從觸診到「以管窺天」：腹腔鏡與子宮內膜異位症的興起，1950s-2000s

From Hands of Flesh to Laparoscopy: A History of Endometriosos in Taiwan, 1950s-2000s

本文探討1950 年代至今子宮內膜異位（endometriosis）在台灣的興起，尤其著重於醫學科技發展的影響及其歷史脈絡。本研究以質性研究的方法進行，訪談婦產科醫師，並對相關的子宮內膜異位症醫療論述加以分析。子宮內膜異位症最早於1950 年代出現，此時其診斷方式主要以婦產科醫師觸診或是因其它腹部手術而連帶發現，子宮內膜異位症患者相當零星而少數，一般對於經痛的處理也並不積極。1970 年代後，醫學的地位逐漸確立，腹腔鏡科技也於家庭計畫推行的成熟期引入，加上不孕科技的發展，子宮內膜異位症的病患逐漸增加，經痛或不孕者成為潛在的病人。子宮內膜異位的歷程與Clarke 等人所談的生物醫療化（biomedicalization）有類似的軌跡，尤其是醫療與科技發展，促使醫師較主動運用科技發現子宮內膜異位症，且採取積極的治療措施。此一歷程有諸多方面的暗示，包括女人身體經驗的重要性的更迭，處理經痛與不孕態度與方式的改變，及醫療操作方式的改變。而後者，則是本文所指的從觸診到「以管窺天」，從手工技藝到影像儀器科技。

This paper traces the history of endometriosis in Taiwan from the 1950s to the present by analyzing oral history interviews with ob/gyns and women with endometriosis as well as written documents （newspapers, magazines, and books）. Endometriosis first emerged in Taiwan in the 1950s, but few cases were reported. Diagnosis relied mainly on gynecological examination by hand or via exploratory surgery. Beginning in the 1970s, endometriosis cases gradually increased as a result of factors such as advances in laparoscopy technology, medicalization of infertility, and physicians writing essays for the popular media. Laparoscopy technology was introduced in the heyday of family planning, and, initially, it was used for sterilization. Soon, alongside ultrasound technology, its use was extended to being a diagnostic tool for endometriosis. This technological dimension is part of what Adele Clarke has termed the biomedicalization of health and illness. This paper explores the history of the extensive, invasive use of reproductive technologies in endometriosis diagnosis and treatment, as well as how those biotechnological procedures often conflicted with women’s body experience in Taiwan.