骨盆腔疼痛课件.pptVIP

骨盆腔疼痛 急性骨盆腔疼痛 慢性骨盆腔疼痛 診斷 急性骨盆腔疼痛-常見原因 早期懷孕併發症,像ectopic pregnancy miscarriage PID Appendicitis Ovarian cyst ”accident” or Mittelschmerz 急性骨盆腔疼痛-其它原因 OHSS Hematomatra or hematocolpos Necrosis of uterine fibroid 其他非婦產科的原因,像腸道或泌尿道疾病 Ovarian cyst accident Dermoid cysts,teratomas,or simple cysts are more common cause of torsion Result of torsion(leading to occlusion of blood supply and necrosis) Presenting symptom of ovarian neoplasm,more common associated with functional ovarian cysts in younger Acute chemical peritonitis if they contain irritant material(as endometriotic or dermoid cysts) Ovarian cyst accident Pain pattern of torsion: -sudden onset of coliky pelvic pain -located to one or other of iliac fossa -more constant after several hours or disappear -initially apyrexial,later on necrosis can cause pyrexia Mittelschmerz From german mittel=middle and schmerz=pain Middle cycle pain occuring at the time of ovulation More common ly in teenagers and older women 慢性骨盆腔疼痛-定義 疼痛的時候超過六個月 慢性骨盆腔疼痛是影響生殖年齡女性最常見的婦科問題 常見原因 Endometriosis Chronic pelvic inflammatory disease Pelvic adhesion Bowel related pain Urological causes Musculoskeletal pain Neuropathic pain Psychological factors 骨盆腔沾粘 引起疼痛的原因還不清楚 In uncontrolled studies,adhesionlysis relief pain In a randomized controlled trial,adhesionlysis 只徵對嚴重緻密血管豐富牽連到腸子的沾粘有幫助,對一般的簡單骨盆腔沾粘沒用 Ovarian remnant syndrome-卵巢周圍有緻密的纖維沾黏所引起的疼痛,藉由抑制或移除卵巢可緩解疼痛 骨盆腔充血 Pelvic vein dilatation?cyclical dragging pelvic pain Occure in premenstrual phase of cycle and worsen in standing or walking 發生的位置與強度變異性大,和深度的性交疼痛有關 Dilated vein 有時可由laparoscopy or ultrasound看到 骨盆腔充血-治療 MPA(medroxyprogesterone acetate) 30-50 mg daily for 3 months-side effect:weight gain,amenorrhea,bloating GnRH analogue-inhibit ovarian function Severe cases-TAH +BSO?curative 腸道有關的疼痛 Irritable bowel syndrome-是最常見引起腸道有關的慢性骨盆腔疼痛,影響10-20%的一般族群,常可影響生殖年齡的女性-它是功能性的疾病,由疼痛的病史及腸胃道的症狀診斷,可用高纖食物及anti-spasmodic drugs constipation-也是常見腸子脹及慢性骨盆腔疼痛的原因 Inflammatory bowel disease-