膀胱的地方,看的清清楚楚。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">「醫生,如果可以的話,子宮卵巢輸卵管全部拿掉。我真是受夠了!」病人術前對我說。而<span style="font-family: inherit;">這次,真的是病人最後一次因為婦產科的病,開進肚子了。</span></div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">開這種刀,對醫師是心性與技術的極大考驗。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">該怎麼開,就是見招拆招,順著骨盆結構邏輯去做、去分。急不得。術後也無法完全確定沒事,心得懸著。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">*</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">隔天查房,先看了抽血報告和護理紀錄,心放下一半。再看到病人,心就放下了幾乎全部。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">「我下床走的很好,痛也減緩了。真的很謝謝妳啊!」握著我的手,病人說。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">「醫生,不瞞妳說,我昨天聽完術前解釋是完全吃不下,還跑到廁所,吐了。」病人妹妹接著說。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">「是啊!我可是把畢生所學都拿出來用,才能將這台刀開下來。」邊說,邊雙手畫圈,做一個運功的手勢。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">大家都笑了。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">大家都辛苦了啊。</div><div dir="auto" style="font-family: inherit;"><br /></div></div></div><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">這台刀因為沾黏嚴重,血呼呼的。怕有人看了會怕,全灰階處理。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG_5EwO201a9dn1vMkFoi-zkLJSA3Syq7_ZjSFh9EbunzvAfw4bN9JDS8m5vjNoBfzzZbvaUln6nYfWeuAMEi7_PEqBGz2IQ7Nr8yXpnVR6pQuDcSZ0-i8MvVS9igfcJ2BqDqUhPmrqfp64aYq5gmuD2DUT-Adyjo32DhTbedC0bOrs7PbV0yaSUBu/s1280/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG_5EwO201a9dn1vMkFoi-zkLJSA3Syq7_ZjSFh9EbunzvAfw4bN9JDS8m5vjNoBfzzZbvaUln6nYfWeuAMEi7_PEqBGz2IQ7Nr8yXpnVR6pQuDcSZ0-i8MvVS9igfcJ2BqDqUhPmrqfp64aYq5gmuD2DUT-Adyjo32DhTbedC0bOrs7PbV0yaSUBu/w640-h360/1.png" width="640" /></a></div><br /><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_XOkMXbxPKM7jfETR12xqTLNe7hlhxITU7sFI45d0AJJdJ7AgVHycxfoGZwna3QvTPvu19N9NtV4FF3PcsycGvXEVs6_E5y6MHtnpWfOY3W9iRgqYCeqOUcUDm5gp-mJXTG96TggvuvD-1-ynLquMINAWciONJkZKDBXZUGIhqGS8CMi_7Cv_VKYW/s1280/2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_XOkMXbxPKM7jfETR12xqTLNe7hlhxITU7sFI45d0AJJdJ7AgVHycxfoGZwna3QvTPvu19N9NtV4FF3PcsycGvXEVs6_E5y6MHtnpWfOY3W9iRgqYCeqOUcUDm5gp-mJXTG96TggvuvD-1-ynLquMINAWciONJkZKDBXZUGIhqGS8CMi_7Cv_VKYW/w640-h360/2.png" width="640" /></a></div><br /><div class="separator" style="clear: both; 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margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUm3UkvsbXhF1LIUwCxYTwRB56hH0qwW6_8Qd-GeeSKaoYKwMmlX9NGybt75aQb_lkwxhZbquzmSJjnkCvZk3WcbZyGi7ZfJL8EB1Mu6080LeZw0yUYkXXjmJV6aw0BOHq2Upo3BZkyBbgudthBMedZWzv7-DzxutDmux6KHnFVvSfXuxx83igixOc/w640-h360/4.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjudX_CuoQTvCW_BdNfpkR4xe8rACzX3IB4qv8wJgXhGHjbDDB19yDzbjzyB99SGX_bAsoM678fe4hRnQBYr7Hpcj_SShrGKIdQSublRH2W-6SCDNS6MHLRDEa8_nb17g12HkZsq451nOA7RMRcxoo0go-6iMrCoEuQeZXJBnm2OJ2hhn0YygOH3Hz1/s1280/5.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjudX_CuoQTvCW_BdNfpkR4xe8rACzX3IB4qv8wJgXhGHjbDDB19yDzbjzyB99SGX_bAsoM678fe4hRnQBYr7Hpcj_SShrGKIdQSublRH2W-6SCDNS6MHLRDEa8_nb17g12HkZsq451nOA7RMRcxoo0go-6iMrCoEuQeZXJBnm2OJ2hhn0YygOH3Hz1/w640-h360/5.png" width="640" /></a></div><br /><br /><div dir="auto" style="font-family: inherit;"><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">接下來是我自己的紀錄,像咒語一樣,一般讀者不用看嘿:</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">1. 術前請泌尿科盧致誠醫師放D-J 。感謝。</div><div dir="auto" style="font-family: inherit;">2. 先把左右側大腸沾黏的地方分開。</div><div dir="auto" style="font-family: inherit;">3. 左側釘死。於是開右側para rectal space到靠近uterosacral lig.處。回頭將右側ureter往外推,發現在US lig 處是雷區。Artery ascending branch, ureter , colon 都在附近。</div><div dir="auto" style="font-family: inherit;">4. 不能硬幹,否則出血討厭。回頭,拿出modified radical的技巧,uterine artery整條分好,從源頭斷,拉起來當guide 把輸尿管完全分離並往外撥。</div><div dir="auto" style="font-family: inherit;">5. 回左側。先進retroperitoneal space ,輸尿管完全看不到,卵巢腫瘤太大,只能先破。</div><div dir="auto" style="font-family: inherit;">6.浴血奮戰,開始分蓋在左側卵巢上的大腸,終於看到ovarian fossa,毫無懸念,斷IP ,大概能掌握ureter走向,先斷LSO 。</div><div dir="auto" style="font-family: inherit;">7.開左側para rectal space,分ureter,順便斷左側子宮動脈,再拉起來把輸尿管推到外太空。(靠!這招怎麼這麼好用。)</div><div dir="auto" style="font-family: inherit;">8. 打okabayashi space(這個我老是做不好),和腸子再一陣纏鬥終於可以打vagina rectal space (這裡真有挑戰,得再想想怎麼做更快)</div><div dir="auto" style="font-family: inherit;">9.膀胱往下撥,bladder pillar也分乾淨。</div><div dir="auto" style="font-family: inherit;">10. colpotomy, suture vaginal cuff. Check colon.Remove specimen.</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="margin: 0.5em 0px 0px; overflow-wrap: break-word;"><div dir="auto" style="font-family: inherit;">DONE !</div></div></div><div dir="auto" style="font-family: inherit;"><br /></div></div><p><br /></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-8328576116377332902022-12-25T18:12:00.002+08:002022-12-25T18:15:48.944+08:00[達文西手術] 巨大巧克力囊腫,腫瘤切除手術。(保留卵巢)<div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">巧克力囊腫是常見的婦產科疾病,也是一種俗稱。正確來說,應該稱作卵巢的子宮內膜異位症。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">子宮內膜異位症好發在有生殖力的育齡女性。長在子宮叫做腺肌症,卵巢俗稱巧克力囊腫,另外還有凶狠的深部浸潤型,能侵犯腸子、泌尿系統等等。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">這次分享的案例,只有20幾歲,未婚,其實也沒特別症狀。而是在健康檢查時意外發現有一顆13公分的巧克力囊腫。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">原本沒什麼特別,但這顆腫瘤裡面卻分成六七個腔室,腫瘤橫跨整個骨盆腔。影像上看起來,腔室密密麻麻好像葡萄。</span></div><div dir="auto" style="font-family: inherit;"><span><a name='more'></a></span></div></div><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">*</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">13公分的腫瘤我常開,不過,若腫瘤有多個腔室,手術就會比較難做。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">原因是多腔室腫瘤的間隔組織很緊,很難剝,沒弄好卵巢會受傷。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">若同時又是巧克力囊腫,狀況就會更棘手一點。因為巧克力囊腫與正常卵巢組織界線,是所有良性卵巢腫瘤中最不明顯的。手術中,需要很有耐心地慢慢剝。若剝錯界線,會犧牲掉很多正常卵巢,進而影響生殖功能。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">這次的案例很年輕,未婚,同時有骨盆沾黏。保護她的卵巢組織,恢復正常骨盆結構與防止沾黏,是我手術的首要目的。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">用機器人開,剝沾黏變得容易許多,腹膜沒有破損,卵巢也保留許多正常組織並縫合好。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">大家可以猜猜我是開哪一側卵巢喔(笑)</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">目前因為有很好的口服藥物,我治療子宮內膜異位的作法是三明治療法: 藥物先行,手術看狀況,術後再用藥維持避免復發。(藥物->手術if need->藥物)</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">會建議手術的病人有三類:</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">1) 腫瘤太大。至於多大目前醫學界沒有定論,我個人是抓在6公分以上,但還是要看個案。畢竟醫療是高度個人化的專業。</div><div dir="auto" style="font-family: inherit;">2) 吃藥無法控制臨床症狀,或腫瘤繼續長大。</div><div dir="auto" style="font-family: inherit;">3) 腫瘤不斷復發,會擔心未來癌化風險,這個要開刀拿掉。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">太年輕的病人,先吃吃藥,若能控制,就能免挨一刀。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">因此,如果經痛越來越嚴重,止痛藥越吃越多,麻煩,到婦產科來,替未來的生殖力做點努力吧。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOlsUhjuv_JFrWJ0Y_8XblLRC5MGA9cFiNZ6fep1iTcUf7nFAQajI4LRoQQ-NrD3Z8wTq9U5SNQLpTndUHnFfHHOkv5N76fqRlaxdBxjgCy8ldk06mluDgm3HKecuF93yqOcFJYvecze5kpoH-AAE2ZGHUHZYINRI0Db928OWDJtl2kojzgSFedNbS/s1280/S_20221212093745_00000000U1203145_1_010.BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOlsUhjuv_JFrWJ0Y_8XblLRC5MGA9cFiNZ6fep1iTcUf7nFAQajI4LRoQQ-NrD3Z8wTq9U5SNQLpTndUHnFfHHOkv5N76fqRlaxdBxjgCy8ldk06mluDgm3HKecuF93yqOcFJYvecze5kpoH-AAE2ZGHUHZYINRI0Db928OWDJtl2kojzgSFedNbS/w640-h360/S_20221212093745_00000000U1203145_1_010.BMP" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">一開始,可以看到很巨大的卵巢腫瘤。