Nascu Patricia C, Vilos George A, Ettler Hellen C, Abu-Rafea Basim, Hollet-Caines Jackie, Ahmad Riad
Department of Obstetrics and Gynecology, St. Joseph's Health Care, The University of Western Ontario, London, Ontario, Canada.
J Minim Invasive Gynecol. 2006 May-Jun;13(3):201-4. doi: 10.1016/j.jmig.2006.02.002.
To determine the prevalence and type of microscopic findings on laparoscopically resected uterosacral ligaments in women with chronic pelvic pain and no visible pelvic disease. The effect of this procedure on the patients' level of pain also was assessed as a secondary objective.
Prospective follow-up (Canadian Task Force classification II-2).
University-affiliated hospital.
Twenty-seven premenopausal women undergoing diagnostic laparoscopy for chronic pelvic pain had a normal pelvis on visual inspection. All patients underwent resection and histologic evaluation of the uterosacral ligaments. Pain relief was evaluated by use of a questionnaire administered before and at 3, 6, and 12 months after surgery.
Microscopic examination identified endometriosis in 2 (7.4%), endosalpingiosis in 3 (11.1%), and inflammation in 14 (51.9%) patients. Laparoscopic uterosacral ligament resection was associated with a reduction in dysmenorrhea (p < or = .001), with 14 (52%) patients reporting improved or resolved symptoms. There was a statistically significant decrease in dyspareunia (p < or = .01) and in the severity of noncyclical pain (p < or = .002). Thirty-five percent of patients no longer required medication for pain control (p < or = .005). The number of days needed off work also decreased.
Despite normal laparoscopic appearance, microscopic endometriosis, endosalpingiosis, and inflammatory changes were found in uterosacral ligaments in 17 (63%) women with chronic pelvic pain. Laparoscopic resection of uterosacral ligaments improved dysmenorrhea, dyspareunia, and noncyclical pain and decreased the number of days lost from work, as well as the proportion of patients who required medication for pain control.
确定慢性盆腔疼痛且无明显盆腔疾病的女性患者经腹腔镜切除的子宫骶韧带的微观检查结果的患病率及类型。作为次要目的，还评估了该手术对患者疼痛程度的影响。
前瞻性随访（加拿大工作组分类II-2）。
大学附属医院。
27名因慢性盆腔疼痛接受诊断性腹腔镜检查的绝经前女性，其盆腔外观正常。所有患者均接受了子宫骶韧带的切除及组织学评估。通过术前及术后3个月、6个月和12个月发放的问卷评估疼痛缓解情况。
显微镜检查发现2例（7.4%）患者有子宫内膜异位症，3例（11.1%）有输卵管内膜异位症，14例（51.9%）有炎症。腹腔镜子宫骶韧带切除术与痛经减轻相关（p≤0.001），14例（52%）患者报告症状改善或消失。性交困难（p≤0.01）及非周期性疼痛严重程度（p≤0.002）有统计学显著下降。35%的患者不再需要药物控制疼痛（p≤0.005）。误工天数也减少了。
尽管腹腔镜检查外观正常，但17例（63%）慢性盆腔疼痛女性的子宫骶韧带中发现了微观子宫内膜异位症、输卵管内膜异位症及炎症改变。腹腔镜子宫骶韧带切除术改善了痛经、性交困难及非周期性疼痛，减少了误工天数以及需要药物控制疼痛的患者比例。
