Labat J-J, Robert R, Delavierre D, Sibert L, Rigaud J
Centre fédératif de pelvipérinéologie, clinique urologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France.
Prog Urol. 2010 Nov;20(12):973-81. doi: 10.1016/j.purol.2010.08.062. Epub 2010 Oct 13.
To determine the characteristics of neuropathic pain and the somatic nerve lesions most frequently encountered in the context of chronic pelvic and perineal pain.
Review of the literature devoted to pelvic and perineal neuralgia.
The diagnosis of pelvic and perineal pain related to a somatic nerve lesion is essentially clinical. The topography of the pain and its characteristics (burning, paraesthesia, etc.) can help to link the pain to the neurological territory involved. Complementary investigations are poorly contributive. Two main systems are involved in this region: sacral nerve roots that give rise to the pudendal nerve and the posterior cutaneous nerve of the thigh, thoracolumbar nerve roots that give rise to the ilioinguinal, iliohypogastric, genitofemoral and obturator nerves. The first system is essentially perineal and the second is essentially anterior inguinoperineal.
Pudendal neuralgia is the most common and most disabling form of pelvic pain. It presents as unilateral or bilateral burning pain of the anterior or posterior perineum that is worse on sitting and relieved by standing, not usually associated with night pain. It is related to a ligamentous nerve compression mechanism. Inferior cluneal neuralgia tends to be experienced as ischial and lateroperineal pain, and is sometimes accompanied by pain in a truncated sciatic territory, corresponding to projections of the posterior cutaneous nerve of the thigh. This neuralgia can be related to a piriformis syndrome or an ischial lesion. Sacral nerve root lesions do not cause acute pain, but are accompanied by sacral sensory loss and urinary, anorectal or sexual disorders. Pain related to ilioinguinal, iliohypogastric and genitofemoral nerves is generally secondary to surgical trauma and scars. Although these various lesions are sometimes difficult to distinguish from each other, an essential part of management consists of performing a local anesthetic block at the trigger point detected in the scar. Referred pain derived from the spinal cord due to thoracolumbar painful minor intervertebral dysfunction is experienced in the inguinal region, pubis, labium majorum and sometimes the trochanter, and only a complete clinical examination of the thoracolumbar region can demonstrate local signs (posterior facet joint pain at several levels, fibromyalgia).
确定慢性盆腔和会阴疼痛情况下神经性疼痛的特征以及最常遇到的躯体神经病变。
回顾有关盆腔和会阴神经痛的文献。
与躯体神经病变相关的盆腔和会阴疼痛的诊断主要依靠临床。疼痛的部位及其特征（灼痛、感觉异常等）有助于将疼痛与受累的神经区域联系起来。辅助检查的作用不大。该区域主要涉及两个系统：发出阴部神经和股后皮神经的骶神经根，以及发出髂腹股沟神经、髂腹下神经、生殖股神经和闭孔神经的胸腰神经根。第一个系统主要涉及会阴，第二个系统主要涉及腹股沟前会阴。
阴部神经痛是盆腔疼痛最常见且最致残的形式。表现为会阴前部或后部单侧或双侧灼痛，坐时加重，站立时缓解，通常不伴有夜间疼痛。它与韧带性神经压迫机制有关。臀下神经痛往往表现为坐骨和会阴外侧疼痛，有时伴有大腿后皮神经投射区域的坐骨神经截断区域疼痛。这种神经痛可能与梨状肌综合征或坐骨病变有关。骶神经根病变不会引起急性疼痛，但会伴有骶部感觉丧失以及泌尿、肛肠或性功能障碍。与髂腹股沟神经、髂腹下神经和生殖股神经相关的疼痛通常继发于手术创伤和瘢痕。尽管这些不同的病变有时难以相互区分，但治疗的一个重要部分是在瘢痕中检测到的触发点进行局部麻醉阻滞。由于胸腰段轻微椎间功能障碍引起的脊髓牵涉痛出现在腹股沟区、耻骨、大阴唇，有时也出现在转子区，只有对胸腰段进行全面的临床检查才能发现局部体征（多个节段的后关节突关节疼痛、纤维肌痛）。