切開後,流出像巧克力狀的內容物。這也是為何卵巢子宮內膜異位會被戲稱為巧克力囊腫。</div><div class="separator" style="clear: both;"><br /></div></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNACloHZ8QDS5ng7VLzK7KK5E10QMTMqEEu0UK5UTkAKs3FHnQHBsRStbOv9_tQbIKonxSnMT0982fPTMLH8EiC-HEZ-FQ7Em7sULVIMqe7o4u4mHwfQtGEesHr1hSLiJvouEnZfulPjoaZshZtC1uLMB0tSEJ0335VdnMDiUhQz3pkJ2ZafBWqrnf/s1280/S_20221212093745_00000000U1203145_1_014.BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNACloHZ8QDS5ng7VLzK7KK5E10QMTMqEEu0UK5UTkAKs3FHnQHBsRStbOv9_tQbIKonxSnMT0982fPTMLH8EiC-HEZ-FQ7Em7sULVIMqe7o4u4mHwfQtGEesHr1hSLiJvouEnZfulPjoaZshZtC1uLMB0tSEJ0335VdnMDiUhQz3pkJ2ZafBWqrnf/w640-h360/S_20221212093745_00000000U1203145_1_014.BMP" width="640" /></a></div><br /></div><div class="separator" style="clear: both; text-align: center;">第一步,先把卵巢和骨盆腔的沾黏分離。</div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOKQvDXfQKNeRvhJ0qm6TzyvhqHNCxn-uXAIz0Mxycil9melMEktRCTtVhxtGOcgLd1tMwlvv7fI7skHE-Gy65NS19WG-gxRXJYdnOQ7ntS06cXyMEMlIjpanWhWDgWQYUMb_JR0y86aP77bu4Kfkd17v0nD42HfMoINIzvkZ7R3cuBZlhYhZ0aFbQ/s1280/S_20221212093745_00000000U1203145_1_016.BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOKQvDXfQKNeRvhJ0qm6TzyvhqHNCxn-uXAIz0Mxycil9melMEktRCTtVhxtGOcgLd1tMwlvv7fI7skHE-Gy65NS19WG-gxRXJYdnOQ7ntS06cXyMEMlIjpanWhWDgWQYUMb_JR0y86aP77bu4Kfkd17v0nD42HfMoINIzvkZ7R3cuBZlhYhZ0aFbQ/w640-h360/S_20221212093745_00000000U1203145_1_016.BMP" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;">第二步,打開卵巢,可以看到裹著一層巧克力色的內膜(即腫瘤內層)。</div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP9Gy-zjCRGVaxYfagmltlcsDp0ILKdUomxuxXcjmEZK9FtT_rz4VwPTBmVp0pblszkN4-Fmoc46RZI1ZScMhk4WKPyEBGZHqosFJfUDHqtaZe2cxJE1AG3-RGC6eVPRZnU-vU4N0-fzXHGwOoasRMIqNYeeJpqDTHP6BvfqHQRArTl_cw9LUOJLFr/s1280/endometrioma%20margin.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP9Gy-zjCRGVaxYfagmltlcsDp0ILKdUomxuxXcjmEZK9FtT_rz4VwPTBmVp0pblszkN4-Fmoc46RZI1ZScMhk4WKPyEBGZHqosFJfUDHqtaZe2cxJE1AG3-RGC6eVPRZnU-vU4N0-fzXHGwOoasRMIqNYeeJpqDTHP6BvfqHQRArTl_cw9LUOJLFr/w640-h360/endometrioma%20margin.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;">第三步,把正常卵巢與異常腫瘤界線清楚分出來,慢慢剝離,力求保留最多卵巢組織。這個案例有許多腔室,就比較厚工一點。</div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGqbwMW7kZ-asxT0b20LH2EY24pRPxZHP_QZ9OoGrZ9kWQW6xCPqHhhy-bBBvZBA24oAGpYI0VyjET5VjJV89IlmyOVA00gwOtxggjtnIMLbPucmgv0iOuOPt-WBLq0yW01tOSjzc9rBCJTeGXYjjRPXgRrKBeqIwspRqZNm2zjZxCcVUB26PUzLl6/s1920/S_20221212093745_00000000U1203145_1_025.BMP" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGqbwMW7kZ-asxT0b20LH2EY24pRPxZHP_QZ9OoGrZ9kWQW6xCPqHhhy-bBBvZBA24oAGpYI0VyjET5VjJV89IlmyOVA00gwOtxggjtnIMLbPucmgv0iOuOPt-WBLq0yW01tOSjzc9rBCJTeGXYjjRPXgRrKBeqIwspRqZNm2zjZxCcVUB26PUzLl6/w640-h360/S_20221212093745_00000000U1203145_1_025.BMP" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;">最後,止血、將卵巢縫合好,手術完成的樣子。把正常的骨盆腔還給病人
(真應該要用達文西鏡頭拍照的,腹腔鏡照起來影像品質就是差了點)</div><div class="separator" style="clear: both; text-align: center;">上方是子宮,下方黃黃的是腸子的油。兩側白色的地方是縫合好的卵巢。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">回到:</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><a href="http://obgyndrwei.blogspot.com/p/blog-page_17.html">達文西手術總頁面 </a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><a href="http://obgyndrwei.blogspot.com/2021/03/blog-post.html">[圖解婦產] 子宮內膜異位症,究竟是啥米?</a></div><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-82472218492822512432022-12-19T21:28:00.000+08:002022-12-19T21:28:00.400+08:00[達文西手術] 腹腔鏡骨盆懸吊手術Pectopexy<p>林小姐59歲,生養了三個小孩,都是自然產。因為做生意平常得站著,還要搬貨,經常腰痠背痛,非常辛苦。</p><p>她在下體摸到東西已經很多年了。</p><p>起初,是用力時能摸到一顆雞蛋大的肉球。慢慢的,肉球越變越大,終於大到會摩擦內褲出血的程度。不過,為了不想麻煩子女,她還是繼續忍耐,沒有就醫。</p><p>最近,因為已經嚴重到尿不出來的程度,才終於和女兒提起,到門診檢查。<span></span></p><a name='more'></a><p></p><p>*</p><p>上面這個故事並不是特例。</p><p>許多女性,照顧家庭盡心盡力,且不喜歡麻煩家人。在這個例子裡,自然產、勞動的工作(尤其是腹部需要用力的姿勢),都會給女性骨盆造成壓力,時間久了,會使骨盆的肌肉和韌帶鬆弛,導致支持力道下降,形成脫垂。</p><p>雖然沒有為了這個主題特別畫漫畫,不過之前有相關的內容,說明子宮對支持骨盆和腸子完全沒有功能,有興趣可以點漫畫看看 :<a href="http://obgyndrwei.blogspot.com/2021/03/2.html#more" target="_blank">拿子宮,腸子會脫垂嗎?</a> </p><p>在下面摸到的肉球,究竟是膀胱、子宮頸還是直腸,一般人實在很難判斷。</p><p>因此,如果有這種狀況,麻煩直接到婦產科就醫,醫師看過就會真相大白了。</p><p>*</p><p>處理骨盆脫垂方式很多,這裡介紹的是腹腔鏡重建的手術選擇,特別適合子宮脫垂的病人。</p><p>常用的腹腔鏡重建手術方式有兩種,皆會使用人造網膜增加支撐力,差別在於固定網膜的位置不同。</p><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">我喜歡利用達文西輔助腹腔鏡去做骨盆懸吊(Pectopexy)。利用機器人,立體視覺能讓我看得更清楚,能靈活旋轉的器械,更是有利縫合。</span></p><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">這個手術有幾個優點:</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">1) 子宮可以不用拿。當然,如果子宮有腫瘤,要同時切除也能一次辦到。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">2) 不影響陰道長度和柔軟度,適合活動力較強的年輕病人:性生活與運動品質都會比較好。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">3) 固定強度高,適合體重較重,和無法避免搬重工作的人。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">當然,傷口小、恢復快和不太痛這些微創手術的既有優點,也是一個不缺的。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">雖然我很想要所有術後的病人都多休息,畢竟再怎樣好的手術,都不是無敵星星吃了就能百毒不侵。但現實就是許多人得工作顧肚子,因此,介紹這個安全、有效的手術給各位。</div><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4Swfj8PlDTYVrdlMcA-IvIJNDR33jvBz_ZV53oQTOjS8WDlphWJdnbmyJMLUYSu5vedsjywfkt7nyUgRF22c3Zk3U1x997FwjZMOMGiG7HjEPIf4Hc6sOK8uBRWVr1gmiQsYgM1yFht2y7mZQXuUK1ABnyqxAq8uhvK8P5uKyIN_zAMHmTdBecsHX/s1280/2%20(24).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4Swfj8PlDTYVrdlMcA-IvIJNDR33jvBz_ZV53oQTOjS8WDlphWJdnbmyJMLUYSu5vedsjywfkt7nyUgRF22c3Zk3U1x997FwjZMOMGiG7HjEPIf4Hc6sOK8uBRWVr1gmiQsYgM1yFht2y7mZQXuUK1ABnyqxAq8uhvK8P5uKyIN_zAMHmTdBecsHX/w640-h360/2%20(24).BMP" width="640" /></a></div><br /><div dir="auto" style="font-family: inherit;">先清楚的把右邊要固定網膜的韌帶分離出來。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxSEkqN8oBOCSSsT-996kgD5mNFZCzfbztKlFjYIlNz32gkKz9ckAgNIs65GCqIe2ixpMmzHLXr_fkIEX0yuXotuuTZ30rsGxk0DIjigNq2U3rsa1WFTN6_E17UaLyi1qtIC32By8JYBr7nHpqH80WEBkCTRpJ_VSMAXcMs_1osILyvbPpv0dHR6qB/s1280/2%20(26).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxSEkqN8oBOCSSsT-996kgD5mNFZCzfbztKlFjYIlNz32gkKz9ckAgNIs65GCqIe2ixpMmzHLXr_fkIEX0yuXotuuTZ30rsGxk0DIjigNq2U3rsa1WFTN6_E17UaLyi1qtIC32By8JYBr7nHpqH80WEBkCTRpJ_VSMAXcMs_1osILyvbPpv0dHR6qB/w640-h360/2%20(26).BMP" width="640" /></a></div><br /><div dir="auto" style="font-family: inherit;">再換左邊,也一樣分離出來,等下得縫合固定。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCyygp55vpUZZltPoXb0JrPvrUR9HBGWI4uOD_r8k1b0neP-wsi6UAG0LOrdL_9fZIEppr-1nSj_Yvr_vet1sv9S7DL4w3T_Vt8-jBFsA3G5m5QZLHN9_fKJYlSeolrHSs5qvj5IUHOk8KTTjAPzDicaqreE7JiUpuga39FEOLVK-_wpxjihRMfWsD/s1280/2%20(31).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCyygp55vpUZZltPoXb0JrPvrUR9HBGWI4uOD_r8k1b0neP-wsi6UAG0LOrdL_9fZIEppr-1nSj_Yvr_vet1sv9S7DL4w3T_Vt8-jBFsA3G5m5QZLHN9_fKJYlSeolrHSs5qvj5IUHOk8KTTjAPzDicaqreE7JiUpuga39FEOLVK-_wpxjihRMfWsD/w640-h360/2%20(31).BMP" width="640" /></a></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /></div>把人造網膜,根據每個人的需求客製化尺寸後,固定好。(這個病人子宮有腫瘤,因此先做了子宮次全切除手術)</div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5MuFCi8vssPFYXe-pSGJlqeQLUv1dOSTlPDVGHNUcIIIDQSgFDpTceues_exRm64ivZVbBq4rZfaoxlbaDDMe5EYn4t6KNTk_LoYnxf2Br-B4NMViVaFnfDGtKEZvNsZo2zoojQKWM3xtCzO7mFVkTGVq3rJzmIYPsC9bCIV1V6YbIxfJkhdhuku0/s1280/2%20(23).