腹腔镜诊治慢性盆腔痛72例临床分析

目的评价腹腔镜诊治慢性盆腔痛的效果。方法对腹腔镜诊治的72例慢性盆腔痛的患者进行回顾分析,比较其临床表现、术中所见、腹腔镜下实施的手术及术后随访资料。结果 72例患者中,腹腔镜证实有病理改变和解剖改变的70例,占97.22%;其中,子宫内膜异位症有35例(48.61%),盆腔粘连23例(31.94%),慢性盆腔炎后遗症9例(12.50%),盆腔静脉淤血症3例(4.17%),盆腔未发现病变2例(2.78%)。术后疼痛症状完全缓解37例(51.39%),部分缓解29例(40.28%),未缓解6例(8.33%)。结论腹腔镜诊断慢性盆腔痛是一种较优越的方法,在寻找病因的同时可给予适当的治疗,值得推广使用。     

腹腔镜诊治慢性盆腔痛42例临床分析

慢性盆腔疼痛是指非周期性的盆腔疼痛历时或超过 3个月 ,且盆腔器官无明显创伤和病理改变。1　一般资料1998年 7月至 2 0 0 0年 10月对 4 2例慢性盆腔痛病人行腹腔镜检查治疗 ,年龄 2 3～ 4 7岁。病程最短 3个月 ,最长 12年。术前临床诊断为慢性盆腔炎 2 3例 (盆腔炎组 ) ,子宫内膜异位症 19例 (内异症组 )。2　腹腔镜下诊断标准[1]2 1　慢性盆腔炎　输卵管慢性充血、水肿、增粗、梗阻、积液、伞端闭锁、扭曲或被覆小白点和周围粘连 ,子宫浆膜充血、活动受限、直肠窝有炎症渗液或粘连宫旁组织充血等。2 2　子宫内膜异位症　按 1985年美国…     

腹腔镜手术诊治盆腔假性囊肿25例临床分析

目的 探讨盆腔假性囊肿的发病机制、术前诊断、预防对策和腹腔镜对其诊治的优势.方法 回顾性分析经腹腔镜手术及病理证实的25例盆腔假性囊肿的患者治疗方法及随访结果.结果 盆腔假性囊肿术前诊断率16%.25例术后经1～3年随访,仅1例复发,治愈率达96%.结论 盆腔假性囊肿多继发于术后或感染后,术中正确处理是预防其发生的主要对策,腹腔镜手术对其诊治有一定优势.     

腹腔镜对168例慢性盆腔痛的诊治

目的探讨慢性盆腔痛（chronic pelvic pain,CPP）的病因,以及腹腔镜在CPP诊断及治疗中的应用价值。方法对168例CPP患者行腹腔镜检查术,有病理改变者同时行腔镜手术。术前常规行妇科检查及盆腔B超检查,术前诊断为慢性盆腔炎者98例,子宫内膜异位70例。结果腹腔镜证实有病理改变者154例,占91.7%,其中32例有2种或2种以上病理改变。14例未发现病理改变,占8.3%。盆腔炎组术前诊断与腹腔镜诊断相符率为54.1%,异位症组术前诊断与腹腔镜诊断相符率为54.3%,两组术前诊断与腹腔镜诊断总相符率为54.2%,腹腔镜检查纠正诊断率45.8%。腹腔镜证实有病理改变者,同时在腹腔镜下行粘连松解、电凝内异症病灶、巧克力囊肿剥除、输卵管切除、阑尾切除等手术共105例。术后使用抗生素、激素、中药、理疗等治疗,治疗总有效率84.0%。结论子宫内膜异位症和慢性盆腔炎是CPP最常见的病因,腹腔镜能明确大部分CPP的病因并同时进行手术治疗,可作为诊治CPP的首选方法。     

消炎痛栓治疗慢性盆腔疼痛综合征75例临床分析

目的:评估消炎痛栓治疗慢性盆腔疼痛综合征(CPPS)的临床效果.方法:将150例CPPS随机分成治疗组和对照组,分别用消炎痛栓和洗必泰栓肛塞,对两组疗效进行评估.结果:消炎痛栓总有效率明显优于洗必泰组,差异有显著性,结论:消炎痛栓治疗CPPS有效,值得推广.     

