腹腔镜骶前神经切断术在慢性盆腔疼痛治疗中的应用

The role of laparoscopic presacral neurectomy for the treatment of choronic pelvic pain

目的 探讨腹腔镜骶前神经切断术治疗慢性盆腔痛的效果及安全性。方法 16例患者均为经物理或药物治疗无效者 ,年龄 2 5～ 4 6岁。其中 7例为慢性盆腔炎 ,9例为子宫内膜异位症。所有病人均行骶前神经切断术 ,其他手术包括子宫次全切除术、盆腔粘连松解术和子宫内膜异位症病灶切除术。结果 本组病人行骶前神经切断术的手术时间为 30～ 5 5min(平均4 1min) ;手术中出血量 30～ 80ml(平均 5 8ml)。平均住院时间为 4 5d。随访 3～ 12月 (平均 7月 ) ,疼痛完全缓解者 13例 ,部分缓解 2例 ,1例无效 ,无术后并发症。结论 腹腔镜骶前神经切断术安全有效 。

Objective To investigate the efficacy and safety of l ap aroscopic presacral neurectomy (LPSN) as the surgical treatment of chronic midli ne pelvic pain and dysmenorrhea. Methods Sixteen women, age 25 to 46 years, who experienced severe pelvic pain and/or dysmenorrhea; 7 of 16 had s ignificant chronic pelvic inflammatory disease and other 9 patients had endometr iosis.All patients were performed laparoscopic presacral neurectomy.Other proced ures, including lysis of adhesions, excision and vaporization of endometriosis, and subtotal hysterectomy were completed as adjuncts to LPSN.Results All patients underwent technically successful laparoscopic presacral neurec tomy without intraoperative and postoperative complications.Average operating ti me was 41 min(30～55min)and average blood loss was 58ml (30～80)ml respectively. Me an postoperative hospital stay was 4.5d.Follow-up 3 to 12 months after surgery, 13 patients reported no midline pain, two had significant reduction of pain, and one had persistence of severe pain.Conclusion Presacral neurecto my can be performed safely and efficiently by laparoscopy and is a valuable alte rnative treatment for pelvic pain.