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5MuFCi8vssPFYXe-pSGJlqeQLUv1dOSTlPDVGHNUcIIIDQSgFDpTceues_exRm64ivZVbBq4rZfaoxlbaDDMe5EYn4t6KNTk_LoYnxf2Br-B4NMViVaFnfDGtKEZvNsZo2zoojQKWM3xtCzO7mFVkTGVq3rJzmIYPsC9bCIV1V6YbIxfJkhdhuku0/w640-h360/2%20(23).BMP" width="640" /></a></div><br /><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;">最後把腹膜縫好,不讓任何網膜外露,能避免造成沾黏,就大功告成。</div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-1299857074098939872022-11-07T18:33:00.002+08:002022-11-07T18:33:38.533+08:00[圖解] 硬式子宮鏡: 電刀 vs 冷刀有何不同? <p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">最近會有住外縣市的初診病人,一進診間就說 : " 醫師,我有腫瘤,要開冷刀! " (自信)</span></p><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">現在,病人們越來越希望了解自己的狀況,並參與治療決策,和過去醫師說了算的狀況差別不小。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><a style="color: #385898; cursor: pointer; font-family: inherit;" tabindex="-1"></a></span>這是好事,畢竟健康是自己的。醫療進步,選擇眾多,青菜蘿蔔各有所好,選擇之下搞清楚狀況,才是最重要的。</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><span><a name='more'></a></span></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">究竟冷刀有什麼電刀沒有的好處? 自費的價值在哪裡?</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">一句話說完重點: 保護內膜,安全且效率高。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">對於仍有生育考量的年輕女性,能減少沾黏機會,頗有價值。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">不過,冷刀並不完美。因為無法止血。當遇到比較困難的個案時,為了讓手術進行得更快更安全,我還是會考慮同時上電刀。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s x126k92a" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">雙刀並用,安全的做好手術最重要。</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaUlaEr4fbQkneSk9DNOHzzAR0B4kYvemgUiQsd1XT_ZhENYJgyti6PHvDiBBdXCzh2QAgeU6WXyxhnu4uzAZ-xVsKqmxU5SI_bhvQiA6obLZqLzgbmji2iCq1TyvA57fkkaYj8YlTCXNLhJFwkd_2eAWxygOZ7erlg9je8Mlz6sjLvYUEUk6vEd9R/s3750/%E9%9B%BB%E5%88%80%E5%86%B7%E5%88%80%E6%AF%94%E8%BC%83_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2500" data-original-width="3750" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaUlaEr4fbQkneSk9DNOHzzAR0B4kYvemgUiQsd1XT_ZhENYJgyti6PHvDiBBdXCzh2QAgeU6WXyxhnu4uzAZ-xVsKqmxU5SI_bhvQiA6obLZqLzgbmji2iCq1TyvA57fkkaYj8YlTCXNLhJFwkd_2eAWxygOZ7erlg9je8Mlz6sjLvYUEUk6vEd9R/w640-h426/%E9%9B%BB%E5%88%80%E5%86%B7%E5%88%80%E6%AF%94%E8%BC%83_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjul2M7-tq6x2I_1Ffab_hKn0BCThBx6gjsnSU_-HGVPPu0itDiNZE_UkcFMM0Xj07Cr6AkEGO2jugTgOCpREd8n6f33A4NrdrfYjl58L14GRp3Kz3NVyaz3y1J8r6rYkOSH0fTVk28PjnSghmWLJWfp369njUYL_S_8xQyTLr1NL5OetcrwRAyMQBM/s2501/%E9%9B%BB%E5%88%80%E5%86%B7%E5%88%80%E6%AF%94%E8%BC%83-02.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjul2M7-tq6x2I_1Ffab_hKn0BCThBx6gjsnSU_-HGVPPu0itDiNZE_UkcFMM0Xj07Cr6AkEGO2jugTgOCpREd8n6f33A4NrdrfYjl58L14GRp3Kz3NVyaz3y1J8r6rYkOSH0fTVk28PjnSghmWLJWfp369njUYL_S_8xQyTLr1NL5OetcrwRAyMQBM/w640-h640/%E9%9B%BB%E5%88%80%E5%86%B7%E5%88%80%E6%AF%94%E8%BC%83-02.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLlsD3NBgkZvlCYdplpXrWSes-6o2ckk1flcCGir5KOseR07hgQL4TlD4dYKdDzE9ysL_C9373SyosvaUJf7KKHwy4ZdlNeo5NUCFaj3AE28kLi5XyIvmaKAVEqq4OmcdC1kehvtVPq9WAg5F5IfYG4D8o3pGt4W8XDZKj-3utb_J_bHns75qaoLkf/s2501/%E9%9B%BB%E5%88%80%E5%86%B7%E5%88%80%E6%AF%94%E8%BC%83-03.jpg" imageanchor="1" style="margin-left: 1em; 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text-align: center;"><br /></div><br /><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-80288382568577921282022-10-31T18:52:00.006+08:002022-10-31T18:55:52.559+08:00[達文西手術] 做過海扶,脫水成豆腐渣渣的肌瘤<p>除了微創手術,統稱為無創手術的海扶刀 (海芙刀)和微波消融,都是近年新興的術式。</p><p>這些治療方式,對於尚未生育但肌瘤不停變大的年輕族群來說,是種選擇。不過,每種治療方式都有些人效果好,有些人效果普通。</p><p>李小姐就是效果普通的那種。</p><span><a name='more'></a></span><p>當初,她選擇使用海扶刀治療長在子宮前壁,非常靠近膀胱的肌瘤。想要治療的主因是因為肌瘤有七公分,壓迫到膀胱,導致她非常的頻尿。</p><p>這種位子的肌瘤不太好開,選擇海扶很合理。</p><p>沒有對錯,事前溝通好就行。</p><p>但,人家的肌瘤做完海扶刀變小,但李小姐的沒有。因此,頻尿狀況持續,她只得進行手術,把肌瘤拿掉。</p><p>*</p><p>做過海扶的肌瘤因為脫水,常常會變得粉粉的,很像豆腐渣。有些肌瘤,則會鈣化變硬。</p><p>粉狀的肌瘤很拿移除,因為腫瘤界線很脆,一剝就碎。碎片就掉的到處都是。</p><p>鈣化的肌瘤雖然好剝,但要把它切條移出肚子,也是大工程。有時候,得用上骨剪!! </p><p>李小姐呢,則是兩者都有。今年五月我開這台刀時,移除檢體著實費了一番功夫啊。</p><p>幸好,她選擇了達文西手術。縫子宮前壁低位、壓進膀胱的傷口,算好縫合。視覺清楚,屑屑看得很清楚,也清得很乾淨。</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA3mnYhBWXE2vqzP--CJJchFVqCXifAE5s910aOns3p0Jp0uAMSlAvgwIc4FNYhOqBDFTF51Qrq2ibo3Rc6u9UzKOvUXH3WWWPOvaCCLNZ6C9VGWlfFph598T_8oqAoB6GfGzJgQEmLNu8CcW-weDgEfNulOxPjCwim1ddzfzsPxO8VVr6RTtZ0_Ae/s1280/5.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA3mnYhBWXE2vqzP--CJJchFVqCXifAE5s910aOns3p0Jp0uAMSlAvgwIc4FNYhOqBDFTF51Qrq2ibo3Rc6u9UzKOvUXH3WWWPOvaCCLNZ6C9VGWlfFph598T_8oqAoB6GfGzJgQEmLNu8CcW-weDgEfNulOxPjCwim1ddzfzsPxO8VVr6RTtZ0_Ae/w640-h360/5.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">微創醫師的磨練,莫過於開這種刀了。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">耐心、體力、口業、都是磨練。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><br /><p><br /></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-55978326779382512602022-10-31T18:18:00.001+08:002022-10-31T18:18:17.294+08:00[達文西手術] 多發性肌瘤切除手術<p>子宮長肌瘤常見。</p><p>長一顆肌瘤者眾,長一堆者肌瘤者也不少。</p><p>通常,如果子宮有多發性肌瘤又有症狀 (例如 : 月經血量多造成貧血、頻尿、便祕等),完成生育願望後,子宮切除是優先選項。</p><p>主因是: 體質會長一堆肌瘤的人,若只做肌瘤切除,未來復發機率還是有的。就算把看的見、碰的著肌瘤全部摘掉,還是有機會留下一些小種子。</p><p>所謂,春風吹又生。還沒停經前,妳的女性荷爾蒙就是春風,肌瘤就可能再生。</p><p>不過,拿子宮對許多人來說還是有很大的心理障礙。加上擔心後遺症,堅持留下子宮只拿肌瘤的族群不少。</p><p>有關拿子宮會有的江湖迷思,包含會不會老化、脫垂、漏尿等等問題,麻煩請見圖解婦產<a href="http://obgyndrwei.blogspot.com/p/blog-page_7.html" target="_blank">破除迷思系列</a>,用漫畫讓妳秒懂。了解後,再下決定,也不遲。</p><span><a name='more'></a></span><p>*</p><p>王小姐就是子宮長一堆肌瘤的那種。</p><p>在了解只拿肌瘤有可能再長,且多發性肌瘤經常長在子宮的不同位置,移除肌瘤時,會造成大大小小的切口,切口有可能沾黏後,王小姐還是下了只拿肌瘤,留子宮的決定。</p><p>幸好,因為她實支實付額度相當高。選擇精細的達文西手術,與放置衛材防止沾黏,都沒有經濟上的壓力,我們就這麼辦吧。</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA7vAB3tT5b73UvS6-9q4xo1qO171p6Gud2LZLmpnxyvJ5hxhzaiIwibTYTfh4jioSNB3SKO_iRyGmTlL0hj12rZx7HChby2WzGy0yuqSrkOCr0TRJt_qL508938XX8nD1pZ6n-DEY9qef0BN5508EAmqCjNYSqLxbnLAVUaTycoiZ0-HtSK1eAxjw/s1280/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA7vAB3tT5b73UvS6-9q4xo1qO171p6Gud2LZLmpnxyvJ5hxhzaiIwibTYTfh4jioSNB3SKO_iRyGmTlL0hj12rZx7HChby2WzGy0yuqSrkOCr0TRJt_qL508938XX8nD1pZ6n-DEY9qef0BN5508EAmqCjNYSqLxbnLAVUaTycoiZ0-HtSK1eAxjw/w640-h360/1.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">大家可以看到,標上數字的都是不同的肌瘤。在規劃手術時,我會盡量把切口數目漸少,降低傷口與周圍組織沾黏的機會。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">畢竟,傷口之所在,沾黏之所在。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYEdwXGtBSYAG7X79YHypDa55k0U8fvV27TdcHBwl983WhPXz5eovOtPfKeb6hyJ9eGGoQ0-0sGEVS-aBSWNZr4Jd1yALTDj2G6iCXP_7VQPrVphURxY_6wq5S3lLr7i7yfVo39orcMqMF6nEZFnd-vxjwetc-n_8E0sJ3ijxT0mR3W7FJ5Y3fsIPP/s1280/2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYEdwXGtBSYAG7X79YHypDa55k0U8fvV27TdcHBwl983WhPXz5eovOtPfKeb6hyJ9eGGoQ0-0sGEVS-aBSWNZr4Jd1yALTDj2G6iCXP_7VQPrVphURxY_6wq5S3lLr7i7yfVo39orcMqMF6nEZFnd-vxjwetc-n_8E0sJ3ijxT0mR3W7FJ5Y3fsIPP/w640-h360/2.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">肌瘤綿綿無絕期。拉了一顆,還有一顆! </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">但這對熟悉腹腔鏡手術的醫生來說,不成問題。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEcDILsQQySgP4bm5HVPjntWRr8Oj3JvOnfhHk1bxl1D0xMWpVrTPaAq_5wBy7EC3K0sPp8CtmUddmtO5t-Cwc4V5GE_Qdfk4iIHnNCwLX2IU05PuJkq0o-6TCfKsH0E_p08nU1OUkrlLRg4R0MxXvlNel-0idFRHkv6RDnk__6rNvkJUk2r0FgMd_/s1280/3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEcDILsQQySgP4bm5HVPjntWRr8Oj3JvOnfhHk1bxl1D0xMWpVrTPaAq_5wBy7EC3K0sPp8CtmUddmtO5t-Cwc4V5GE_Qdfk4iIHnNCwLX2IU05PuJkq0o-6TCfKsH0E_p08nU1OUkrlLRg4R0MxXvlNel-0idFRHkv6RDnk__6rNvkJUk2r0FgMd_/w640-h360/3.