汤春生副主任医师:根据病人病史查体及辅助检查,子宫内膜异位症诊断基本明确。但病人腹痛严重,有些情况用子宫内膜异位症不太好解释。如①腹痛时间在月经后加重,疼痛特点为持续性阵发加剧。②疼痛部位偏高,在脐耻之间正中部位。③疼痛时检查体征与自觉症状不符合。痛时面色黄、出冷汗、痛苦貌,需有人按摩腰背部。但血压脉搏无改变,腹部软,无压痛反跳痛。④灌肠及膀胱充盈时疼痛加重,表示有牵扯性疼痛,考虑内膜异位症所致肠粘连存在,但无梗阻症象。⑤疼痛严重时强镇痛剂亦不能奏效。入院后已完善各项检查,内科、普外、泌尿外科已排除胃肠道疾病、腹膜后肿瘤以及泌尿系统结石。神经外科也排除了脊神经病变及腰骶椎病变。住院已20天,用抗生素、丹那唑400mg 每日二次,观察腹痛无减轻。病人很痛苦,一般情况渐弱,进食差,需输液支持治疗,不宜拖延。目前以妇科情况为主,有手术探查指征。拟行子宫及附件切除,术中注意探查,必要时行“骶前神经切除”,有助于消除盆腔疼痛。 Tang Chunsheng Deputy Chief Physician: According to the patient’s medical history and auxiliary examination, the basic diagnosis of endometriosis clear. However, patients with severe abdominal pain, in some cases with endometriosis is not good to explain. Such as ① abdominal pain after menstruation increased, the pain characterized by persistent paroxysmal aggravate. ② high parts of the pain, midway between the umbilical shame. ③ pain when checking signs and symptoms do not meet. Pain when the face yellow, a cold sweat, painful appearance, someone needs someone to massage the waist and back. But no changes in blood pressure pulse, abdominal soft, no tenderness rebound pain. ④ enema and bladder filling pain worse, indicating that the pain involved, consider the presence of intestinal adhesion caused by endometriosis, but no obstruction symptoms. ⑤ strong pain when strong analgesic does not work. Admission has been improved after the inspection, internal medicine, general surgery, urology has ruled out gastrointestinal diseases, retroperitoneal tumors and urinary tract stones. Neurosurgery also ruled out spinal neuropathy and lumbosacral lesions. Hospitalized for 20 days, with antibiotics, Danazol 400mg twice daily, no reduction in abdominal pain. The patient is very painful, the general situation faded, poor eating, infusion supportive treatment, should not be delayed. Currently the main gynecological conditions, surgical exploration indications. The proposed uterus and attachment resection, intraoperative attention exploration, if necessary, “presacral nerve resection,” helps to eliminate pelvic pain.