宫腔镜联合腹腔镜在慢性盆腔痛诊治中的临床应用

目的:探讨宫腔镜联合腹腔镜在慢性盆腔疼痛(CPP)诊治中的临床应用。方法:对80例CPP患者进行宫腔镜联合腹腔镜诊治术,术前均行B超检查,术后按时复诊。对CPP患者的妇科致病因素进行归类划分,分析其治疗情况和疗效。结果:宫、腹腔镜联合检查发现盆腔或/和宫腔内异常74例,占92.50%;B超检查异常53例,占66.25%;两种检查方法对比差异有统计学意义(P<0.005)。单纯盆腔内病变34例,占42.50%;宫腔内与盆腔内病变共存者25例,占31.25%;单纯宫腔内病变15例,占18.75%;未发现异常6例,占7.50%。盆腔内致病因素:子宫内膜异位性疾病(32.50%)、慢性盆腔炎(13.75%)、盆腔粘连(12.50%)、盆腔肿瘤(12.50%),盆腔静脉淤血综合征(2.50%)。宫内致病因素:子宫内膜息肉(23.75%)、黏膜下子宫肌瘤(7.50%)、子宫内膜增生症(6.25%)和宫腔粘连(5.00%)。子宫内膜异位性疾病、慢性盆腔炎、盆腔粘连、盆腔肿瘤及单纯宫内疾病的宫、腹腔镜治疗有效率分别为88.46%、90.91%、90.00%、90.00%和66.67%,共65例有效,总有效率为81.25%。结论:CPP患者以子宫内膜异位性疾病和子宫内膜息肉的发病率最高。宫腔镜能够明确CPP的宫内致病因素,宫腔镜联合腹腔镜是提高CPP诊断和治疗的有效方法。

Clinical application of hysteroscopy and laparoscopy in diagnosis and treatment of chronic pelvic pain

Objective: To explore the clinical application of hysteroscopy combined with laparoscopy in diagnosis and treatment of chronic pelvic pain ( CPP) . Methods: 80 patients with CPP were diagnosed and treated by laparoscopy and hysteroscopy,ultrasound exam- ination before operation and follow - up on time after operation were carried out,the gynecological pathogenic factors of patients with CPP were classified and divided,and the curative effect was analyzed. Results: 74 patients and 53 patients with pelvic or/and intrauterine abnor- malities were found by laparoscopy combined with hysteroscopy and ultrasound,respectively,accounting for 92. 50% and 66. 25% ,there was significant difference ( P < 0. 005) ; 34 patients were found with simple pelvic lesions,accounting for 42. 50% ; 25 patients were found with coexistence of intrauterine lesions and pelvic lesions,accounting for 31. 25% ; 15 patients were found with simple intrauterine lesions, accounting for 18. 75% ; 6 cases were normal,accounting for 7. 50% . Pelvic pathogenic factors: endometriosis ( 32. 50% ) ,chronic pelvic inflammatory disease ( 13. 75% ) ,pelvic adhesion ( 12. 50% ) ,pelvic tumors ( 12. 50% ) and pelvic congestion syndrome ( 2. 50% ) ; intra- uterine pathogenic factors: endometrial polyp ( 23. 75% ) ,submucosal hysteromyoma ( 7. 50% ) ,endometrial hyperplasia ( 6. 25% ) and in- trauterine adhesion ( 5. 00% ) ; After combined treatment of hysteroscopy and laparoscopy,the effect rates of endometriosis,chronic pelvic inflammatory disease,pelvic adhesion,pelvic tumors and simple intrauterine lesions were 88. 46% ,90. 91% ,90. 00% ,90. 00% and 66. 67% ,respectively,the total effect rate was 81. 25% ( 65 patients) . Conclusion: The incidences of endometriosis and endometrial pol- yp are the highest in patients with CPP. Hysteroscopy can provide intrauterine pathogenic factors for CPP clearly,hysteroscopy combined with laparoscopy is an effective method in diagnosis and treatment of CPP.