Johnson N P, Farquhar C M, Crossley S, Yu Y, Van Peperstraten A M, Sprecher M, Suckling J
Department of Obstetrics and Gynaecology, National Women's Hospital, University of Auckland, Auckland, New Zealand.
BJOG. 2004 Sep;111(9):950-9. doi: 10.1111/j.1471-0528.2004.00233.x.
To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis.
A prospective double-blind randomised controlled trial (RCT).
Single-centre, secondary-level gynaecology outpatient service and tertiary-level pelvic pain and endometriosis outpatient service in Auckland, New Zealand.
One hundred and twenty-three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis.
Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months.
Changes in non-menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured.
There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline -4.8 versus-0.8 (P= 0.039), 42.1%versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P= 0.045). There was no significant difference in non-menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes.
LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.
确定腹腔镜子宫神经切除术（LUNA）对子宫内膜异位症女性及无腹腔镜检查证据显示存在子宫内膜异位症的慢性盆腔疼痛女性的疗效。
一项前瞻性双盲随机对照试验（RCT）。
新西兰奥克兰的单中心二级妇科门诊及三级盆腔疼痛和子宫内膜异位症门诊。
123名因慢性盆腔疼痛接受腹腔镜检查以进行诊断和治疗的女性，其中56名无腹腔镜检查证据显示存在子宫内膜异位症，67名有子宫内膜异位症。
将两组女性随机分组，首先是无子宫内膜异位症证据的女性，其次是接受腹腔镜手术治疗子宫内膜异位症的女性，分别接受LUNA或不接受LUNA。采用参与者和评估者双盲法。在术后24小时、3个月和12个月对疼痛结果进行随访。
非经期盆腔疼痛、痛经、深部性交痛和排便困难的变化，主要通过这些类型疼痛的视觉模拟评分（VAS）较基线水平降低50%或更多来评估，此外还通过中位数VAS的变化是否存在显著差异来评估。还统计了因盆腔疼痛和并发症需要进一步手术或开始新的药物治疗患者的数量。
在无子宫内膜异位症的慢性盆腔疼痛女性中，接受LUNA治疗的患者在12个月随访时痛经明显减轻（视觉模拟量表（VAS）较基线的中位数变化为-4.8 vs -0.8（P = 0.039），42.1% vs 14.3%的患者痛经成功缓解，定义为痛经的视觉模拟疼痛量表降低50%或更多（P = 0.045）。在无子宫内膜异位症的女性中，接受LUNA治疗与未接受LUNA治疗的患者在非经期盆腔疼痛、深部性交痛或排便困难方面无显著差异。在腹腔镜手术治疗子宫内膜异位症的基础上加用LUNA，在任何疼痛结局方面均无显著差异。
LUNA对无子宫内膜异位症的痛经有效，尽管没有证据表明LUNA对非痛经性慢性盆腔疼痛或与子宫内膜异位症相关的任何类型慢性盆腔疼痛有效。