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">這是肌瘤全部移除後,縫合的手術照片。子宮看起來還是不太規則,但不用擔心,三個月後就會回復的很漂亮的。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">照片中可以看到藍色的線,這是腹腔鏡專用的特殊倒鉤縫線,可以增加縫合的效率,降低出血。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">另外,我習慣先使用傷口封合劑。這種衛材能幫忙止血( 縫合的針孔有時容易滲血)。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">最後,再視病人狀況使用防沾黏。目前防沾黏有粉狀、片狀與凝膠狀。這個病人由於傷口在子宮後壁,主要可能沾黏的周圍組織是下方的直腸。直腸有平整的表面,因此我選擇使用片狀的防沾黏貼片(很好鋪、很平整)。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">手術沒什麼出血,術後隔天,王小姐就出院啦。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">特別提一下: 傷口封合劑、防沾黏衛材,都會自行吸收,術後不用再取出,別擔心。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><br />魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-27151839118055569122022-10-31T16:48:00.001+08:002022-10-31T16:48:55.899+08:00[達文西手術] 保持子宮內膜完整,黏膜下肌瘤切除手術 (有圖)<p>陳小姐長年在美國工作,苦於每個月月經爆量。雖然經常頭暈,走路和爬頭梯都會喘,臉色也不太好。但因為工作忙碌,一直沒有積極就醫。</p><p>此次回台灣,才發現子宮長了幾顆肌瘤,血紅素更是只剩下3.3g/dl ,非常的低 (健康女性血紅素約為12-13g/dl),難怪她會有典型的貧血症狀。</p><p>*</p><p>女性子宮有肌瘤並不少見,但,並非所有肌瘤都需要手術。是否需要手術也和肌瘤大小沒有絕對關係。</p><p>至於那些肌瘤要開刀,請參見圖解漫畫<a href="http://obgyndrwei.blogspot.com/2021/01/blog-post_7.html">怎樣的肌瘤要開刀</a>,非常淺顯易懂,這裡就不多說。</p><p>*</p><p>陳小姐的肌瘤就是需要開刀的那種。<span></span></p><a name='more'></a><p></p><p>肌瘤不小,有8公分、直接壓迫脆弱的子宮內膜,且長在縫合比較困難的子宮後壁。除了會造成月經爆量,導致貧血之外,也會同時影響受孕。</p><p>考慮她尚未生育,手術除了移除肌瘤並做到最好的縫合之外,保持內膜完整性,避免影響受孕也相當重要。經過討論,她選擇使用達文西輔助,進行腹腔鏡微創手術。</p><p><a href="http://obgyndrwei.blogspot.com/2022/01/blog-post.html">[圖解婦產] 達文西手術的三大優勢: 更清、更穩、更靈活</a></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTUXtcjbNQuLIYFowxenhrtPCz0a_pAllnBrMdT2WVH_pRkuPDka7-5Ohdss4EB_gs9yxf4g3Xa8UO3yEftwvywLDGRZoaVyJxEZX4LlL3tO-0XnDXsB95oJGl3RkpxSLzjnjYNoduCx0v66j6p5lUex35S2ClPzIF67NjOpuBuDkQWmy0whzD5Ta5/s1920/1%20(1).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTUXtcjbNQuLIYFowxenhrtPCz0a_pAllnBrMdT2WVH_pRkuPDka7-5Ohdss4EB_gs9yxf4g3Xa8UO3yEftwvywLDGRZoaVyJxEZX4LlL3tO-0XnDXsB95oJGl3RkpxSLzjnjYNoduCx0v66j6p5lUex35S2ClPzIF67NjOpuBuDkQWmy0whzD5Ta5/w640-h360/1%20(1).BMP" width="640" /></a></div><br /><p>可以看到,子宮被肌瘤撐得很大,幾乎占滿整個畫面。</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgENErQQXTfYLbH6rh5J0u_s6qbWqrmf2k-y8h8r1tZKZRGDK5dufPizm_e5rZ5gFKvk08aQVRsemWFEYzPQmIg9ImLUb7cxZYXsnaE-otH-lb2ZOWaP1lg3rJNLmIdt15shz_Klwoxj4Dx6p6zEQBSj-FfOe3quRwx_VohLu4-3ZFHHpKI8DGYJN65/s1280/submucosal%20myoma.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgENErQQXTfYLbH6rh5J0u_s6qbWqrmf2k-y8h8r1tZKZRGDK5dufPizm_e5rZ5gFKvk08aQVRsemWFEYzPQmIg9ImLUb7cxZYXsnaE-otH-lb2ZOWaP1lg3rJNLmIdt15shz_Klwoxj4Dx6p6zEQBSj-FfOe3quRwx_VohLu4-3ZFHHpKI8DGYJN65/w640-h360/submucosal%20myoma.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">這張術中圖片左下角,是白色堅硬有點像貢丸的肌瘤。實線圈起來的,則是嬌弱易破損的子宮內膜。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuE37zcCuRQbWYUvLv1O-X4QjhTr5lx56dm15IQ5P0MlAIUbZ8wbJhoE5-Op3WWQa1EaknBwHJwsSpCDq-mpxDoCi22LeOwR6Vnb5B3TI3nEbysLkZcydN49jFUjd9F_sEjtJ-Vy7R1YzoME2zmuMCJmJJw6e69fm8tdHlEFcRc3t7TRUFRrqbifk9/s1280/sub1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuE37zcCuRQbWYUvLv1O-X4QjhTr5lx56dm15IQ5P0MlAIUbZ8wbJhoE5-Op3WWQa1EaknBwHJwsSpCDq-mpxDoCi22LeOwR6Vnb5B3TI3nEbysLkZcydN49jFUjd9F_sEjtJ-Vy7R1YzoME2zmuMCJmJJw6e69fm8tdHlEFcRc3t7TRUFRrqbifk9/w640-h360/sub1.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><br /></div>這張則看得更明顯。移除肌瘤後,露出原本緊貼的子宮內膜。這種手術是肌瘤切除中比較困難的一種,主因是內膜很脆弱,容易在移除肌瘤時破損,導致受孕率降低,或者胎盤植入肌肉層。<div><br /></div><div>但透過達文西系統,能看得更清楚,故能盡量減少破損發生的機率。</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDIMAN7uSUdB1uuFzQQ9qACBWslgj8OT-E1ut2ul4lFBNQRuUBa3okpHJQ6YD_mMKZJUZmgyxmFxBSCqQVcQZt7QeS-zktA70LQbdXPDT6Mua8_fpariHrY4OUVjrrt0Ig8dJwZTxBE9P5s8xDj9Hm8uSFoz-2CzNpbPD-QozMMn9q9m1tZNGqEGUt/s1920/2%20(1).BMP" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDIMAN7uSUdB1uuFzQQ9qACBWslgj8OT-E1ut2ul4lFBNQRuUBa3okpHJQ6YD_mMKZJUZmgyxmFxBSCqQVcQZt7QeS-zktA70LQbdXPDT6Mua8_fpariHrY4OUVjrrt0Ig8dJwZTxBE9P5s8xDj9Hm8uSFoz-2CzNpbPD-QozMMn9q9m1tZNGqEGUt/w640-h360/2%20(1).BMP" width="640" /></a></div><br /><div><p>把子宮肌肉層,一層層的仔細對齊縫合。並在最後使用傷口封合劑和防沾黏產品,就大功告成。</p><p>陳小姐在術後第二天出院,恢復良好。待子宮休息一年,便可以考慮懷孕。</p><p><br /></p></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-42073959122008739822022-07-28T19:45:00.004+08:002022-07-28T19:48:13.912+08:00[圖解] 那些良性卵巢腫瘤要開刀? <p>上一集漫畫,我們簡單解釋卵巢長了水瘤,該怎麼辦。在這集,就讓我們聊一下那些腫瘤是真的不會消,真的得乖乖追蹤~<br /><br />一般來說,良性卵巢腫瘤,即使長到超過10公分以上,大部分還是可以使用微創手術處理。好好追蹤,在適當的時間接受手術,就可以避免不必要的卵巢扭轉和過多正常卵巢組織傷害。<br /><br />特別值得一提的是巧克力囊腫。這種腫瘤,會造成經痛、不孕、沾黏,是卵巢腫瘤中比較難纏的角色。除了手術需要很謹慎,為了避免復發,藥物在術前與術後都有重要角色。<br /><br />有關巧克力囊腫常用的藥物與注意事項,我們下篇漫畫再談。</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjldyYGZSdpXuc0fPn-qUPdg09l6RNkmU50_vK2iuc7mP1t2qh4s-NTNjwi8Y6uReaoRoYFKyyt2bGNB8y6IOXorWk6g_BkINbd_FIRLe1aZDD2gzk4smyNIJ2M-notyvlkwVVfqmQ5cBCEJFwxMPwiTRvbHOyYu9ZMoLQ0jcmNHnXoZmbpMIYQDJdl/s3750/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2500" data-original-width="3750" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjldyYGZSdpXuc0fPn-qUPdg09l6RNkmU50_vK2iuc7mP1t2qh4s-NTNjwi8Y6uReaoRoYFKyyt2bGNB8y6IOXorWk6g_BkINbd_FIRLe1aZDD2gzk4smyNIJ2M-notyvlkwVVfqmQ5cBCEJFwxMPwiTRvbHOyYu9ZMoLQ0jcmNHnXoZmbpMIYQDJdl/w640-h426/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" width="640" /></a></div><span><a name='more'></a></span><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6UOHex8EVpSyA0sCpl58Xr5KKmdcl2-hQtK7CYbYKpp_WBW25hAJLxm3HnLvN89eKowsS048q-a0TwBsdBaDlQuf9sMCgrJIMe4QYliclxRmiKAbY_hjDNN31viPARaZpf3xYtg5_2Rtjk4b-JXX-t42_t-bGy7rsRJZEUZgByXO10IAx0-afyRa6/s2501/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80-02.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6UOHex8EVpSyA0sCpl58Xr5KKmdcl2-hQtK7CYbYKpp_WBW25hAJLxm3HnLvN89eKowsS048q-a0TwBsdBaDlQuf9sMCgrJIMe4QYliclxRmiKAbY_hjDNN31viPARaZpf3xYtg5_2Rtjk4b-JXX-t42_t-bGy7rsRJZEUZgByXO10IAx0-afyRa6/w640-h640/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80-02.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEM92Mxpatj3qoxbEK3NTuy01n4tnFJJ49f1b0KoQR5wJXThm0BFWVebmQdm6d_RxbchHLRhpxV5-9uIs8hEFdBc1L0CAr7ci2eDwBsnjUUWFf-uhw0Zu87YEtZIz5BZmAIRuzeKnpHmiWtCrbC6T_yACFbCK5orpUkXGVkrtPeyIdOhHKOo3BjEgr/s2501/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80-03.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEM92Mxpatj3qoxbEK3NTuy01n4tnFJJ49f1b0KoQR5wJXThm0BFWVebmQdm6d_RxbchHLRhpxV5-9uIs8hEFdBc1L0CAr7ci2eDwBsnjUUWFf-uhw0Zu87YEtZIz5BZmAIRuzeKnpHmiWtCrbC6T_yACFbCK5orpUkXGVkrtPeyIdOhHKOo3BjEgr/w640-h640/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80-03.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhCfBK9Mvp-Y64P_WcmZsYpDY7znUC23TmsXUvJoE2IUcXYQ0H3mer35kxij8anHzxohIAYk_0uDdQDZV_eoJtm7P6OBm3kwu6C2SAw1cw4j8xoAIG-eOzXfASl2TpuuX0jT7-70Lg5c9WzSejBmRLKlMrnC24m82r6UvcUXES6G1GQ73ANcrhw84I/s2501/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80-04.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2500" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhCfBK9Mvp-Y64P_WcmZsYpDY7znUC23TmsXUvJoE2IUcXYQ0H3mer35kxij8anHzxohIAYk_0uDdQDZV_eoJtm7P6OBm3kwu6C2SAw1cw4j8xoAIG-eOzXfASl2TpuuX0jT7-70Lg5c9WzSejBmRLKlMrnC24m82r6UvcUXES6G1GQ73ANcrhw84I/w640-h640/%E5%93%AA%E4%BA%9B%E5%8D%B5%E5%B7%A2%E8%85%AB%E7%98%A4%E8%A6%81%E9%96%8B%E5%88%80-04.