略论“患者要求全子宫切除”

我也经常看到申请单上这样写的病史。

我认为，如果过治疗或治疗不当，这种陈述不能作为临床医生免责的依据。因为患者不知道治疗规范，即使临床医生曾经和患者解释过并且得到患者的同意，到了法庭上，患者只要说“我不懂”，临床医生就得输官司。

类似的案例发生过多起。

为临床医生捏把汗，也为病理同行们提个醒。外院的诊断在术前一定要借片子来复诊，或者重新活检。虽然这些步骤由临床医生掌控，我们还是要帮助临床医生把好关。

如果勉强报了CIN 2，是适合LEEP的。

此例并没有CIN 2。完全是湿疣的改变，最多报CIN 1。

切子宫肯定是过治疗啦。才38岁哦！同情ing……

 I agree with most of your opinion. It seems to me that this is a LEEP specimen given the relative abundant and intact stroma. Most parts show CIN1 (or with HPV infection in China) and few photos show CIN2 change. I am assuming that no invasive carcinoma in other parts of the specimen. Now If resection margins are negative for CIN2 lesion, then she should be able to be totally exempt from hysterectomy. Now this is a delicate issue in China since I know most of you do not use color inks to ink resection margin. You have to use your experience and judgement to evaluate if resection margins are positive or not. If margin positive for CIN2, it will be important to have an ECC to make sure CIN2 is not deep inside or involving in endocervical glands. If latter is negative, then clinicians have two options: 1) do another thin "LEEP" procedure to get rid of left over CIN2. However, in up to 80% of cases reported in US, pathologic examination cannot find any CIN2 in second LEEP specimen even previous LEEP margins are positive. 2) Most clinicians in US, at least in our hospital, will follow patient with either PAP test every 6 months and/or HPV test. Recent ALTS study indicates that HPV test in follow up is more specific since 40% of HPV positive patients will develop recurrent CIN2+ lesions when HPV is persistently positive post LEEP, compared to 5% whne HPV is negative. For this case and most cases in China, I suggest to follow with PAP plus HPV test, given  no accurate position of positive margins can be provided if you do not ink the margin.

I totally agree with hpn0808's opinion that even patient asked for hysterectomy, clinicians should provide better information and advise to patient. Otherwise, what is need for doctors anyway? We doctors shoud treat patients with care and dignity in my opinion. In US, the first oath to GOD for any medical students is: NO HARM TO YOUR PATIENTS!

abin老师能帮助翻译吗？

 由于处理上的要求，我肯定不会报CIN1-2