骨盆疼痛：手术，子宫内膜异位和子宫内膜异位严重程度的症状和预测因素是什么？,medRxiv - Obstetrics and Gynecology

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骨盆疼痛：手术，子宫内膜异位和子宫内膜异位严重程度的症状和预测因素是什么？
medRxiv - Obstetrics and Gynecology Pub Date : 2021-02-01 , DOI: 10.1101/2021.01.29.21250806
Isabelle Conroy , Samantha S Mooney , Shane Kavanagh , Michael Duff , Ilona Jakab , Katharine Robertson , Amy L Fitzgerald , Alexandra Mccutchan , Siana Madden , Sarah Maxwell , Shweta Nair , Nimita Origanti , Alish Quinless , Kelly Mirowska-Allen , Megan Sewell , Sonia R Grover

背景：慢性盆腔疼痛（CPP）是一种常见病，严重影响了许多妇女的生活质量和健康。建议使用腹腔镜检查和组织病理学检查骨盆疼痛并同时切除子宫内膜异位症。但是，子宫内膜异位症与骨盆疼痛之间的关联仍然具有挑战性，只有30-50％的疼痛女性能识别出子宫内膜异位。目的：探讨一组接受CPP治疗的妇女的手术预测指标，以鉴定子宫内膜异位和子宫内膜异位的严重程度。材料和方法：本研究属于持续性盆腔疼痛项目的一部分，这是一项前瞻性观察性队列研究（ANZCTR：ACTRN12616000150448）。转到公共妇科诊所就诊的有疼痛的女性被随机分配到2个妇科部门进行常规护理，然后进行36个月的调查，进行为期6个月的调查，评估人口统计学，病史，生活质量以及用李克特量表测量的疼痛症状。回顾手术笔记，并进行子宫内膜异位症分期。结果：在征募的471名妇女中，有102名接受了腹腔镜或剖腹手术的妇女，其中52名患有子宫内膜异位症（n = 37 I-II期； n = 15 III-IV期）。妇科单位，骨盆疼痛强度和下等位都是手术的预测指标（几率（OR）0.342; 95％CI 0.209-0.561; OR 1.303; 95％CI：1.079-1.573; OR 0.767; 95％CI：0.620-0.949分别）。没有发现可用于子宫内膜异位症诊断的预测因素，而严重程度的唯一预测因素是年龄的增长（OR 1.155； 95％CI：1.047-1.310）。结论：疼痛强度和妇科单位是进行腹腔镜检查的关键指标，但是疼痛的严重程度不能预测子宫内膜异位症的诊断或分期。这些发现表明，有必要回顾当前指导骨盆痛手术实践的框架。

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Pelvic Pain: what are the symptoms and predictors for surgery, endometriosis and endometriosis severity?

Background: Chronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women. Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain. Aims: To explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP. Materials and Methods: This study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of 2 gynaecology units for routine care and followed for 36-months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Operative notes were reviewed, and endometriosis staged. Results: Of 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis (n=37 stage I-II; n=15 stage III-IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (Odds ratio (OR) 0.342; 95%CI 0.209-0.561; OR 1.303; 95%CI: 1.079-1.573; OR 0.767; 95%CI: 0.620-0.949 respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155; 95%CI: 1.047-1.310). Conclusions: Pain intensity and gynaecology unit were key predictors of undergoing laparoscopy, however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice towards surgery for pelvic pain.

更新日期：2021-02-01

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