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p><br /></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-91269445218452853072022-07-17T20:11:00.005+08:002022-07-19T16:20:05.098+08:00[圖解] 卵巢長水瘤怎麼辦? 需要開刀還是追蹤 ? <p></p><div class="separator" style="clear: both; text-align: left;">在門診,經常有病人問 : " 魏醫師,之前有醫師說我卵巢有長水瘤,能請妳再確認一次嗎? 這該怎麼辦? 是不是得開刀呢? "</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">用卵巢水瘤當關鍵字去google,得到的答案經常會把人給嚇壞。因此,許多人一知道自己有水瘤,就會立刻找第二位醫師再次確認。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">其實,水瘤只是一種通稱,也不一定是真的有問題。這集圖解婦產,我們就來聊一下如果被告知卵巢有水瘤,接下來該怎麼辦。</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">下一集,則是會跟大家介紹,那些是真的有需要開刀的卵巢腫瘤。看完這兩集漫畫,大家心裡就有底啦! </div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4AuEXW0FNyudTgZbhu75ykWNDZ0RXcmoLyCvtW2TRj27DLR4NKJSUGkevX37TgcdSIdSx_9kKUsBUmYXCjHlS5UDzfQnLD8szQczqDE5-azmxMYvpjSjbZaqktoafy1PvPIZhsJYbqXaRsaGH0lAPpBQqROeJAc1iAlnokULVt3MMXjDSD2x1jP4O/s3750/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2500" data-original-width="3750" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4AuEXW0FNyudTgZbhu75ykWNDZ0RXcmoLyCvtW2TRj27DLR4NKJSUGkevX37TgcdSIdSx_9kKUsBUmYXCjHlS5UDzfQnLD8szQczqDE5-azmxMYvpjSjbZaqktoafy1PvPIZhsJYbqXaRsaGH0lAPpBQqROeJAc1iAlnokULVt3MMXjDSD2x1jP4O/w640-h426/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6_%E5%B7%A5%E4%BD%9C%E5%8D%80%E5%9F%9F%201.jpg" width="640" /></a></div><span><a name='more'></a></span><div class="separator" style="clear: both; text-align: center;"><br /></div> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb6qEsF22aLUK5-wmCkuHmDT7L2_eWD1GvDguWIh0hNsqPTeYT8RCiJmrRkt6ZHIama6HLRi8uCNS1oz82KulTajSCwQ2yYUi15DJU8n0hqSC2Zrf-0UhN4DlEy46I75Ygb3x9i40UFFnWQzLHBuLHc5d6J2adHnQXhgwnPlkNjTrEIwvW5ud1_2xP/s2501/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6-02.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb6qEsF22aLUK5-wmCkuHmDT7L2_eWD1GvDguWIh0hNsqPTeYT8RCiJmrRkt6ZHIama6HLRi8uCNS1oz82KulTajSCwQ2yYUi15DJU8n0hqSC2Zrf-0UhN4DlEy46I75Ygb3x9i40UFFnWQzLHBuLHc5d6J2adHnQXhgwnPlkNjTrEIwvW5ud1_2xP/w640-h640/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6-02.jpg" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQmR1kfd7Z2rJaihGvO6IpaI_CJ701kuLHiMljdvsrBYKliTIDifvJw-sSPJLE-VrFw1onBeUXMj8Y8eS0uoOrsnnn_fvkwpDMH1os75J7cuCC-AASaYfe8og_H1etJWm0W-fK2bD1H5NohfQa_AdAl5XTWWrf8C54hbJw61NhRjmSd3brahfrxjn-/s2501/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6-03.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2501" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQmR1kfd7Z2rJaihGvO6IpaI_CJ701kuLHiMljdvsrBYKliTIDifvJw-sSPJLE-VrFw1onBeUXMj8Y8eS0uoOrsnnn_fvkwpDMH1os75J7cuCC-AASaYfe8og_H1etJWm0W-fK2bD1H5NohfQa_AdAl5XTWWrf8C54hbJw61NhRjmSd3brahfrxjn-/w640-h640/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6-03.jpg" width="640" /></a></div></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrEE62I-6rbA84Vt_5A4MbxgknOiUh8AHRwJ-SnxNcQsBO9E6YLbLj9uxFfLq7I3RvYRK36HYrXAR6iGXUD9ViXQNCMZd1NgxjqkxSoa29_li_KPl42w52N2GUU4iotIP7yTYd3LgmnPE4OvDsjGEC-3i5uvJvgsvU4lGDRarjirVrfZSVeWPVQEYu/s2501/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6-04.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2500" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrEE62I-6rbA84Vt_5A4MbxgknOiUh8AHRwJ-SnxNcQsBO9E6YLbLj9uxFfLq7I3RvYRK36HYrXAR6iGXUD9ViXQNCMZd1NgxjqkxSoa29_li_KPl42w52N2GUU4iotIP7yTYd3LgmnPE4OvDsjGEC-3i5uvJvgsvU4lGDRarjirVrfZSVeWPVQEYu/w640-h640/%E5%8D%B5%E5%B7%A2%E9%95%B7%E6%B0%B4%E7%98%A4%E6%80%8E%E9%BA%BC%E8%BE%A6-04.jpg" width="640" /></a></div></div><br /><p></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-78389862519374718902022-06-13T10:47:00.002+08:002022-07-17T19:21:17.815+08:00[三讀致富心態] 理財,理的其實是價值觀。<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibwMEXqvN0D-_5UHfFD9qnSket7RJZx10mGvjUeGLshpXCtuPotChCyiojyBMa5K8bRUMJpm8j4XT87vq1DcbFvMbu8XBgTi5boffdTZmY3vD8TFWqO9_EoV5VjHnrkqlbV4NSMj91BD7MKy53KiZpgijEr5iJpKXu6jsDnSvZUmLGqrjO0s_6rptW/s880/6Te2qb-880x500.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="880" height="182" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibwMEXqvN0D-_5UHfFD9qnSket7RJZx10mGvjUeGLshpXCtuPotChCyiojyBMa5K8bRUMJpm8j4XT87vq1DcbFvMbu8XBgTi5boffdTZmY3vD8TFWqO9_EoV5VjHnrkqlbV4NSMj91BD7MKy53KiZpgijEr5iJpKXu6jsDnSvZUmLGqrjO0s_6rptW/s320/6Te2qb-880x500.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="background-color: white; font-family: Vollkorn; font-size: 17.6px;">pic. reference: https://tsmc2330.com/articles/332</span></div><br /><span color="var(--primary-text)" style="font-family: inherit; font-size: 0.9375rem; white-space: pre-wrap;"> 又把致富心態精讀了第三次。</span><span color="var(--primary-text)" style="font-family: inherit; font-size: 0.9375rem; white-space: pre-wrap;">將幾點影響我很深的觀念和各位朋友們分享。</span><div><span><a name='more'></a></span><p><span color="var(--primary-text)" style="font-family: inherit; font-size: 0.9375rem; white-space: pre-wrap;"> 結論其實很簡單:</span></p><div style="font-family: inherit;"><div dir="auto" style="font-family: inherit;"><div class="ecm0bbzt hv4rvrfc dati1w0a e5nlhep0" data-ad-comet-preview="message" data-ad-preview="message" id="jsc_c_10w" style="font-family: inherit; padding: 4px 16px;"><div class="j83agx80 cbu4d94t ew0dbk1b irj2b8pg" style="display: flex; flex-direction: column; font-family: inherit; margin-bottom: -5px; margin-top: -5px;"><div class="qzhwtbm6 knvmm38d" style="font-family: inherit; margin-bottom: 5px; margin-top: 5px;"><span class="d2edcug0 hpfvmrgz qv66sw1b c1et5uql lr9zc1uh a8c37x1j fe6kdd0r mau55g9w c8b282yb keod5gw0 nxhoafnm aigsh9s9 d3f4x2em iv3no6db jq4qci2q a3bd9o3v b1v8xokw oo9gr5id hzawbc8m" color="var(--primary-text)" dir="auto" style="display: block; font-family: inherit; font-size: 0.9375rem; line-height: 1.3333; max-width: 100%; min-width: 0px; overflow-wrap: break-word; word-break: break-word;"><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><b>1. 簡單生活與高儲蓄率</b></div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">追求高薪資沒有特別的意義,因為社會比較的天花板實在太高了。當我們能夠一個月賺5萬、目光就會看著10、20、50、100萬.....沒有終點。當眼界變廣了,就會知道受薪階級這一點點薪水實在不需要多談。比較,追逐,只是徒增煩惱。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">我們要能夠有意識地理解且承認某種程度的收入,就能夠讓自己感覺到滿足。這是種必須培養的能力。</div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">*</div><div dir="auto" style="font-family: inherit;">有錢人其實更容易覺得自己沒錢。因為他們會被邀請參加有錢人的聚會,而裡面的超級有錢人會讓這些普通有錢人感覺自己很窮。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">這點在我某些已經混進去的朋友們口中,得到了證實(笑)。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">所以,別覺得更有錢就會解決些什麼。我們能掌握的永遠都是自己的心態和慾望。理財,理的其實是價值觀。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">因此,簡單舒適而非奢華浮誇的生活,既能夠把大家從過勞中釋放出來,維持身體、心理健康(請避免暴飲暴食和規則運動),還能控制花費,增高儲蓄率。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">能存下錢,才有辦法進一步談投資。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><b>2. 永遠預留資產安全邊際,這讓預測未來變得沒有必要。</b> </div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">進入投資的世界,第一個想的得是風險。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">不舉債投資、預留足量現金、選擇廣泛標的的指數型基金且長期持有,能夠帶來財富的累積。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">無須過度擔憂波動(像2020和2022年的現在),這是獲利必須得忍受的事情。就好像參觀遊樂園得付門票。留在市場內,活下來不被洗出場,即可。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">要能做到這點,就是投資人心理得感到安全。要感到安全,除了本業足量的現金流、家庭存款量之外,就是選擇的對的投資標的。