Milingos Spyros, Protopapas Athanasios, Kallipolitis George, Drakakis Petros, Loutradis Dimitrios, Liapi Anthoula, Antsaklis Aris
First Department of Obstetrics and Gynecology, University of Athens, Alexandra Maternity Hospital, Athens, Greece.
Gynecol Obstet Invest. 2006;62(1):48-54. doi: 10.1159/000092023. Epub 2006 Mar 15.
BACKGROUND/AIMS: Endometriosis is considered an important cause of chronic pelvic pain. Despite its high prevalence, controversy still exists regarding the true association between the extent of endometriosis and the severity of symptoms. We conducted this prospective study to investigate the association between the stage of endometriosis and type and severity of pain, and to evaluate the efficacy of laparoscopic surgery in pain relief.
Ninety-five patients complaining of chronic pain were diagnosed with endometriosis and were treated with laparoscopic surgery. The severity of pain was assessed in patients with an endometriosis AFS (American Fertility Society) score less than 16 (group 1) and those with an AFS score greater than or equal to 16 (group 2), preoperatively and 6 months after surgery, using a visual pain scale. Any reduction in pain scores by 2 points or more was considered to be an improvement.
Dysmenorrhea and deep dyspareunia, were significantly more frequent in patients of group 2. Preoperative pain scores were significantly higher for dysmenorrhea (p = 0.0022) and deep dyspareunia (p < 0.0001) but not for non-menstrual pain in group 2. Deep dyspareunia was correlated with the presence of dense pelvic adhesions. After surgery, dysmenorrhea improved in 43% of cases in group 1, vs. 66% of cases in group 2 (p = 0.0037). For deep dyspareunia, improvement was reported by 33% in group 1, vs. 67% in group 2 (p = 0.074). Improvement in non-menstrual pain was not significantly different between the two groups (67% vs. 56%).
Advanced endometriosis is more frequently related to dysmenorrhea and deep dypareunia in comparison to early disease. Laparoscopic surgery may offer relief or improvement in the majority of patients with endometriosis and chronic pelvic pain. Cases with advanced disease seem to benefit the most.
背景/目的：子宫内膜异位症被认为是慢性盆腔疼痛的重要原因。尽管其发病率很高，但关于子宫内膜异位症的程度与症状严重程度之间的真正关联仍存在争议。我们进行了这项前瞻性研究，以调查子宫内膜异位症的分期与疼痛类型及严重程度之间的关联，并评估腹腔镜手术在缓解疼痛方面的疗效。
95例主诉慢性疼痛的患者被诊断为子宫内膜异位症，并接受了腹腔镜手术治疗。使用视觉疼痛量表对子宫内膜异位症美国生育协会（AFS）评分低于16分的患者（第1组）和AFS评分大于或等于16分的患者（第2组）在术前和术后6个月的疼痛严重程度进行评估。疼痛评分降低2分或更多被认为是有改善。
第2组患者的痛经和深部性交痛明显更常见。第2组中，术前痛经（p = 0.0022）和深部性交痛（p < 0.0001）的疼痛评分显著更高，但非经期疼痛的评分无显著差异。深部性交痛与致密盆腔粘连的存在相关。术后，第1组43%的病例痛经有所改善，而第2组为66%（p = 0.0037）。对于深部性交痛，第1组报告有改善的为33%，第2组为67%（p = 0.074）。两组非经期疼痛的改善情况无显著差异（67%对56%）。
与早期疾病相比，晚期子宫内膜异位症更常与痛经和深部性交痛相关。腹腔镜手术可能使大多数子宫内膜异位症和慢性盆腔疼痛患者的疼痛得到缓解或改善。晚期疾病患者似乎受益最大。
