Quality of Life in Women with Endometriosis Pelvic Pain Treated with the Levonorgestrel-Releasing Intrauterine System

Objective: To evaluate the quality of life in patients with endometriosis pelvic pain before and after the application of the levonorgestrel-releasing intrauterine system (LNG-IUS). Design: Open non-comparative study. Setting: Obstetrics and Gynecology Hospital at Monterrey, Mexico. Sample: 29 women aged 18 to 40 years with pelvic pain associated with endometriosis confirmed by laparoscopy. Methods: After laparoscopy but before LNG-IUS insertion (basal visit) and 6 months afterwards, modified Endometriosis Health Profile (EHP-30) was applied. Main outcomes measures: Size of change of questionnaire scores, need of additional analgesic therapy and adverse effects. Statistical Analysis: Differences in the questionnaire scores before and after intervention were analyzed by Student t-test. Results: Final analysis set included 29 women aged 31.7 ± 4.7 years years. The ASRM surgical staging of endometriosis was mild in 19.3 moderate in 13.7 and severe in 76% of the patients. The general perception of quality of life improved from 52 at baseline to 98% at six months (p < 0.001). Adverse events were mild in nature, 19 patients reported no adverse events during the study (65.5%). Two patients (6.9%) required the use of concomitant therapy with non-steroidal analgesics for relief of pain. Conclusion: The application of LNG-IUS in patients with pelvic pain associated with endometriosis improved significatively all aspects related with quality of life as measured with Endometriosis Health Profile (EHP-30). We concluded that LNGIUS may be an effective and convenient therapeutic alternative for the management of pain associated with endometriosis.

Pelvic pain in endometriosis: is success of therapy gone in cigarette smoke?

The objective of the study was to assess potential individual factors influencing the efficacy of combined surgical and medical therapy in en-dometriosis patients with pelvic pain. For this purpose we performed a prospective study using a specifically designed questionnaire among patients suffering from persistent pelvic pain and undergoing laparoscopy and further GnRH analogue therapy in a university-based gyne-cologic department. Eighty-one women of re-productive age with histologically confirmed endometriosis were enrolled. A questionnaire gathered information from women on the fol-lowing groups of variables: age, marital status, education, reproductive and medical history including previous pregnancies and parity, knowledge of accompaniing pelvic disorders, concurrent cigarette smoking, as well as general quality of life estimates including self-image. Pelvic pain was scored using a visual analogue scale. Patients filled out the questionnaires before surgery and upon completing medical therapy. Data were statistically evaluated. After cessation of therapy, 53% of patients reported absence of pain. Only 12% of pain-free patients were smokers. This corresponded to slightly more than one third (35%) of all smokers in the study. However, 56% of non-smoker participants reported a positive outcome that proved to be significantly larger than the ratio of pain-free smoker participants (p = 0.02). Improvement in quality of life was reported by 74% of all patients, and only 9% of them were smokers. However, 47% were smokers among patients reporting no change or worsening in quality of life (p < 0.01). Based on our results, we can conclude, that regular smoking might have a disadvantageous impact on the success rate of combined surgical and medical therapy for endometriosis related pelvic pain.

Vaginal endoscopy combined with gonadotropin-releasing hormone agonist successfully treated a patient with cervical endometriosis:a case report

A 36-year-old unmarried woman with no sexual history presented with 12 days of uncontrollable yellowish vaginal discharge,bloating,lower back pain,frequent urination,and urgency.Her menstrual cycles were regular with moderate flow and worsening dysmenorrhea.Ultrasound and magnetic resonance imaging identified uterine and cervical masses.Laparoscopic surgery and postoperative gonadotropin-releasing hormone agonist injections led to significant lesion reduction.The patient is currently on oral dienogest acetate with ongoing follow-up.

