电视腹腔镜技术对慢性盆腔痛诊治研究

目的：探讨慢性盆腔痛的病因和提高其治疗效果。方法：应用电视腹腔镜技术对４２例慢性盆腔痛病人进行了治疗。其中术前诊断为慢性盆腔炎者２３例，子宫内膜异位症者１９例。结果：腹腔镜检查发现术前术后诊断的总相符率为５９．５％，腹腔镜检查纠正诊断率４０．５％。在腹腔镜下行松解粘连、电凝病灶、开窗清除囊肿及切除病变输卵管等手术。术后中西医结合治疗。该组病人治疗的总有效率８５．７％。结论：腹腔镜技术对慢性盆腔痛明确诊断提供了依据，并改善了治疗效果     

电视腹腔镜技术对慢性盆腔痛诊治研究

为探讨慢性盆腔痛的原因，从１９９５年３月～１９９７年８月应用电视腹腔镜技术对４２例慢性盆腔痛患者进行了临床研究。术前诊断慢性盆腔炎者２３例（盆腔炎组），子宫内膜异位症者１９例（内异症组）。经腹腔镜检查后发现，盆腔炎组中证实为慢性盆腔炎者１３例，子宫内膜异位症者５例，盆腔静脉淤血综合征２例，盆腔粘连１例，慢性阑尾炎１例，正常盆腔１例，术前后诊断相符率５６．５％；内异症组中证实为内异症者１２例，慢性盆腔炎者３例，盆腔静脉淤血综合征２例，盆腔粘连１例，正常盆腔１例，术前后诊断相符率６３．２％，两组总相符率为５９．５％，腹腔镜检查纠正诊断率４０．５％。在电视腹腔镜下松解粘连、电凝病灶、开窗清除囊肿及切除输卵管处理和术后中西药综合治疗，该组病人治疗的总有效率８５．７％。对腹腔镜技术对慢性盆腔痛各种病变的诊治特点进行了分析讨论，认为腹腔镜技术为慢性盆腔痛确定诊断及治疗提供了依据     

AAPT Diagnostic Criteria for Chronic Abdominal,Pelvic, and Urogenital Pain: Irritable Bowel Syndrome

In conjunction with the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration and the American Pain Society, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy (AAPT) initiative strove to develop the characteristics of a diagnostic system useful for clinical and research purposes across disciplines and types of chronic pain conditions. After the establishment of these characteristics, a working group of clinicians and clinical and basic scientists with expertise in abdominal, pelvic, and urogenital pain began generating core diagnostic criteria and defining the related extraintestinal somatic pain and other symptoms experienced by patients. Systematic diagnostic criteria for several common abdominal, pelvic, and urogenital pain conditions are in development. In this report, we present the proposed AAPT criteria for irritable bowel syndrome (IBS), the most common chronic, noncancer abdominal pain condition. A systematic review and synthesis was conducted to complement the Rome IV Diagnostic Criteria for IBS. Future efforts will subject these proposed AAPT criteria to systematic empirical evaluation of their feasibility, reliability, and validity. The AAPT IBS criteria are part of an evidence-based classification system that provides a consistent vocabulary regarding diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms of the disorder. A similar approach is being applied to other chronic and often debilitating abdominal, pelvic, and urogenital pain conditions.

A randomized clinical trial for the effect of static stretching and strengthening exercise on pelvic tilt angle in LBP patients

BackgroundStretching and strengthening exercises are commonly used to improve muscle shortness of the hamstring as any tension in this muscle can have an effect on the pelvic posture. Thus, the aim of this study was to evaluate the effects of two methods of improving short hamstring on the angle of pelvic tilt in LBP sufferers.MethodsForty-five low back pain patients aged 19–59 years with hamstring tightness participated in this clinical trial. The patients were categorized randomly into three groups: 1- static stretching, 2-strengthening exercise and 3-control group. The two intervention groups received physical therapy and special exercise program thrice a week in a total of 12 sessions, while the control group received only conventional physical therapy. Before and after the treatment implementation, the pelvic tilt and straight leg raising (SLR) degree were assessed for each group.ResultAfter 12 sessions of treatment, the ANCOVA models indicated non-significant differences in pelvic tilt angle and SLR score changes (p > 0.05), among the three groups. In addition, no statistically significant correlation was observed between the pelvic tilt and SLR test [except for the strengthening exercise group (Pearson correlation coefficient = −0.54, P < 0.05)].ConclusionsIn LBP sufferers, both static stretching and strengthening of hamstring muscle in its lengthened position caused elongation and extensibility in the hamstring muscle and increased SLR test score, but did not change pelvic tilt angle.     