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">如果都能做到,就不太需要花費注意力在媒體的預測。這會替你省下海量的時間與能量,讓你可以投資在更重要的事情上,例如:充實本業和好好過日子。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><b>3. 理財的最主要目的是幸福感,不是帳面上數字。</b></div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">我身邊有些朋友會舉債投資、做反向操作,期待獲得超額報酬。他們的想法不能說錯,只是代價很高。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">代價就是心情起伏不定,甚至影響工作。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">這一年來,我最深刻的體會是: 平靜,難得且珍貴。能夠好好吃飯、好好睡覺,情緒起伏不大,即是幸福。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">不過,這是我個人的定義。若要談研究,幸福感最相關指標則是對時間的掌控。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">理財,最終的目的就是讓人感覺幸福。讓我們能在想要的時間,和想要的人,做想要的事。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">基本上,就是一種自由。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="font-family: inherit; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">別忘了呀~</div></div></span></div></div></div></div></div><div style="font-family: inherit;"><div class="stjgntxs ni8dbmo4 l82x9zwi uo3d90p7 h905i5nu monazrh9" data-visualcompletion="ignore-dynamic" style="border-radius: 0px 0px 8px 8px; font-family: inherit; overflow: hidden;"><div style="font-family: inherit;"><div style="font-family: inherit;"><div style="font-family: inherit;"><div class="l9j0dhe7" style="font-family: inherit; position: relative;"><div class="bp9cbjyn m9osqain j83agx80 jq4qci2q bkfpd7mw a3bd9o3v kvgmc6g5 wkznzc2l oygrvhab dhix69tm jktsbyx5 rz4wbd8a osnr6wyh a8nywdso s1tcr66n" style="align-items: center; border-bottom: 1px solid var(--divider); color: var(--secondary-text); display: flex; font-family: inherit; font-size: 0.9375rem; justify-content: flex-end; line-height: 1.3333; margin: 0px 16px; padding: 10px 0px;"><div class="bp9cbjyn j83agx80 buofh1pr ni8dbmo4 stjgntxs" style="align-items: center; background-color: white; color: #65676b; display: flex; flex-grow: 1; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; overflow: hidden;"><span aria-label="看看誰對這個傳達了心情" class="du4w35lb" role="toolbar" style="font-family: inherit; z-index: 0;"><span class="bp9cbjyn j83agx80 b3onmgus" id="jsc_c_10z" style="align-items: center; display: flex; font-family: inherit; padding-left: 4px;"><span class="np69z8it et4y5ytx j7g94pet b74d5cxt qw6c0r16 kb8x4rkr ed597pkb omcyoz59 goun2846 ccm00jje s44p3ltw mk2mc5f4 qxh1up0x qtyiw8t4 tpcyxxvw k0bpgpbk hm271qws rl04r1d5 l9j0dhe7 ov9facns kavbgo14" style="border-bottom-color: var(--card-background); border-left-color: var(--card-background); border-radius: 11px; border-right-color: var(--card-background); border-style: solid; border-top-color: var(--card-background); border-width: 2px; font-family: inherit; height: 18px; margin-left: -4px; position: relative; width: 18px; z-index: 2;"><span class="t0qjyqq4 jos75b7i j6sty90h kv0toi1t q9uorilb hm271qws ov9facns" style="border-radius: 9px; display: inline-block; font-family: inherit; height: 18px; width: 18px;"></span></span></span></span></div><div class="kb5gq1qc pfnyh3mw c0wkt4kp" style="background-color: white; color: #65676b; flex-grow: 0; flex-shrink: 0; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; width: 7px;"></div></div></div></div></div></div></div></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-11870686259235501662022-04-19T18:39:00.011+08:002023-04-17T19:36:51.505+08:00[達文西手術] 巨大後子宮頸肌瘤切除手術 (有圖)<p>34歲女性,已經生過一胎,還想再生一胎。<br /><br />肌瘤從懷孕前的4公分,生完變成10公分。原以為生完會慢慢縮小,但卻繼續增大到14公分,因此不得不開刀。</p><p><span style="background-color: white; color: #050505; font-family: inherit; white-space: pre-wrap;">由於肌瘤位子在靠近子宮頸處,傳統腹腔鏡不容易處理。為了安全起見,於是我建議她接受達文西手術。</span></p><p><span></span></p><a name='more'></a><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;"><br /></span><p></p><p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">利用達文西系統,手術時能很清楚的分離腫瘤與周邊的組織,避免傷害到脆弱的輸尿管。同時,也能很細緻的處理餵養肌瘤的大條血管,避免不必要的組織損傷。</span></p><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">整台刀,幾乎沒有流任何血,80分鐘就結束了。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">對於仍有生育需求的女性來說,這樣開刀對子宮的傷害最小。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;">若預算充足或有保險給付,建議考慮達文西系統做手術,好處多多。</span></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">*<span style="font-family: inherit;">*</span></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">DaVinCi robotic assisted laparoscopic myomectomy. retroperitoneal type cervical myoma 14cm </div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">Specimen :616 g</div><div dir="auto" style="font-family: inherit;">Blood loss : minimal</div><div dir="auto" style="font-family: inherit;">Operation time:60 mins (remove specimen 20mins not included)</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeGXbNC3aRGr32_9jTRTbP61fY-3plSb0Qyc7I8Wuw3ICMsNeFtuHIOGxcME85xYNVr2m8A24RmoSmStHKQEweBaT91ST7p0igtJWYj9tqQkUiR7cI4PJDvzP9oAQ9_06dc5sXTN0ia4B37fYj_bb5teOvc-olngOwoFRyzOavvLcRNK-VSDkBnJNt/s1920/1%20(1).JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeGXbNC3aRGr32_9jTRTbP61fY-3plSb0Qyc7I8Wuw3ICMsNeFtuHIOGxcME85xYNVr2m8A24RmoSmStHKQEweBaT91ST7p0igtJWYj9tqQkUiR7cI4PJDvzP9oAQ9_06dc5sXTN0ia4B37fYj_bb5teOvc-olngOwoFRyzOavvLcRNK-VSDkBnJNt/w400-h225/1%20(1).JPG" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhJoFZUzKBhq5JkWd4H0xZAtOopQAQNsafTNiQdDwr2n__GYz0yRJGaWCNeSMMccIk95eDasG7ehTvqPMHgtiGpesi_o86_6w-eLcR1Imxcf9FRGUkOjMaDY9_I1FK6cmnqN0DK-ORC5yV22b-oVL1Sv9I8GsU2KKvwDKHUlDzY2yL5xisM2el5WRK/s1920/1%20(3).JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhJoFZUzKBhq5JkWd4H0xZAtOopQAQNsafTNiQdDwr2n__GYz0yRJGaWCNeSMMccIk95eDasG7ehTvqPMHgtiGpesi_o86_6w-eLcR1Imxcf9FRGUkOjMaDY9_I1FK6cmnqN0DK-ORC5yV22b-oVL1Sv9I8GsU2KKvwDKHUlDzY2yL5xisM2el5WRK/w400-h225/1%20(3).JPG" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFiXru32NoLDvZejbF_hN4PVH8cYI6_AE8lx3_DEk3H0QJfH1UrbFJaoOpYQnWbwjyrWyU71pBFrgb4GFJcFflDy15KTazmaqY8_W1J1GlMz0hpRO2BFgMOOKQlKPyxk_vXFa2Zri7gHXz37Z1OzCXQk5KUSNzq3xlETEGjcyM32RJxzb18bfR_1rD/s1920/2%20(6).JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1920" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFiXru32NoLDvZejbF_hN4PVH8cYI6_AE8lx3_DEk3H0QJfH1UrbFJaoOpYQnWbwjyrWyU71pBFrgb4GFJcFflDy15KTazmaqY8_W1J1GlMz0hpRO2BFgMOOKQlKPyxk_vXFa2Zri7gHXz37Z1OzCXQk5KUSNzq3xlETEGjcyM32RJxzb18bfR_1rD/w400-h225/2%20(6).JPG" width="400" /></a></div><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-56045711671789662592022-01-24T20:42:00.006+08:002022-07-19T16:13:21.747+08:00[圖解] 什麼是單孔腹腔鏡手術<p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">這三天,我經歷了12公分的肌瘤切除、12公分的全子宮切除,和13公分的卵巢腫瘤切除……</span></p><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">現在,單孔腹腔鏡微創手術已經非常成熟,可以處理許多婦科腫瘤問題。提供女性朋友一個傷口更小、更不痛、恢復更快的手術選擇。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">許多病人都很好奇,我究竟如何利用2公分、藏在肚臍的傷口開刀的。這份漫畫將回答這個問題。