Ehler E, Kost'ál M
Neurologická klinika PKN, FZS Univerzita Pardubice.
Ceska Gynekol. 2010 Oct;75(5):423-8.
Peripheral nerves in obstetrics and gynecology are damaged with moderate frequency. Mostly there are iatrogenic lesions, that most often develop during delivery, operations and also in course of smaller invasive procedures. In genitofemoral nerve lesions neuralgic pain in groin and vulva is the most striking symptom, in cutaneous femoris lateralis nerve damage there are unpleasant paresthesias of lateral thigh. In case of femoral or obturator nerve lesion a weakness of thigh muscles with difficulties of standing and walking is the most typical. In pudendal nerve damage the autonomic disturbances (incontinence of feaces and urine) and pain in perineum are in the foreground of the patient's complains. After a knowledgeable history taking and detailed clinical examination the next step of diagnostics are neurophysiological investigations (neurography and needle electomyography). In special cases there is racional to use imaging methods (ultrasonography, MRI, CT). In majority of these iatrogennic nerve lesions the conservative approach is successful (rehabilitation, medicaments against neuropathic pain) and only in a small proportion of patients the neurosurgeon consultation is necessary.
妇产科中的周围神经损伤发生率适中。大多是医源性损伤，最常发生在分娩、手术以及一些较小的侵入性操作过程中。在生殖股神经损伤时，腹股沟和外阴的神经痛是最突出的症状；在股外侧皮神经损伤时，大腿外侧会出现令人不适的感觉异常。在股神经或闭孔神经损伤的情况下，大腿肌肉无力以及站立和行走困难是最典型的症状。在阴部神经损伤时，自主神经功能障碍（大小便失禁）和会阴部疼痛是患者主诉的主要问题。在进行详细的病史采集和全面的临床检查后，下一步诊断是进行神经生理学检查（神经电图和针极肌电图）。在特殊情况下，使用影像学方法（超声、磁共振成像、计算机断层扫描）是合理的。在大多数这些医源性神经损伤中，保守治疗方法是成功的（康复治疗、使用治疗神经性疼痛的药物），只有一小部分患者需要神经外科医生会诊。