盆底生物反馈治疗慢性盆腔疼痛综合征的应用研究

目的评价生物反馈治疗慢性盆腔疼痛综合征的临床疗效。方法249例慢性盆腔疼痛综合征患者采用生物反馈治疗，治疗周期10～15d，每次20～30min，观察治疗前、治疗后12周的各项指标变化：前列腺炎症状评分（NIH—CPSI）、排尿评分（VS）、生活质量评分（QOL）、疼痛强度评分（COVAS）、最大尿流率（Qmax），并对结果进行统计学分析。结果213例患者坚持治疗10～15d，生物反馈治疗前后NIH—CPSI评分（22、4±5．1vs7．1±3．8），COVAS评分（4．2±2．3vs1．9±1．6）、排尿评分（7．7±2．1vs2．3±1．5）、QOL评分（9．2±2．4vs2．3±1．9）、和Qmax（11.5±3.2ml／svs14．9±5．6ml／s）差异有统计学意义（P〈0．05）。有效率为68．1％。结论 生物反馈治疗能明显改善CPPS患者疼痛、尿频、尿急和生活质量，是一种安全有效的治疗方法。     

Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions,pain and quality of life: a systematic review

Background

Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy.

Tryptase-PAR2 axis in experimental autoimmune prostatitis,a model for chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects up to 15% of the male population and is characterized by pelvic pain. Mast cells are implicated in the murine experimental autoimmune prostatitis (EAP) model as key to chronic pelvic pain development. The mast cell mediator tryptase-β and its cognate receptor protease-activated receptor 2 (PAR2) are involved in mediating pain in other visceral disease models. Prostatic secretions and urines from CP/CPPS patients were examined for the presence of mast cell degranulation products. Tryptase-β and PAR2 expression were examined in murine EAP. Pelvic pain and inflammation were assessed in the presence or absence of PAR2 expression and upon PAR2 neutralization. Tryptase-β and carboxypeptidase A3 were elevated in CP/CPPS compared to healthy volunteers. Tryptase-β was capable of inducing pelvic pain and was increased in EAP along with its receptor PAR2. PAR2 was required for the development of chronic pelvic pain in EAP. PAR2 signaling in dorsal root ganglia led to extracellular signal-regulated kinase (ERK)1/2 phosphorylation and calcium influx. PAR2 neutralization using antibodies attenuated chronic pelvic pain in EAP. The tryptase-PAR2 axis is an important mediator of pelvic pain in EAP and may play a role in the pathogenesis of CP/CPPS.     

Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain

Aim

This study aimed to compare the prevalence of pelvic musculoskeletal dysfunctions in women with and without Chronic Pelvic Pain (CPP).

盆腔痛骶前孔神经阻滞疗法的临床研究

目的:本研究旨在从妇科神经解剖学角度入手,探索一种新的阻滞方法,简便有效地治疗盆腔痛.方法:以尸检、解剖学基础为依据,提出骶前孔阻滞法, 并与多种相关的方法进行影像学分析比较.结果:骶前孔阻滞疗法,影像学观察药物分布及临床效果优于其他相关方法.结论:骶前孔阻滞操作简便、有效.     

Efficacy of melatonin in the treatment of endometriosis: A phase II,randomized, double-blind,placebo-controlled trial

Endometriosis-associated chronic pelvic pain (EACPP) presents with an intense inflammatory reaction. Melatonin has emerged as an important analgesic, antioxidant, and antiinflammatory agent. This trial investigates the effects of melatonin compared with a placebo on EACPP, brain-derived neurotrophic factor (BDNF) level, and sleep quality. Forty females, aged 18 to 45 years, were randomized into the placebo (n = 20) or melatonin (10 mg) (n = 20) treatment groups for a period of 8 weeks. There was a significant interaction (time vs group) regarding the main outcomes of the pain scores as indexed by the visual analogue scale on daily pain, dysmenorrhea, dysuria, and dyschezia (analysis of variance, P < 0.01 for all analyses). Post hoc analysis showed that compared with placebo, the treatment reduced daily pain scores by 39.80% (95% confidence interval [CI] 12.88–43.01%) and dysmenorrhea by 38.01% (95% CI 15.96–49.15%). Melatonin improved sleep quality, reduced the risk of using an analgesic by 80%, and reduced BNDF levels independently of its effect on pain. This study provides additional evidence regarding the analgesic effects of melatonin on EACPP and melatonin’s ability to improve sleep quality. Additionally, the study revealed that melatonin modulates the secretion of BDNF and pain through distinct mechanisms.