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目的探讨慢性盆腔痛(chronic pelvic pain,CPP)的病因,以及腹腔镜在CPP诊断及治疗中的应用价值。方法对168例CPP患者行腹腔镜检查术,有病理改变者同时行腔镜手术。术前常规行妇科检查及盆腔B超检查,术前诊断为慢性盆腔炎者98例,子宫内膜异位70例。结果腹腔镜证实有病理改变者154例,占91.7%,其中32例有2种或2种以上病理改变。14例未发现病理改变,占8.3%。盆腔炎组术前诊断与腹腔镜诊断相符率为54.1%,异位症组术前诊断与腹腔镜诊断相符率为54.3%,两组术前诊断与腹腔镜诊断总相符率为54.2%,腹腔镜检查纠正诊断率45.8%。腹腔镜证实有病理改变者,同时在腹腔镜下行粘连松解、电凝内异症病灶、巧克力囊肿剥除、输卵管切除、阑尾切除等手术共105例。术后使用抗生素、激素、中药、理疗等治疗,治疗总有效率84.0%。结论子宫内膜异位症和慢性盆腔炎是CPP最常见的病因,腹腔镜能明确大部分CPP的病因并同时进行手术治疗,可作为诊治CPP的首选方法。
Objective To investigate the etiology of chronic pelvic pain (CPP) and the value of laparoscopy in the diagnosis and treatment of CPP. Methods 168 cases of CPP patients underwent laparoscopy, with pathological changes at the same time endoscopic surgery. Preoperative routine gynecological examination and pelvic ultrasound B, preoperative diagnosis of chronic pelvic inflammatory disease in 98 cases, 70 cases of endometriosis. Results There were 154 cases of pathological changes confirmed by laparoscopy, accounting for 91.7%, of which 32 cases had 2 or more pathological changes. 14 cases found no pathological changes, accounting for 8.3%. The coincidence rate of preoperative diagnosis and laparoscopic diagnosis was 54.1% in pelvic inflammatory disease group and 54.3% in preoperative diagnosis of laparoscopy and ectopic group, and 54.2% in preoperative diagnosis and laparoscopic diagnosis in both groups. The abdominal cavity Mirror examination to correct the diagnosis rate of 45.8%. Laparoscopic confirmed pathological changes, at the same time in laparoscopic adhesion release, coagulation endometriosis lesions, chocolate cyst stripping, tubal resection, appendectomy and other surgery a total of 105 cases. Postoperative use of antibiotics, hormones, Chinese medicine, physical therapy and other treatment, the total effective rate of 84.0%. Conclusions Endometriosis and chronic pelvic inflammatory disease are the most common causes of CPP. Laparoscopy can identify most of the causes of CPP and perform surgical treatment at the same time, which is the first choice for diagnosis and treatment of CPP.