《骨盆腔疼痛》ppt课件

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1、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ectopicpregnancy&miscarriagePIDAppendicitisOvariancyst”accident”orMittelschmerz急性骨盆腔疼痛-其它原因OHSSHematomatraorhematocolposNecrosisofuterinefibroid其他非婦產科的原因,像腸道或泌尿道疾病OvariancystaccidentDermoidcysts,teratomas,orsimplecystsaremorecommoncause

2、oftorsionResultoftorsion(leadingtoocclusionofbloodsupplyandnecrosis)Presentingsymptomofovarianneoplasm,morecommonassociatedwithfunctionalovariancystsinyoungerAcutechemicalperitonitisiftheycontainirritantmaterial(asendometrioticordermoidcysts)OvariancystaccidentPainpatternoftors

3、ion:-suddenonsetofcolikypelvicpain-locatedtooneorotherofiliacfossa-moreconstantafterseveralhoursordisappear-initiallyapyrexial,lateronnecrosiscancausepyrexiaMittelschmerzFromgermanmittel=middleandschmerz=painMiddlecyclepainoccuringatthetimeofovulationMorecommonlyinteenagersando

4、lderwomen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EndometriosisChronicpelvicinflammatorydiseasePelvicadhesionBowelrelatedpainUrologicalcausesMusculoskeletalpainNeuropathicpainPsychologicalfactors骨盆腔沾粘引起疼痛的原因還不清楚Inuncontrolledstudies,adhesionlysisreliefpainInarandomizedco

5、ntrolledtrial,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Ovarianremnantsyndrome-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PelvicveindilatationcyclicaldraggingpelvicpainOccureinpremenstrualphaseofcycleandworseninstandingorwalking發生的位置與強度變異性大,和深度的性交疼痛有關Dilatedvein有時可由laparosco

6、pyorultrasound看到骨盆腔充血-治療MPA(medroxyprogesteroneacetate)30-50mgdailyfor3months-sideeffect:weightgain,amenorrhea,bloatingGnRHanalogue-inhibitovarianfunctionSeverecases-TAH+BSOcurative腸道有關的疼痛Irritablebowelsyndrome-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

7、狀診斷,可用高纖食物及anti-spasmodicdrugsconstipation-也是常見腸子脹及慢性骨盆腔疼痛的原因Inflammatoryboweldisease-painandbloodydiarrhea泌尿道的原因(I)Interstitialcystitis-不明原因的發炎情況,它可引起疼痛及泌尿道的症狀,像frequency,urgency,nocturia;當膀胱脹滿,疼痛會增加,當解尿後,疼痛會緩解-可用膀胱鏡診斷(submucosaledemaandpetechiae)-dyspareunia(+)泌尿道的原因(II)Chron

8、icurethralsyndrome-symptomsofirritation,postvoidingful