盆腔淤血综合征诊治现状

盆腔淤血综合征（PCS）是指盆腔静脉曲张、淤血引起的,以慢性盆腔疼痛（CPP）为主要症状的临床综合征。由于对该病认识上的限制和诊断上的困难,临床上PCS 常被漏诊或误诊。一般治疗及药物治疗可暂时缓解症状,然而容易出现症状反复。目前介入治疗已经成为PCS首选的治疗方法。     

盆腔静脉淤血综合征的病因与影像学诊断

盆腔静脉淤血综合征是由于盆腔静脉曲张、血液回流障碍而引发的一系列下腹部不适症候群,是临床医生容易忽视和误诊的一类疾病。本文就近年来国内外的研究结果进行综述,其重点是探讨其病因和诊断方法,特别是彩色多普勒超声诊断该病的可行性。     

前列安栓治疗慢性盆腔疼痛综合征疗效观察

目的:观察前列安栓治疗慢性盆腔疼痛综合征(CPPS)的疗效.方法:对180例EPS常规检查及细菌培养(Meares-stamey四杯法),后按NIH分类标准(1995年)确诊为CPPS.并随机分成治疗组90例应用前列安栓,对照组90例应用野菊花栓,单盲对照观察疗效.结果:治疗组痊愈12例( 13.3%),显效36例( 40.0%),有效30例( 33.4%),总显效率 53.3%,总有效率 86.7%,明显优于对照组( 63.3%),由于采用改进后的水溶性栓剂,治疗组仅有10例轻度肛门不适及排便感,2例出现腹泻,3例有轻度腹痛,均可耐受.结论:前列安栓治疗CPPS安全,疗效满意.     

慢性前列腺炎/慢性盆腔疼痛综合征治疗进展

慢性前列腺炎/慢性盆腔疼痛综合征(Chronic Pro-statitis/Chronic Pelvic Pain Syndrome,CP/CPPS)即美国国立卫生研究院(National Institutes of Health,NIH)分类系统中的Ⅲ型前列腺炎,是泌尿男科门诊最常见的疾病之一,该病在世界范围内发病率...     

慢性盆腔淤积综合征的腔内栓塞治疗

目的 探讨腔内栓塞治疗盆腔淤积综合征(PCS)的疗效及经验.方法 对21例PCS患者行血管腔内栓塞治疗,采用视觉模拟评分法(VAS)评估患者术前及术后3个月PCS症状的改善程度.结果 所有患者的技术成功率、临床成功率均为100%,未出现弹簧圈移位、肺动脉栓塞等并发症.患者术后疼痛症状均有明显缓解,术前、术后VAS分别为8.3±0.8、4.1±0.9(t=20.684,P <0.001).结论 血管腔内栓塞治疗PCS安全、有效、微创,但远期疗效仍需随访.     

慢性前列腺炎/慢性盆腔疼痛综合征的物理治疗进展

慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)作为男性常见的泌尿生殖系统疾病,近年来在物理治疗领域取得了显著的进展。物理治疗以其非侵入性、副作用小、有效性明确、患者依从性高等特点,逐渐成为CP/CPPS治疗的重要手段之一。在慢性前列腺炎的物理治疗中,常用的方法主要包括前列腺按摩、生物反馈治疗、磁疗、超声波及冲击波治疗、热疗、针灸治疗以及电生理治疗等。这些方法通过不同的物理效应而最终达到缓解患者的疼痛和其他不适症状的目的。本文将对这些CP/CPPS的物理治疗方法的最新研究进展进行归纳总结,浅析其作用机制及各自优缺点,以供临床治疗时参考,同时也为研究人员提供新的理念与思路。     

男性慢性盆腔疼痛综合征

慢性疼痛是临床上很常见的症状，许多患者因此而就诊，它严重地影响患者的生活质量。身体上各个部位都可能出现这种症状，因而几乎涉及临床各专科。引起慢性疼痛的原因和机理大多数并不清楚，故治疗上主要是减轻疼痛为主，但效果不但令患者，也使医生感到失望。就泌尿外     