The correlation of matrix metalloproteinase expression and oxidative stress in ectopic endometrial tissue with pelvic adhesion and pelvic pain

Objective:To study the correlation of matrix metalloproteinase expression and oxidative stress in ectopic endometrial tissue with pelvic adhesion and pelvic pain in patients with endometriosis (EMs).Methods:A total of 67 patients with EMs who accepted oophorocystectomy in our hospital between May 2014 and April 2016 were selected to collect ectopic endometrial tissue and eutopic endometrial tissue, 45 patients who accepted tubal sterilization in our hospital during the same period were selected to collect normal endometrial tissue, and the expression levels of matrix metalloproteinases and their inhibitors as well as the levels of oxidative stress-related molecules were detected.Results:MMP2, MMP3, MMP7, 8-iso-PGF2α, AOPP and 8-OHdG levels in ectopic endometrial tissue were significantly higher than those in eutopic endometrial tissue and normal endometrial tissue while TIMP1, TIMP2, CAT, PON-1 and SOD levels were significantly lower than those in eutopic endometrial tissue and normal endometrial tissue;MMP2, MMP3, MMP7, 8-iso-PGF2α, AOPP and 8-OHdG levels in ectopic endometrial tissue of EMs patients with severe pain and moderate pain were significantly higher than those of EMs patients with mild pain while TIMP1, TIMP2, CAT, PON-1 and SOD levels were significantly lower than those of EMs patients with mild pain;MMP2, MMP3, MMP7, 8-iso-PGF2α, AOPP and 8-OHdG levels in ectopic endometrial tissue of EMs patients with severe pain were significantly higher than those of EMs patients with moderate pain while TIMP1, TIMP2, CAT, PON-1 and SOD levels were significantly lower than those of EMs patients with moderate pain.Conclusion:The abnormally high expression of matrix metalloproteinases and the abnormal activation of oxidative stress response in ectopic endometrial tissue are closely related to the degree of pelvic pain.

Laparoscopic diagnosis of endometriosis—Clinical study

Objective: To examine the laparoscopic findings in patients with suspicion of endometriosis. Study Design: Retrospective study. Setting: Department of Obstetrics and Gynecology, University of Oulu, Finland. Sample: First-time laparoscopy, without any known surgical diagnosis, was made in 53 consecutive patients between January 2006 and November 2011. Main Outcome Measures: The laparoscopic findings, staging of endometriosis, the percentages of different symptoms linked with endometriosis. Results: Laparoscopy revealed endometriosis in 40% of cases. Most frequent symptoms were dysmenorrhea (86%) and dyspareunia (81%) followed with vibration pain (71%), urinary symptoms (29%) and lowered fertility (24%). Only 5% of patients with endometriosis complained of bowel symptoms, which were significantly more common in patients without endometriosis (28%) (p = 0.034). The median interval between the onset of symptoms and laparoscopic diagnosis was 1.9 years (SD 3.2, range 0.6 - 11). Conclusions: The interval between the onset of symptoms and laparoscopic diagnosis is short reflecting the prompt availability of the necessary facilities in specialist health care. Finally laparoscopy seems to be safe in cases of endometriosis suspicion.

Endometriosis: An “Unexplored”, “Neglected” or “Forgotten” Condition in Africa?

Endometriosis is a condition that is commonly encountered in gynaecological practice. Endometriosis has varied, non-specific clinical presentations and its diagnosis sometimes poses a challenge to the clinician. We have encountered various women with clinical presentation highly suggestive of endometriosis. Further diagnosis using imaging and biopsy confirmed endometriosis. This paper presents our experience of endometriosis in our care of African women and a review of the literature on endometriosis. We want to highlight the various clinical presentations of endometriosis, appraise the various methods for diagnosis, discuss the treatment modalities available and evaluate the impact of this condition on women. We want to emphasize the fact that African women also suffer from this condition, and impress upon clinicians, the necessity for closer look for the condition, stimulate discussion and research into endometriosis in Africa as it seems this condition is “neglected or forgotten” in Africa.

Digital Twin of the Female Pelvic Floor

Digital twin technology, originally developed for intricate physical systems, holds great potential in women’s healthcare, particularly in the management of pelvic floor disorders. This paper delves into the development of a digital twin specifically for the female pelvic floor, which can amalgamate various data sources such as imaging, biomechanical assessments, and patient-reported outcomes to offer personalized diagnostic and therapeutic insights. Through the utilization of 3D modeling and machine learning, the digital twin may facilitate precise visualization, prediction, and individualized treatment planning. Nevertheless, it is crucial to address the ethical and practical challenges related to data privacy and ensuring fair access. As this technology progresses, it has the potential to revolutionize gynecological and obstetric care by enhancing diagnostics, customizing treatments, and increasing patient involvement.

