Huchon C, Aubry G, Ploteau S, Fauconnier A
Service de gynécologie & obstétrique, CHI Poissy-St-Germain-en-Laye, Université Versailles-Saint-Quentin en Yvelines, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France.
Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France.
Gynecol Obstet Fertil Senol. 2018 Mar;46(3):168-176. doi: 10.1016/j.gofs.2018.02.022. Epub 2018 Mar 9.
In case of consultation for chronic pelvic pain or suspicion of endometriosis, it is recommended to evaluate the pain (intensity, resonance) and to search out the evocative and localizing symptoms of endometriosis (Grade B). The main symptoms suggestive of endometriosis are: severe dysmenorrhea (NP2), deep dyspareunia (NP2), painful defecation during menstruation (NP2), urinary tract symptoms during menstruation (NP2) and infertility (NP2). In patients with chronic pelvic pain, it is recommended to search deep infiltrating endometriosis in patients with painful defecation during menstruation or severe deep dyspareunia (Grade B). It is recommended to search symptoms suggestive of sensitization in painful patients with endometriosis (Grade B). When suggestive symptoms of endometriosis are present, a directed gynecological examination is recommended, where possible, including examination of the posterior vaginal cul-de-sac (Grade C). In assessing pain intensity or evaluating analgesic effectiveness of a treatment, it is recommended to use a scale to measure the intensity of pain (Grade A). In the management of symptomatic endometriosis, it is recommended to evaluate the quality of life (Grade C).
对于慢性盆腔疼痛进行会诊或怀疑患有子宫内膜异位症时,建议评估疼痛情况(强度、共鸣)并找出子宫内膜异位症的诱发和定位症状(B级)。提示子宫内膜异位症的主要症状有:严重痛经(NP2)、深部性交困难(NP2)、月经期排便疼痛(NP2)、月经期泌尿系统症状(NP2)以及不孕(NP2)。对于慢性盆腔疼痛患者,建议对月经期排便疼痛或严重深部性交困难的患者检查深部浸润性子宫内膜异位症(B级)。建议对患有子宫内膜异位症的疼痛患者检查是否存在敏感化症状(B级)。当出现子宫内膜异位症的提示症状时,建议尽可能进行针对性的妇科检查,包括阴道后穹窿检查(C级)。在评估疼痛强度或评估治疗的镇痛效果时,建议使用疼痛强度测量量表(A级)。在有症状的子宫内膜异位症管理中,建议评估生活质量(C级)。