[2007.5.20][转贴][APTX青山病院]早孕失败后外科处理的相关问题

wangyuankai

Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care

Some of the ideas in this article were presented at the annual meeting of the Council on Resident Education in Obstetrics and Gynecology/Association of Professors of Gynecology and Obstetrics, Mar. 1-4, 2003, Anaheim, CA.
Lisa H. Harris, MD, PhD, Vanessa K. Dalton, MD, MPH, Timothy R.B. Johnson, MD, MA

Received 18 August 2006; received in revised form 7 November 2006; accepted 8 January 2007

Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.

Key words: curettage, induced abortion, medical history, spontaneous abortion, vacuum aspiration



Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care

手术治疗早期妊娠失败:历史,政治，安全和护理成本效益

Some of the ideas in this article were presented at the annual meeting of the Council on Resident Education in Obstetrics and Gynecology/Association of Professors of Gynecology and Obstetrics, Mar. 1-4, 2003, Anaheim, CA.
Lisa H. Harris, MD, PhD, Vanessa K. Dalton, MD, MPH, Timothy R.B. Johnson, MD, MA

在这篇文章中一些观点，已在年度理事会会议住院医教育在妇产科教授协会妇产科,3月1日至4日,2003年，阿纳海姆,加拿大.
isa H. Harris, MD, PhD, Vanessa K. Dalton, MD, MPH, Timothy R.B. Johnson, MD, MA

Received 18 August 2006; received in revised form 7 November 2006; accepted 8 January 2007
2006年8月18日投稿; 2006年11月7日收到校对搞; 于2007年1月8日接收

Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.

早孕失败和人工流产往往是不同处理, 即使两者都以安全的子宫排空为目标,. 早孕失败常用刮除手术在手术室处理麻醉状态下的病人.人工流产手术最常见的处理是在诊所，用真空抽吸方法来处理清醒状态或镇静状态下的病人. 医学证据因素并不支持常规术室早孕失败的治疗. 这篇评论回顾这些不同治疗方案的历史起源,探索政治对这些治疗方案延续应有的作用, 在密歇根大学利用经验,编辑如何在历史,政治 与生物医学交叉下提出患者治疗方案. 密歇根大学提出，诊所真空抽吸术可以用于早孕失败的治疗.先前，病人都是在手术室接收治疗。这些变革，需要医院，全体职工,和住院医接收培训. 我们努力使自然流产和人工流产之间的界限模糊，以此提高病人的照顾和更好地利用医院的资源.

Key words: curettage, induced abortion, medical history, spontaneous abortion, vacuum aspiration

关键词:刮除术,人工流产,病史，自然流产,真空抽吸术

编译后：约406字


从历史，政治，安全和护理成本效益角度探讨手术治疗早期妊娠失败

于2003年3月1日至4日，在加拿大阿纳海姆市召开的住院医教育和妇产科教授协会年度理事会会议会上，本文的一些观点被提出来讨论。

早孕失败和人工流产往往处理方式是不同的，即使两者都以安全的子宫排空为目标。早孕失败常用刮除手术在手术室处理麻醉状态下的病人，而人工流产手术最常见的处理是在诊所，用真空抽吸方法来处理清醒状态或镇静状态下的病人，但以往的医学证据并不支持常规术室早孕失败的治疗。这篇评论回顾了这些不同治疗方案的历史起源，政治背景对这些治疗方案延续所起到的应有作用。在密歇根大学，利用经验，编辑如何在历史,政治 与生物医学交叉下提出患者的治疗方案。密歇根大学提出，在诊所真空抽吸术可以用于早孕失败的治疗，而先前，病人都是在手术室接收治疗。这些变革，需要医院，全体职工，和住院医接收培训。现在我们努力使自然流产和人工流产之间的界限模糊，以此提高对病人的照顾和更好地利用医院的资源。