Intra-ligamentous fibroid removed laparoscopically

In this paper, we report the case of a left round ligament fibroid in a 24 year-old, gravida 0, female that was successfully managed laparoscopically. Operative findings also included severe adnexal adhesions bilaterally, severe adhesions of the liver to the anterior abdominal wall (Fitz-Hugh-Curtis syndrome), pigmented areas on the left tube, uterus and posterior broad ligament (that proved to be endometriosis), and low capacity bladder (450 cc at 70 cm water pressure) with florid glomerulations and Hunner’s ulcers consistent with typical interstitial cystitis. Beside the feasibility of laparoscopic management of intra-ligamentous tumors this case highlights the common multifactorial nature of chronic pelvic pain and the frequent association of endometriosis and interstitial cystitis.

子宫内膜异位症患者腹腔镜手术后不同分型对消化功能的影响

目的探讨不同临床病理分型子宫内膜异位症(EMs)患者腹腔镜术后消化功能的影响。方法收集2018年12月至2022年12月期间115例腹腔镜诊断为EMs患者的临床资料,根据患者临床病理分型将患者分为腹膜型内异症(PEM)组(n=35)、卵巢内异症(OMA)组(n=37)、深部浸润型内异症(DIE)组(n=43)。收集患者一般资料,通过视觉模拟评分(VAS)评估所有患者术后6个月和12个月疼痛情况,并通过胃肠道生活质量指数(GIQLI)和诺尔斯爱克斯里斯科特症状量表(KESS)比较3组术后消化功能变化情况。结果3组研究对象在一般资料方面无显著差异,具有可比性。OMA组的手术时间显著长于PEM组,而DIE组的手术时间、出血量和住院时间均显著高于其他两组(P<0.01)。DIE组有88.37%的患者接受肠道手术,显著高于其他两组(P<0.01)。3组患者术后并发症发生率较低,无统计学意义(P>0.05)。DIE组在术前GIQLI评分较低,KESS评分较高,表明其胃肠功能较差。术后GIQLI评分和KESS评分相比于其他两组,差异有统计学意义(P<0.01)。3组患者术前和术后12月的VAS得分无显著差异,但DIE组在术后1年的GIQLI评分和KESS评分显著低于PEM组和OMA组(P<0.01)。结论不同临床病理分型的EMs患者腹腔镜术后消化功能存在差异,DIE组的消化功能受损最严重,需要更多的关注和干预。

母乳喂养对子宫内膜异位症相关疼痛影响

目的评估母乳喂养对子宫内膜异位症患者痛经、性交困难和慢性盆腔痛(CPP)影响。方法研究对象为48例子宫内膜异位症孕妇,分娩后根据母乳喂养持续时间分为3个亚组:1-2个月(A组)(n=14)、3-5个月(B组)(n=15)和6-8个月(C组)(n=19)。分别在妊娠前(T0)、分娩后3个月(T3)、6个月(T6)、12个月(T12)和24个月(T24),采用10点视觉模拟量表(VAS)评估患者痛经、性交困难和CPP疼痛强度。结果与妊娠前相比,A组、B组和C组患者分娩后VAS痛经评分均降低,其中A组和B组患者仅仅在分娩后3和6个月痛经评分改善有统计学差异(所有P<0.05);而C组患者在随访期间评分改善均有统计学差异(所有P<0.05)。痛经改善与母乳喂养时间成正相关(r=0.628;P=0.017)。A组、B组和C组患者CPP评分均有所改善,但只有C组患者在分娩后3、6和12个月降低有统计学差异(所有P<0.05)。CPP改善与母乳喂养时间成正相关(r=0.714;P=0.021)。结论母乳喂养可使子宫内膜异位症患者痛经和CPP改善,并且与母乳喂养持续时间成比例。