</div><span><a name='more'></a></span><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; 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text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjo1ybx4THNyM-e9ZN5_L7Yo2k9UTE22jUEEKdY1eyPTN6f_2xXJ8J2xf53wzqUfrb0KWYU-3_onQoDiZNUQKY2McwjTGLL2utPMjidg3ND_joRgMKMhuBSalMDlYppUKygJ6SvZ7aHDmWK1oqjm9GFDoat66wAGvfPYlOwsFfyzI6kLSTrWpbKxFfm=s2501" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2500" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEjo1ybx4THNyM-e9ZN5_L7Yo2k9UTE22jUEEKdY1eyPTN6f_2xXJ8J2xf53wzqUfrb0KWYU-3_onQoDiZNUQKY2McwjTGLL2utPMjidg3ND_joRgMKMhuBSalMDlYppUKygJ6SvZ7aHDmWK1oqjm9GFDoat66wAGvfPYlOwsFfyzI6kLSTrWpbKxFfm=w640-h640" width="640" /></a></div><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-31801168880514285152022-01-24T20:35:00.001+08:002022-07-19T16:13:55.594+08:00[圖解] 達文西手術系統的三大優勢: 更清、更穩、更靈活<p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">從今年初起,我開始在柳營奇美醫院施行達文西手術。</span></p><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">開始做達文西後,再回頭看原本覺得已經很清楚的4K腹腔鏡,嗯,開始覺得沒那麼清楚,就只能看個大概~縫合的精細程度,就更不用提了,達文西完勝!</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">這,就是所謂的由奢入儉難吧!(笑)</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">難度不高的手術,我用單孔腹腔鏡就能搞定。相較於達文西,傷口小自費也較少。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">不過,三大類型的手術,達文西系統還是有絕對優勢。<span style="font-family: inherit;">因為,達文西就是看得更清楚,動作更穩定細緻,器械也更靈活。</span><span style="font-family: inherit;">越難的手術,越能彰顯其威力。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div><div dir="auto" style="font-family: inherit;">這三大類手術,分別是: 空間狹小的手術、需精細縫合的手術、需仔細剝離組織的手術。接下來,我們就來看看那些手術適合吧!</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; 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text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhOtdPZAk5fJxCg5xqq0KaHrlYn6FVnpZ4kKzj45CJRhdhCp2k9e2gFbjO-Grbp8YA2Ynm_p4JxxEZeYS2DV61WrKaTbvHRCdmZ1MJ3o0LrsAn02SLQXQXROzXoxHlsB0kHT_kl3BfuZwLlR7QmQHJebjpU5NKbY5I5egT8Rrhx9ndfZ5Uc4AKjgFpr=s2501" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2501" data-original-width="2500" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEhOtdPZAk5fJxCg5xqq0KaHrlYn6FVnpZ4kKzj45CJRhdhCp2k9e2gFbjO-Grbp8YA2Ynm_p4JxxEZeYS2DV61WrKaTbvHRCdmZ1MJ3o0LrsAn02SLQXQXROzXoxHlsB0kHT_kl3BfuZwLlR7QmQHJebjpU5NKbY5I5egT8Rrhx9ndfZ5Uc4AKjgFpr=w640-h640" width="640" /></a></div><br /><div dir="auto" style="font-family: inherit;"><br /></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-7347825552639858932021-08-17T21:06:00.002+08:002021-08-17T21:06:50.608+08:00[圖解] 破除迷思系列(三) 拿子宮會尿失禁嗎? <p><span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">今天,替一位美國人拆掉寬度達17公分的大子宮。</span></p><div class="" data-block="true" data-editor="8o0sd" data-offset-key="bgik7-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="bgik7-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="bgik7-0-0" style="font-family: inherit;">術前,我們就知道病人因為信仰,即使貧血也無法輸血。不僅麻醉科嚴正以待,寬子宮直接壓迫骨盆,正常解剖構造全部跑掉,如何避免輸尿管受損也是一大挑戰。</span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="4k7te-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="4k7te-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="4k7te-0-0" style="font-family: inherit;"><br data-text="true" /></span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="fbulp-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="fbulp-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="fbulp-0-0" style="font-family: inherit;">自從接受 </span><span class="diy96o5h" data-offset-key="fbulp-1-0" end="8" spellcheck="false" start="5" style="background-color: var(--text-highlight); font-family: inherit;">賴鴻政</span><span data-offset-key="fbulp-2-0" style="font-family: inherit;"> 教授達文西手術技巧指導後,我就徹底改變開刀習慣。光今年,就已經成功在困難手術中保住三條輸尿管(笑),今天,則是第四條。行筆至此,覺得老師實在功德滿滿!</span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="bt90o-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="bt90o-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="bt90o-0-0" style="font-family: inherit;"><br data-text="true" /></span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="aekqt-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="aekqt-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="aekqt-0-0" style="font-family: inherit;">解釋病情時,教友特別提到她很在意尿失禁議題。正好提醒我上刊這份破除迷思的漫畫。</span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="587el-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="587el-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="587el-0-0" style="font-family: inherit;"><br data-text="true" /></span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="6fb6j-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="6fb6j-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="6fb6j-0-0" style="font-family: inherit;">包含這篇,一共四篇子宮切除常見的江湖迷思,就完備了。希望能夠幫忙更多病人在手術前,理解狀況,消除疑慮,緩解恐懼。</span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="b656-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="b656-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span><a name='more'></a></span><span data-offset-key="b656-0-0" style="font-family: inherit;"><br data-text="true" /></span></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="557nq-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; 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margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="2047" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjooXAbDQjTOh3u11Sr33zzBxjw-fUg1oH5H5wdwAoUrpUrlwg_EuL2hagKipnWok5DsE9zIEqjlPXY3e8tl2UfFJe_7_gWdJpiGNgOVVzaXWs98L5HZY6frOvdgCwQSWMmyoVKsWIYims/w640-h640/%25E7%25A0%25B4%25E9%2599%25A4%25E8%25BF%25B7%25E6%2580%259D%25E7%25B3%25BB%25E5%2588%2597%25E4%25B8%2589-04.jpg" width="640" /></a></div></div><br /><div class="separator" style="clear: both; text-align: left;">回到主頁面: <a href="http://obgyndrwei.blogspot.com/p/blog-page_7.html">魏君卉醫師圖解婦產</a></div><br /><div class="_1mf _1mj" data-offset-key="557nq-0-0" style="direction: ltr; font-family: inherit; position: relative;"><br /></div></div><div class="" data-block="true" data-editor="8o0sd" data-offset-key="73igi-0-0" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="73igi-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span class="diy96o5h" end="14" start="0" style="background-color: var(--text-highlight); font-family: inherit;"><br /></span></div><div class="_1mf _1mj" data-offset-key="73igi-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span class="diy96o5h" end="14" start="0" style="background-color: var(--text-highlight); font-family: inherit;"><br /></span></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-28555480697074874042021-08-04T20:38:00.001+08:002021-08-04T20:38:03.434+08:00[圖解] 子宮頸,拿不拿,究竟差在哪裡 ?<p> <span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">只要諮詢子宮切除手術,大家會在門診問的考古題,不外乎就是這四題:</span></p><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">1. 拿子宮,會變老嗎?</div><div dir="auto" style="font-family: inherit;">2. 拿子宮,會脫垂嗎?</div><div dir="auto" style="font-family: inherit;">3. 聽說拿子宮會尿失禁? </div><div dir="auto" style="font-family: inherit;">4. 究竟子宮頸要不要拿呢?</div><span><a name='more'></a></span><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">無論病人第一題是問哪題,只要我講出其他三題,往往都會收到 " 妳怎麼知道! " 這種驚訝的目光。 </div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">傻傻的,因為太陽底下沒有新鮮事呀 ! 這幾個問題每個門診我都要回答好幾次呢 ! (笑)</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">然而,由於網路上的答案非常混亂,常見到病人看了錯誤的資訊而過度恐懼,導致延誤病情。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">倒不是說網友分享的經驗是假的,而是疾病的因果關係,沒有專業知識會很難判斷,許多言論就淪於猜測。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">有鑑於此,我才會決定把這四個疑問畫成漫畫,方便大家理解。