宫腹腔镜手术诊治慢性盆腔痛80例临床观察

目的评价宫腹腔镜手术诊治慢性盆腔痛(CPP)的有效性。方法 80例慢性盆腔痛患者,均联合应用宫腹腔镜明确致痛原因,并行相应的镜下治疗,同时行B超检查术后随访3个月评价治疗效果。结果 80例中,宫腹腔镜诊治性手术证实盆腔及宫腔内病变74例(92.5%),B超检查发现41例(51.3%)。致痛病因主要为子宫内膜异位症、慢性盆腔炎盆腔粘连、卵巢肿瘤、盆腔静脉淤血征、宫腔占位和节育环移位等。宫腹腔镜手术治疗各类疾病69例,CPP疼痛缓解64例(92.8%),无明显并发症。结论联合应用宫腹腔镜可明确大部分CPP患者的致痛病因,诊断率高于B超检查,镜下治疗效果满意。     

慢性盆腔疼痛211例原因分析

慢性盆腔疼痛是妇科常见的症状之一。很多疾病都可以引起疼痛,例如慢性盆腔炎、子宫内膜异位症、盆腔静脉淤血症、盆腔脏器术后及一些内外科疾病等。由于引起慢性盆腔疼痛的疾病很多,要判断疼痛产生的部位及病变程度较为困难。为探索原因,现对211例慢性盆腔疼痛进行分析:1临床资料1.1我院自2002年1月至2004年2月,妇科住院病例中有慢性盆腔疼痛者211例,年龄最大60岁,最小18岁,平均37.8岁。1.2诊断慢性盆腔疼痛是指引起盆腔同一部位疼痛持续发生超过6个月以上者。通过病史及体征,经过药物试验治疗、手术治疗后及腹腔镜诊断治疗,对慢性疼痛作出…     

腹腔镜骶前神经切断术治疗慢性盆腔疼痛43例临床分析

慢性盆腔疼痛（CPP）是指引起任何类型持续6个月或以上的盆腔疼痛,是影响女性生活质量的一种常见症候群,其原因复杂,药物或物理治疗有效率低,成为妇科医师面临的棘手问题。目前腹腔镜检查已成为诊断CPP的金标准。本院对因慢性盆腔疼痛行腹腔镜检查的43例患者施行骶前神经切断术,取得了满意的手术效果。     

骶管封闭治疗25例慢性盆腔疼痛综合征

慢性前列腺炎是男性常见病,而其中90％以上为慢性盆腔疼痛综合征(CPPS),临床多采用抗菌素治疗,因缺乏明确的细菌感染证据,往往疗效欠佳。我们从麻醉疼痛治疗学角度出发,采用骶管封闭治疗25例病人,痊愈15例(60％),显效10例(40％),总有效率100％。现总结报告如下。     

综合治疗女性慢性盆腔疼痛的效果观察

目的探讨女性慢性盆腔疼痛的有效治疗方法。方法联合采用α受体阻断剂、抗抑郁剂治疗，同时进行心理辅导和适当运动。6周为1个疗程。结果治疗组48例患者中痊愈36例，显效8例，无效4例，总有效率91．66％，明显优于对照组（60．42％）。结论联合采用α受体阻断剂、抗抑郁剂治疗同时进行心理辅导和适当运动等是治疗慢性盆腔疼痛的一种确切有效的治疗方法。     

慢性盆底疼痛综合征患者中西医结合治疗尿动力及性功能变化分析

目的探讨中西结合治疗慢性盆底疼痛综合征患者尿动力及性功能变化。方法 80例患者随机分为两组,对照组给予盐酸特拉唑嗪、安特尔口服,治疗组在对照组给药方案的基础上+前列欣胶囊口服,1个月为1个疗程。观察治疗前后患者尿动力变化及国际勃起功能障碍评分。结果两组治疗后最大尿流率及最大尿道压与治疗前比较,差异有统计学意义(P<0.05);治疗组与对照组比较治疗后最大尿流率显著升高,最大尿道压显著下降,差异有统计学意义(P<0.05)。治疗组治疗后IIEF-5评分较治疗前显著升高(P<0.05)。治疗后治疗组IIEF-5评分较对照组显著升高(P<0.05)。结论中西结合治疗可明显改善慢性盆底疼痛综合征患者尿动力和性功能。     