前列通瘀胶囊治疗慢性盆腔疼痛综合征临床研究

慢性前列腺炎是影响成年男性生活质量的常见病,估计全球男人的发病率为9%～14%[1].据美国国家卫生研究院(NIH)分类标准(1995年),慢性前列腺炎分为慢性细菌性前列腺炎(Ⅱ类)、慢性非细菌性前列腺炎/慢性盆腔疼痛综合征(chronic pelvic pain syndrome,CPPS)(Ⅲ类)以及无症状炎症性前列腺炎(Ⅳ类)三类[2].其中CPPS即慢性非细菌性前列腺炎(CNP)又分为炎症性(Ⅲa)(指EPS中WBC＞10/HP)和非炎症性(Ⅲb)(指EPS中WBC≤10/HP)二种.CPPS在慢性前列腺炎中占多数.由于本病病理机制仍不明确,目前尚无满意的治疗方法.自1999年11月至2002年3月,我们采用前列通瘀胶囊治疗CPPS 156例,分炎症性和非炎症性二组进行观察,现报告如下.     

慢性盆腔疼痛综合征的诊断及综合治疗：附103例报告

目的 探讨慢性盆腔疼痛综合征（ＣＰＰＳ）的有效诊治方法。方法 对１９９６年５月～１９９８年６月仍随访的ＣＰＰＳ患者１０３例进行诊治分析,７６例接受“四杯试验”（ＶＢ１、ＶＢ２、ＶＢ３及ＥＰＳ）,２７例接受按摩前尿液及按摩后尿液培养,均阴性,其中６９例ＥＰＳ、ＶＢ３或按摩后尿液显微镜下检查白细胞１～１７个／ＨＰ;治疗上选用５－氟喹诺酮、α－受体阻滞剂、非甾体抗炎药、别嘌呤醇等。结果 全部患者获得６个     

综合治疗慢性前列腺炎/慢性盆腔疼痛综合征的远期疗效

慢性前列腺炎是一种与多种因素有关、流行较广的疾病,许多人尽管经过常规治疗多年,但是疗效不佳。作者对53名长期慢性前列腺炎患者进行分步综合治疗,并且应用美国国立卫生研究院慢性前列腺炎症状指数积分进行随访,至少6月。治疗方法包括抗生素、前列腺按摩、抗炎植物药、α受体阻     

Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome

AimTo assess the efficacy of venous embolization treatment for the pelvic congestion syndrome (PCS).Patients and methodsRetrospective study of 33 female patients undergoing pelvic venous embolization between January 2008 and May 2012 in Bordeaux. The inclusion criteria were clinical symptoms of PCS documented by transabdominal Doppler ultrasound and/or pelvic magnetic resonance imaging. Patients with pelvic varicose veins feeding saphenous varicose veins were excluded. The efficacy of treatment was assessed on a Visual Analog Scale (VAS).ResultsThirty-three patients were included and the mean follow up period was 26 months (3–59 months). The VAS was 7.37 (standard deviation: 0.99) before embolization and 1.36 (standard deviation: 1.73) after embolization (P < 0.0001). Twenty patients reported that their symptoms had completely disappeared, 11 had partially disappeared and two had gained no improvement. A significant fall was found in the number of patients with dyspareunia (P < 0.0001). A single technical embolization failure was reported.ConclusionOur series demonstrates the efficacy of embolization treatment with a significant fall in the VAS in patients with PCS.     

Effects of acupuncture for chronic pelvic pain syndrome with intrapelvic venous congestion: Preliminary results

BACKGROUND: The present study was designed to reveal the usefulness of acupuncture for chronic pelvic pain syndrome with intrapelvic venous congestion as evaluated by symptom scores, transrectal ultrasonography (TRUS) and magnetic resonance (MR) venography. METHODS: Ten male patients suffering from non-inflammatory chronic pelvic pain syndrome (NIH category IIIB) with intrapelvic venous congestion were treated using acupuncture. Eight patients had previously received pharmacotherapy, which was unsuccessful. Acupuncture was performed using disposable stainless steel needles, which were inserted into the bilateral BL-33 points and rotated manually for 10 min. The treatment was repeated every week for 5 weeks without other therapeutic maneuvers. Results from TRUS and MR venography, as well as clinical symptoms based on the NIH chronic prostatitis symptom index (NIH-CPSI) and the international prostate symptom score (IPSS), were compared before and after the treatment. RESULTS: No side-effects were recognized throughout the treatment period. The average pain and QOL scores of the NIH-CPSI 1 week after the 5th acupuncture treatment decreased significantly (P < 0.05 and P < 0.01, respectively) compared with the baseline. The maximum width of the sonolucent zone 1 week after the 5th treatment also decreased significantly (P < 0.01, compared with the baseline). Intrapelvic venous congestion demonstrated by MR venography was significantly improved in four patients. CONCLUSION: This study provided novel information concerning the therapeutic effects of acupuncture on non-inflammatory chronic pelvic pain syndrome.     

