手术相关女性慢性盆腔痛的病因及诊治分析  

Clinical Analysis of Causes and Treatment of Chronic Pelvic Pain in Post-surgical Female Patients

作　　者：侯征[1] 牛子儒 姚颖[1] 王莎 韩劲松[1] 郭红燕[1] 贺豪杰[1] Hou Zheng;Niu Ziru;Yao Ying(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191

出　　处：《中国微创外科杂志》2021年第1期31-35,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨女性术后慢性盆腔痛的病因、诊断流程及治疗方法。方法回顾性分析2019年7月~2020年6月我院诊治的60例术后慢性盆腔痛资料。根据病因进行个体化治疗,包括加巴喷丁、神经阻滞、抗生素、口服避孕药、手术、中成药等。疗效评价标准:(1)完全缓解,疼痛消失,视觉模拟评分(Visual Analogue Scale,VAS)降至0分;(2)部分缓解,疼痛减轻,VAS评分或疼痛频率降低≥50%;(3)无效,VAS评分及疼痛频率降低<50%。结果诊断神经病理性疼痛34例(56.7%),盆腔炎症性疾病11例(18.3%),子宫内膜异位症7例(11.7%),盆腔炎症性疾病合并神经病理性疼痛2例(3.3%),盆腔炎症性疾病合并子宫内膜异位症2例(3.3%),子宫内膜异位症合并神经病理性疼痛2例(3.3%),肠易激综合征1例(1.7%),原因不明1例(1.7%)。除5例因备孕未治疗外,55例治疗后随访1~9个月,平均2.6月。完全缓解18例,部分缓解34例,无效3例。有效率94.5%(52/55)。结论手术相关女性慢性盆腔痛可能的病因包括神经病理性疼痛、子宫内膜异位症、盆腔炎症性疾病,亦可能为消化系统或泌尿系统疾病,诊断过程中应仔细鉴别,针对病因进行个体化治疗。Objective To investigate the etiology,evaluation and treatment of chronic pelvic pain in post-surgical female patients.Methods Clinical data of 60 post-surgical female patients with chronic pelvic pain from our clinic were collected between July 2019 and June 2020.Treatment was individualized according to evaluation,including gabapentin administration,nerve block,antibiotics,oral contraceptives,surgery,traditional Chinese medicine.The criteria of efficacy was defined as the followings:(1)Complete response,pain disappeared,Visual Analogue Scale(VAS)score dropped to 0;(2)Partial response,pain relief,VAS score or pain frequency decreased≥50%;(3)No response,VAS score or pain frequency decreased<50%.Results There were 34 cases(56.7%)of neuropathic pain,11 cases(18.3%)of pelvic inflammatory disease,7 cases(11.7%)of endometriosis,2 cases(3.3%)of pelvic inflammatory disease with concurrent neuropathic pain,2 cases(3.3%)of pelvic inflammatory disease with concurrent endometriosis,2 cases(3.3%)of endometriosis with concurrent neuropathic pain,1 case(1.7%)of irritable bowel syndrome,and 1 case(1.7%)of unexplained chronic pelvic pain.Five cases were not treated due to pregnancy plan.Another 55 cases were followed up from 1 to 9 months after treatment,with an average of 2.6 months.We found complete response in 18 cases,partial response in 34 cases,and no response in 3 cases,with an effective rate of 94.5%(52/55).Conclusions Chronic pelvic pain in post-surgical women has complex etiology and may result from diseases such as neuropathic pain,endometriosis,pelvic inflammatory disease,digestive and urinary disease.Careful evaluation is key in guiding treatment.

关 键 词：慢性盆腔痛 术后慢性疼痛 阴部神经痛 神经阻滞 加巴喷丁 

分 类 号：R713[医药卫生—妇产科学]