艾灸联合电刺激镇痛治疗慢性盆腔疼痛的效果观察

目的：观察艾灸联合电刺激镇痛治疗慢性盆腔疼痛的效果。方法对93例慢性盆腔疼痛患者采用低频神经肌肉刺激治疗仪行电刺激治疗,同时用艾条灸关元、子宫、归来、三阴交和八髎穴等穴位,治疗前后进行疼痛评分。结果经连续2个疗程治疗后,疼痛消失48例（51.6%）,疼痛缓解30例（32.3%）,无效15例（16.1%）,总有效率为83.9%。患者治疗前疼痛评分2∽8分,平均（4.85±2.32）分,治疗后0∽4分,平均（2.61±1.37）分,治疗后疼痛评分较治疗前显著降低（P〈0.01）。经半年随访,治愈的48例患者中,有9例复发需再次治疗。无明显不良反应发生。结论艾灸联合电刺激治疗慢性盆腔疼痛是一种安全、有效的治疗方法,值得推广。     

腹腔镜手术联合康妇消炎栓治疗盆腔粘连合并慢性盆腔痛的临床观察

目的 探究腹腔镜手术联合康妇消炎栓治疗盆腔粘连合并慢性盆腔痛的临床效果.方法 选择2015年4月至2016年5月本院收治的盆腔粘连合并慢性盆腔痛患者94例,根据随机数字表法分为两组,每组47例.观察组实施腹腔镜手术联合康妇消炎栓治疗,对照组仅给予腹腔镜手术治疗.治疗后,比较两组患者临床疗效、盆腔疼痛程度,记录两组患者不良反应发生情况.结果 治疗后6个月,观察组NPRS评分低于对照组,组间比较,差异有统计学意义(P＜0.05);对照组治疗有效率为82.98％,明显低于观察组的95.74％,组间比较,差异有统计学意义(P＜0.05);观察组生理职能、健康状况、社会功能、精神健康、情感职能评分均高于对照组,组间比较,差异有统计学意义(P＜0.05);两组患者治疗期间均未出现明显不良反应.结论 对盆腔粘连合并慢性盆腔痛患者采用腹腔镜手术联合康妇消炎栓治疗,能有效改善患者疼痛症状,提高临床疗效与生活质量,安全性高,值得临床应用与推广.     

坦索罗辛治疗慢性盆底痛综合征的研究

目的:探讨坦索罗辛治疗慢性盆底痛综合征(CPPS)的有效性及安全性。方法:随机双盲对照研究,50例患者随机分为坦索罗辛组22例(0.2mg每晚1次),安慰剂对照组28例。分别在治疗开始、2周、4周、12周,治疗结束4周、8周、12周观察患者CPSI评分。结果:50例患者完成研究,治疗12周后,坦索罗辛组CPSI评分较对照组有显著的下降(分别是3.5,9.8,P<0.01);疼痛评分较对照组有显著改善(分别是1.7,6.0,P<0.01);总有效率显著高于对照组(分别是78.2%,25.1%)。在治疗结束后12周,坦索罗辛组的CPSI评分较治疗结束时有所升高,而对照组没有显著的变化(与治疗前比较CPSI总分下降分别是4.4,1.7)。结论:坦索罗辛治疗CPPS是安全、有效的,可以显著的改善患者的疼痛症状,但远期疗效不理想。     

经皮低频脉冲电刺激治疗女性慢性盆腔痛35例临床观察

目的:评价经皮低频脉冲电刺激治疗女性慢性盆腔痛的临床疗效。方法:回顾性分析2009年1月—2011年7月35例慢性盆腔痛患者经皮低频脉冲电刺激治疗后的临床资料。结果:35例均完成治疗,治疗结束时复查,其中治愈0例,有效33例(有效率94.28%),无效2例(5.72%)。治疗结束后3个月追踪随访,有3例失访,剩余32例患者中,治愈率为0(0/32),有效率93.75%(30/32),无效6.25%(2/32),无一例复发,差异均有统计学意义(P<0.05)。所有患者整个治疗过程未出现明显不良反应。结论:经皮低频脉冲电刺激治疗能明显改善女性慢性盆腔痛患者的疼痛症状,并且无不良反应,是一种安全可靠的治疗方法。     

133例特发性盆腔痛的治疗观察

目的探讨特发性盆腔痛的有效治疗方法。方法133例特发性盆腔痛患者随机分为两组：非药物组和药物组。药物组给予口服非甾体类抗炎药加调节植物神经功能药,非药物组给予体外高频热疗加心理辅导治疗,对比两组的治疗效果。结果非药物组共57例,42例有效,有效率74.5%;药物组共76例,34例有效,有效率44.7%,P〈0.05,差异有统计学意义,非药物组疗效优于药物组。结论体外高频透热疗法加心理辅导在特发性盆腔疼痛治疗中具有肯定的效果。     

Pharmacotherapy strategies in chronic prostatitis/chronic pelvic pain syndrome management

Importance of the field: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most common diagnoses arising out of urologic office visits. It is a costly problem and sufferers compare the effect of this syndrome on quality of life as being similar to the effects of diabetes mellitus and myocardial infarction. The syndrome is variable in presentation and symptom management and efficacy will vary between inflicted men.