Chronic pelvic pain: An imaging approach

Chronic pelvic pain is defined as disabling pain of at least six months duration. Chronic pelvic pain has often multiple causative factors. Careful analysis of clinical history and detailed clinical examination must be carried out to guide further imaging investigations. Endometriosis is a common cause of chronic pelvic pain, although there is no correlation between the severity of lesions and pain intensity. Pelvic ultrasonography should be the first line imaging examination to search for causative conditions that include endometriosis, adenomyosis, pelvic varices and chronic infection. Magnetic resonance imaging (MRI) is useful for making the positive diagnosis and assessing the spread of endometriosis. MRI is more accurate than ultrasonography for the diagnosis of tubo-ovarian abscess when an adnexal mass is identified. Duplex and color Doppler ultrasonography as well as MR angiography are the best imaging technique for the diagnosis of pelvic congestion syndrome. In patients with pudendal neuralgia, cross-sectional imaging help exclude nerve compression.     

卵巢静脉综合征4例报告

报告４例右卵巢静脉综合征，临床表现为以前期，经期，妊娠期和分娩后反复作右腰痛，或伴有同侧下腹部疼痛和尿路感染，也可出现无痛性全程肉眼血尿，均经静脉尿路造影，逆行输尿管造影确诊，行肾固定术及卵巢静脉切除术，术后恢复良好，认为外科治疗应包括切除右卵巢静脉，纤维组织鞘，输尿管狭窄段，恢复输尿管通畅，有肾下垂直可同时作肾固定术，控制尿路感染。     

Laparoscopic treatment of ovarian vein syndrome.

BACKGROUND: Ovarian vein syndrome is a rare cause of teral obstruction. In this report, we describe an unusual presentation of the syndrome successfully treated with laparoscopic techniques. METHODS: The patient presented with a 12-month history of right flank pain and a right abdominal mass. The preoperative evaluation revealed renal malrotation, hydronephrosis, decreased renal function, and presumed ureteropelvic junction obstruction. RESULTS: By using a transperitoneal laparoscopic approach, an enlarged ovarian vein was identified as the cause of the ureteral obstruction. The ovarian vein was divided with a laparoscopic stapler. The patient's postoperative course was unremarkable, and she was discharged from the hospital on the second postoperative day. At 3-months follow-up, the patient was completely asymptomatic without evidence of obstruction. DISCUSSION: Ovarian vein syndrome remains a rare diagnosis of exclusion. A careful preoperative evaluation is required to exclude other causes of ureteral obstruction. By using a laparoscopic approach, the ureter and obstructing vessel were readily identified to effectively treat the patient. With the minimally invasive approach, postoperative recovery and patient quality of life were improved.     

Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome

Objectives Psychosocial factors reported by patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) promote greater pain, disability, and ultimately poorer quality of life (QOL). We targeted those parameters in the development of a cognitive-behavioral (CB) program designed specifically for CP/CPPS. Methods and materials Five NIH sponsored biopsychosocial studies examined predictors of pain, disability, and QOL in CP/CPPS men. Pain, urinary symptoms, QOL, depressive symptoms, catastrophic thinking about pain, perceived control over pain, pain-contingent resting as a pain coping measure, social support and interaction, sexual functioning, and relationship issues were assessed. These data showed that CB intervention for pain catastrophizing, pain contingent rest, social support and depressive symptoms is warranted for men with CP/CPPS Results An evidence based 8-week CB program was developed. The content of the CB sessions are defined in an instructional patient workbook for each of the weekly 1-h sessions. The CB program guides patients in examining the relationship between their symptom-based distress, their thinking at such times and the emotions linked with those thoughts, and their behavioral responses to their particular thinking style (e.g., illness vs. wellness focused). Patients complete such analyses by using a Reaction Record format, which also delineates new thinking/behavioral responses. Conclusions The CB program developed for CP/CPPS is the first comprehensive attempt to target specific evidence supported biopsychosocial variables for both symptom and QOL improvement in CP/CPPS and is expected to provide a useful tool for the clinical management of this chronic condition.