Lee Peter A
Division of Pediatric Endocrinology, Department of Pediatrics, Penn State College of Medicine, The Milton S Hershey Medical Center, Hershey, PA 17033-0850, USA.
J Pediatr Endocrinol Metab. 2004 Feb;17(2):133-40. doi: 10.1515/jpem.2004.17.2.133.
Factors that have led to reassessment of the care of intersex patients are discussed with specific attention to the following issues: 1) role of the parents in medical decisions, 2) full disclosure to patients and parents of details of results of diagnostic tests, possible therapies, and outcome date, 3) excessive exposure during medical examinations, 4) the impact of in utero androgen upon the central nervous system, and 5) the challenge to defer surgery until the child is 'old enough' to give consent. An overview of the approach to intersex patients is included with particular emphasis upon the 'optimal gender' approach developed about 50 years ago. It is clear that care of the child with genital ambiguity must be individualized, with parents and patients regularly receiving updated information concerning the etiology, treatment and outcome among children with similar diagnoses. A medical team approach is advocated, with the goal of striking the best balance between outcome data and differing opinions.
文中讨论了促使对两性畸形患者护理进行重新评估的因素，并特别关注以下问题：1）父母在医疗决策中的作用；2）向患者及其父母充分披露诊断测试结果、可能的治疗方法和预期结果的详细信息；3）医学检查过程中的过度暴露；4）子宫内雄激素对中枢神经系统的影响；5）将手术推迟到孩子“足够大”能够给予同意的挑战。文中还概述了对两性畸形患者的治疗方法，特别强调了大约50年前发展起来的“最佳性别”方法。显然，对生殖器模糊的儿童的护理必须个体化，父母和患者应定期获得有关病因、治疗和类似诊断儿童的结果的最新信息。提倡采用医疗团队的方法，目标是在结果数据和不同意见之间取得最佳平衡。