<span style="font-family: inherit;">相信看完漫畫,能幫助妳了解正確的大觀念。</span></div><div dir="auto" style="font-family: inherit;"><span style="font-family: inherit;"><br /></span></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">不過,每個人的病情都是獨特的,在意的事情也不同。如果決定要手術,還是得跟醫師討論後,再制定最適合妳的醫療計畫喔~</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj358ctdLb5ym8zPAFHnCaaJxJX3qqNtbNkn_fNtPpb8KNE3Yq8df_gtaz5Q2dcWUUgbN5ITZ9itY68mG2J14Kn7c6PnwUEu1Y9RKFJ7tiHXWg2vIly7rNKrHKDnndhnXU4veO8YTlyUzU/s2048/%25E7%25A0%25B4%25E9%2599%25A4%25E8%25BF%25B7%25E6%2580%259D%25E7%25B3%25BB%25E5%2588%2597%25E5%259B%259B_%25E5%25B7%25A5%25E4%25BD%259C%25E5%258D%2580%25E5%259F%259F+1.jpg" imageanchor="1" style="margin-left: 1em; 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margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="2047" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhQQEAtV83e7J6jlDtE4l1CrF1k7qDCJ-9eNwN8ujhNQ0dN4cWCONzTko23XHDVFDUmT-XeIfhdV2UjPNqpNF2exR4gZ0rLCQhoTFTS1kQD6PvYzPY4ow5kJfr-nlSwdjziMG5a6-r0Mk/w640-h640/%25E7%25A0%25B4%25E9%2599%25A4%25E8%25BF%25B7%25E6%2580%259D%25E7%25B3%25BB%25E5%2588%2597%25E5%259B%259B-04.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXY4WMLMYEcGo0NsKblgLzoOA7DoISg8I4nZGutfdD1kf77IS9OBC6-SU8etflI4LT8jxv-Ciw8b-mZH-aFngTz3bXMNYiByQMatYTKWSMzDNvgW0xDW-gG7jCTmrg8ZZY0GeMxfH9g2s/s2048/%25E7%25A0%25B4%25E9%2599%25A4%25E8%25BF%25B7%25E6%2580%259D%25E7%25B3%25BB%25E5%2588%2597%25E5%259B%259B-05.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="2048" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXY4WMLMYEcGo0NsKblgLzoOA7DoISg8I4nZGutfdD1kf77IS9OBC6-SU8etflI4LT8jxv-Ciw8b-mZH-aFngTz3bXMNYiByQMatYTKWSMzDNvgW0xDW-gG7jCTmrg8ZZY0GeMxfH9g2s/w640-h640/%25E7%25A0%25B4%25E9%2599%25A4%25E8%25BF%25B7%25E6%2580%259D%25E7%25B3%25BB%25E5%2588%2597%25E5%259B%259B-05.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: left;">回到首頁: <a href="http://obgyndrwei.blogspot.com/p/blog-page_7.html">魏君卉醫師圖解婦產</a></div><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-43103592086761672362021-08-04T19:49:00.002+08:002022-07-19T16:14:23.392+08:00[圖解] 門診排刀三部曲<p> <span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">因為一趟路有點遠,若要安排手術,我真的很希望一次術前門診就能安排妥當。</span></p><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">所以有三件事情拜託大家:</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">1)<b>先問好保險額度,尤其是實支實付額度。</b>這樣我才知道手術東西能用到多好。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">2)<b>先找好住院照顧的人</b>,如果可以的話,盡量一起到門診排刀。因為每台刀之前,我都會解釋很多細節,大家一起聽,有疑問一起答,會更有默契。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">3)<b>如果從其他醫院帶光碟片的,先存進自己的筆電,開好帶進診間。</b>醫院因為軟體版權,各路英雄的圖片不一定打的開。然後我是電腦苦手,圖片打不開妳又眼巴巴的瞧著我,我會害羞,就更打不開了。</div><div dir="auto" style="font-family: inherit;"><br /></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">拜託大家了~</div><div dir="auto" style="font-family: inherit;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjItjhGwJ2ztTfZIZyMYczpu8x-sMV2AoxX3bfEIVhsUhQ_X03BwWxk52m-3irMu-OmWF9uj1L_fnQMX5OjgFavf63VWBzHITBcWBiNsXJ8NnNHXm-JB_w4tj4xTpqQfiizmyne6DGJxLc/s2048/%25E9%2596%2580%25E8%25A8%25BA%25E6%258E%2592%25E5%2588%2580%25E4%25B8%2589%25E9%2583%25A8%25E6%259B%25B2%25EF%25BC%25BF%25E6%2596%25B0%25E7%2589%2588_%25E5%25B7%25A5%25E4%25BD%259C%25E5%258D%2580%25E5%259F%259F+1.jpg" style="margin-left: 1em; 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text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitw2qW4H1JEBklUfJZwVK45GchN8IUsEkocS_SWAq_K8RiNBE8FSXvs8-wycf_YydhWySquEKOmIOg5n5wmBkQcEPQJcff4pzdL67HexvOJBsmzsCuwTirWlvwezZ0A0NEoanSit2KprE/s2048/%25E9%2596%2580%25E8%25A8%25BA%25E6%258E%2592%25E5%2588%2580%25E4%25B8%2589%25E9%2583%25A8%25E6%259B%25B2%25EF%25BC%25BF%25E6%2596%25B0%25E7%2589%2588-04.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="2047" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitw2qW4H1JEBklUfJZwVK45GchN8IUsEkocS_SWAq_K8RiNBE8FSXvs8-wycf_YydhWySquEKOmIOg5n5wmBkQcEPQJcff4pzdL67HexvOJBsmzsCuwTirWlvwezZ0A0NEoanSit2KprE/w640-h640/%25E9%2596%2580%25E8%25A8%25BA%25E6%258E%2592%25E5%2588%2580%25E4%25B8%2589%25E9%2583%25A8%25E6%259B%25B2%25EF%25BC%25BF%25E6%2596%25B0%25E7%2589%2588-04.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div>回首頁 : <a href="http://obgyndrwei.blogspot.com/p/blog-page_7.html" target="_blank">魏君卉醫師圖解婦產</a><br /><div dir="auto" style="font-family: inherit;"><br /></div></div>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com0tag:blogger.com,1999:blog-6631301324953336307.post-91879419210816919062021-03-29T18:06:00.007+08:002022-06-13T10:50:30.573+08:00[閱讀心得] 致富心態: 留有餘裕,是獲得幸福的不二法門。<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXtJlW6wCvuM4zPnsi933Q6w-niFyyuF8PmU4m6dkg_OziIBawn81K87eaajWwCaRjYBtPXhNum9SOZ589PA3EVmIJUWMJGs4MryYnqCH16tLV-Ep3CMluvsEEpyct52iXLUyeqpJQKsI/s880/6Te2qb-880x500.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="880" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXtJlW6wCvuM4zPnsi933Q6w-niFyyuF8PmU4m6dkg_OziIBawn81K87eaajWwCaRjYBtPXhNum9SOZ589PA3EVmIJUWMJGs4MryYnqCH16tLV-Ep3CMluvsEEpyct52iXLUyeqpJQKsI/w400-h228/6Te2qb-880x500.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;">pic. reference: https://tsmc2330.com/articles/332</div><p>這是一本好讀的書。</p><p>即使寫下這篇心得的這個時刻,已經距離我讀完整本書可能有一個月以上。不過,單憑閱讀時我記在Memo紙上的短句,就足以讓這本書再次閃閃發光。</p><p>由於這是我自己的讀書筆記,所以就用我最有感的問答方式來記錄吧。</p><p><b>問題一: 金錢可以如何讓我們更開心?</b></p><p>答案: <b style="background-color: #ffe599;">買到自由</b>。尤其是時間的自由: 讓我們能夠,在想要的時間,與想要的人,做想要的事。</p><p>而不是用金錢去買其實不一定真的喜歡的東西,去取悅不一定喜歡的人。</p><span></span><span><a name='more'></a></span><p><b>問題二: 如何能增加生活幸福感?</b></p><p>答案: </p><p>根據研究 (書上有寫但我不care) <b style="background-color: #ffd966;">擁有對生活的掌握感</b>,是預測正向幸福的可靠指標。而增加對生活掌控感最好的方式,就是在行事曆上留有彈性 ( Cushion )。</p><p>這點與我自己的生活經驗相符:手術排程,我永遠預留約20%左右的彈性空間,給無法預期、很緊急的個案。這會讓我對自己的工作掌握度更有信心,而不會在病人有需求時顯得捉襟見肘。</p><p>回報就是更穩定的醫療與手術品質。</p><p>這道理在投資理財領域也是相同的: 不過度槓桿,手上永遠留有一定比例的現金(我自己是總資產的20%),會讓人在空頭時不恐慌殺出,不被迫賤賣資產,還有子彈可以逢低進場。</p><p>回報就是更容易留在市場中,不被當成韭菜割去賣。</p><p><b>問題三: 如何跳脫無止盡的比較?</b></p><p>答案: " 忌妒別人賺的錢比自己多,是很嚴重的錯誤。" 這句話在窮查理的普通知識中,第一篇開宗明義就講了。</p><p>社會上比較的天花板太高,幾乎無人能觸及,是財富比較的真實狀況。</p><p>當月薪5萬,羨慕著月薪10萬。達到10萬,則欽羨30、50、100萬。若真能賺到每個月100萬,身邊的人會換過一輪,開始競爭起月薪1000萬。</p><p>華爾街收入前五的分析師,年薪是3億美金。</p><p>若能<span style="background-color: #ffe599;"><b>坦然接受自己在某個收入水平就能獲得滿足</b></span>,就有機會跳脫無止盡的比較。反之,則會因為貪得無厭的心態,淪落在過勞、高風險投資的處境,直到遺憾發生。</p><p><b>問題四: 如何保有財富? </b></p><p>答案: 高儲蓄率。 秘訣只有二: </p><p>(1) 控制欲望 (2) 存錢不需要理由,可以單純為了存錢而存錢。</p><p>當我們看到某人開著500萬的豪車,唯一能確認的就是某人銀行帳戶少了500萬(或債務多了500萬)</p><p><b>問題五: 何謂高明的理財之道? </b></p><p>答案: <span style="background-color: #ffe599;"><b>持續不讓事情出錯</b></span>。包含著守財的能力(問題四的答案),與求生的能力(問題二的答案)。</p><p><b>問題六:如何在逆境中讓財務成長?</b></p><p>答案: 認識長尾效應。理解少數事件擁有絕對巨大的影響力。</p><p>在投資歷史中無須次次做對,只要持續不讓事情出錯,留有餘裕,在某幾次市場逆境中有機會作對即可。</p><p><b>問題七:何謂合理的投資策略 ?</b></p><p>答案: <span style="background-color: #ffe599;"><b>穩當又不違反人性</b></span>。</p><p>晚上睡得著(一夜好眠比超額報酬更重要) ,偶而小額買買自己喜愛的股票(人性愛賭博的弱點啊,但金額不能動搖國本)。我手上的costco、apple、google......都是我順應人性擁有的股票。</p><p><b>問題八: 本書令我最有感的投資心法</b></p><p>答案: </p><p>(1) 永保長期樂觀與理解到處都是地雷,這兩者並不互斥。 </p><p>(2) 過去不能展望未來。因為從未發生的事,始終都在發生。</p><p>這兩點不只投資,人生亦如是。</p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p> </p><p><br /></p><p><br /></p><p><br /></p><p><br /></p>魏君卉http://www.blogger.com/profile/17046283542012015875noreply@blogger.com1