Areas covered in this review: CP/CPPS is not highly responsive to therapy. As such, it is often a waxing and waning illness with symptoms in multiple domains, including urinary symptoms, pain and ejaculatory dysfunction. The pharmacotherapeutic options and management strategies for CP/CPPS presented in this review are based on the published literature from September 1989 to January 2010. When available, randomized, placebo-controlled studies were reviewed to aid in making definitive recommendations for treatment strategies.

What the reader will gain: The reader will be familiarized with the commonly used classes of pharmaceutical and non-pharmaceutical therapies. Readers will then use the efficacy data to inform treatment decisions for patients with disparate symptomatology. This will be crystallized in the author's treatment algorithm and summary statement.

Take home message: Many practitioners use antimicrobials as a first-line agent, particularly a fluoroquinolone, such as levofloxacin. Trimethoprim/sulfamethoxazole is another medication alternative, with comparable response rates. Many afflicted men will have significant improvement on a 4- to 6-week regimen of a fluoroquinolone antibiotic. Second-line pharmacotherapy includes alpha-blockers, 5-alpha reductase inhibitors and anti-inflammatories for men with urinary symptoms or pain as a predominant symptom domain. Other pharmacotherapy includes steroids, glycosaminoglycans and phytotherapy. Surgical options are generally not recommended for CP/CPPS. Despite the lack of curative therapies, effective symptom management can be achieved with knowledge of the classes of pharmacotherapy. Therapeutic decisions can be based on the symptoms of the patient. Pelvic floor physical therapy is a useful second-line therapy in the author's opinion, but randomized controlled trials and standardization of technique for CP/CPPS are needed before recommendations can be substantiated.     

Gynecological indications for the use of botulinum toxin in women with chronic pelvic pain

Chronic pelvic pain in women is a common symptom with a wide variety of etiologies that demand accurate diagnosis and appropriate treatment if pain reduction is to be effected. Superficial conditions such as provoked vestibulodynia and problems affecting deeper structures such as pelvic floor muscle spasm are difficult to treat and can have significant impacts on quality of life for the sufferer.Apart from daily pain, symptoms such as painful intercourse (dyspareunia), painful bowel motions (dyschesia) and exacerbation of period pain (dysmenorrhea) are commonly reported by patients. For inflammatory conditions, and in areas where muscle spasm is thought to contribute to pain, botulinum toxins (BoNT) are used with considerable success.For gynecological indications, there are limited data, in the form of case reports and small series, to indicate that BoNT used in the vulva may have a benefit for 3-6 months after injection of 20-40 U of BOTOX^®; for women with provoked vestibulodynia. Re-treatment is reported to be successful and side effects are limited. Controlled studies are essential to further explore this indication.For pelvic floor muscle spasm, a greater number of women have been studied and a double blind, randomized controlled study has reported a significant reduction in pelvic floor pressures with significant pain reduction for some types of pelvic pain compared to baseline. There were no differences in pain compared to the control group who had physical therapy as an intervention. Physical therapy could be used as a non-invasive first line treatment, with BoNT injections reserved for those who are refractory to treatment.In summary, BoNT treatment for a variety of gynecological indications seems successful with limited side effects, although there are minimal data, particularly in superficial vulval conditions. To allow recommendation for wider utilization of this treatment, it is essential that more research is performed to add further evidence to our current knowledge.     

腹腔镜手术治疗盆腔炎性包块50例临床分析

目的:探讨腹腔镜手术治疗盆腔炎性包块的可行性及价值.方法:收集2005年10月～2009年2月的50例腹腔镜手术治疗盆腔炎性包块的临床资料进行回顾性分析.结果:50例中49例在镜下完成,1例行开腹手术,术后1例复发;手术时间(78.51±42.84)min、失血量15(15-500)ml、住院时间(12.46±7.32)d.结论:腹腔镜手术治疗盆腔炎性包块安全、可靠、创伤小、恢复快、复发率低,具有较好的临床应用价值.