Steele Lucy A, Mooney Samantha S, Gilbee Ebony S, Grover Sonia R
School of Medicine, Austin Hospital Clinical School, Victoria, Melbourne, Australia.
Department of Endosurgery, Mercy Hospital for Women, Victoria, Melbourne, Australia.
Aust N Z J Obstet Gynaecol. 2024 Apr;64(2):95-103. doi: 10.1111/ajo.13749. Epub 2023 Sep 22.
Persistent pelvic pain (PPP) is a complex and often debilitating condition. While widely accepted to be multifactorial in nature, the precise aetiology of PPP remains elusive. In many cases, women who undergo laparoscopy for PPP will have no visible pathology identified (a 'negative' laparoscopy). Currently, there are no consensus guidelines which outline the recommended management following a negative laparoscopy, and the woman's experiences and outcomes are not widely known.
This review aims to identify and summarise the literature surrounding the experiences of women with PPP who have a negative laparoscopy; specifically, their outcomes of pain, quality of life (QoL), satisfaction with care, and their overall management.
A systematic search of the electronic databases Ovid Medline, PubMed and Embase was performed. Studies in English exploring the outcomes of women with PPP following a negative laparoscopy were included.
Four studies consisting of a total of 200 women were included. Results were inconsistent. Three studies concluded that the majority of women with PPP had persistent pain following a negative laparoscopy. A single study found that pain significantly improved after negative laparoscopy. QoL outcomes varied, with two studies reporting a positive impact and two studies reporting a deleterious impact on QoL following a negative laparoscopy.
The impact on pain outcomes and QoL following a laparoscopy that does not diagnose pathology remains unknown, and the available evidence is insufficient to guide evidence-based practice. This review highlights a significant gap in our understanding of surgical management for PPP.
持续性盆腔疼痛（PPP）是一种复杂且常使人衰弱的病症。虽然普遍认为其本质上是多因素的，但PPP的确切病因仍不明确。在许多情况下，因PPP接受腹腔镜检查的女性未发现可见病变（“阴性”腹腔镜检查）。目前，尚无共识指南概述阴性腹腔镜检查后的推荐管理方法，且女性的经历和结果也未广为人知。
本综述旨在识别并总结围绕PPP且腹腔镜检查结果为阴性的女性经历的文献；具体而言，是她们的疼痛结果、生活质量（QoL）、对护理的满意度及其总体管理情况。
对电子数据库Ovid Medline、PubMed和Embase进行了系统检索。纳入了用英文探讨PPP女性阴性腹腔镜检查后结果的研究。
纳入了四项研究，共200名女性。结果不一致。三项研究得出结论，大多数PPP女性在阴性腹腔镜检查后仍有持续性疼痛。一项研究发现阴性腹腔镜检查后疼痛明显改善。生活质量结果各不相同，两项研究报告有积极影响，两项研究报告阴性腹腔镜检查后对生活质量有有害影响。
未诊断出病变的腹腔镜检查对疼痛结果和生活质量的影响尚不清楚，现有证据不足以指导循证实践。本综述凸显了我们对PPP手术管理理解上的重大差距。