子宫内膜异位症炎性因子凝血指标与病情严重程度的相关性分析

目的评估子宫内膜异位症患者炎症以及凝血指标水平变化及其临床意义。方法本研究选取2020年1月至2023年12月期间我院收治子宫内膜异位症患者共计80例作为研究对象,对患者临床资料进行回顾性分析。以盆腔粘连程度不同进行分组,观察各组患者子宫内膜异位症患者炎症、凝血指标水平变化情况;同时以疼痛程度的不同分组,进一步分析不同疼痛程度子宫内膜异位症患者炎症、凝血指标水平变化情况进行观察,同时对炎性因子、凝血指标水平与盆腔粘连、疼痛程度的相关性结果进行分析。结果重度粘连子宫内膜异位症分组患者活化部分凝血酶时间(APTT)为(30.0±3.2)s,与其他组别患者对比差异无统计学意义(P>0.05);不同粘连程度分组子宫内膜异位症患者凝血酶时间(PT)、凝血酶原时间(TT)检出值对比,随着盆腔粘连程度加重,各指标明显下降(P<0.05);不同粘连程度分组子宫内膜异位症患者纤维蛋白原(FIB)、D-二聚体(D-D)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、白细胞介素-8(IL-8)检出值对比,随着盆腔粘连程度加重,各指标明显上升(P<0.05)。重度疼痛子宫内膜异位症患者APTT、PT、TT、FIB、DD检出值与其他分组患者对比差异无统计学意义(P>0.05);不同疼痛程度分组子宫内膜异位症患者TNF-α、TGF-β1、以及IL-8检出值对比,随着疼痛程度加重,上述指标明显上升(P<0.05)。子宫内膜异位症患者PT与盆腔粘连严重程度呈负相关性关系(r=-0.237,P<0.05),FIB、D-D、TNF-α、TGF-β1、IL-8与盆腔粘连严重程度呈正相关性关系(r=0.711,0.351,0.276,0.440,0.448,P<0.05);子宫内膜异位症患者TNF-α、TGF-β1以及IL-8与疼痛程度呈正相关关系(r=0.410,0.453,0.311,P值均<0.05)。结论对于子宫内膜异位症患者而言,炎性因子以及凝血指标水平均呈现出异常改变,炎性因子和凝血指标的改变在很大程度上可为粘连程度的判断提供相应的参考依据,同时疼痛程度与凝血指标水平异常改变存在相关性关系,提示可基于检测炎性因子以及凝血指标的方式,对子宫内膜异位症患者病情严重程度进行准确判定与预测。

心理护理干预在子宫内膜异位症所致慢性盆腔痛患者中的应用效果

目的探讨心理护理干预在子宫内膜异位症所致慢性盆腔痛患者中的应用效果。方法选取2022年2月至2023年2月潍坊市中医院收治的78例子宫内膜异位症所致慢性盆腔痛患者为研究对象,按照随机数字表法将其分为参照组(39例)、试验组(39例)。参照组采取常规护理干预,试验组在参照组基础上采取心理护理干预,比较两组不良情绪、疼痛程度。结果试验组焦虑自评量表、抑郁自评量表评分低于参照组,疼痛程度低于参照组,差异有统计学意义(P<0.05)。结论心理护理干预在子宫内膜异位症所致慢性盆腔痛患者中的应用效果显著,能够改善情绪,减轻疼痛,值得推广。

Potential impact of COVID-19 pandemic on endometriosis

The impact of coronavirus disease 2019(COVID-19)on endometriosis(EM)is currently unclear.Here,we aimed to describe the potential influence of COVID-19 on the pathogenesis,clinical symptoms,and treatment of EM.The cytokine storm caused by COVID-19 may induce the occurrence and progression of EM,and immunosuppression of COVID-19 may help the ectopic endometrium escape from immune clearance.Consequently,the forced social isolation and the cancelation of non-emergency medical treatment during the COVID-19 pandemic aggravate anxiety and psychological pressure,which can aggravate the symptoms related to EM and delay routine medical services.

225例女性慢性盆腔痛的病因分析及诊治探索

目的:分析女性慢性盆腔痛的病因,探索诊断流程及治疗方法。方法:225例患者填写《慢性盆腔痛评估表》,结合查体及辅助检查,分析疼痛的病因、诊断流程及治疗方法。结果:诊断子宫内膜异位症或子宫腺肌症、盆腔炎性疾病、阴部神经痛、间质性膀胱炎的患者各占36.4%、27.6%、5.3%、4.9%。14.2%的患者诊断不明原因的慢性盆腔痛。患者采取个体化的治疗,包括口服短效避孕药、手术、经皮穴位电刺激、膀胱灌洗、阴部神经阻滞术等,治疗后患者的疼痛缓解率在80%以上。结论:慢性盆腔痛病因多样,常见疾病包括子宫内膜异位症、子宫腺肌症、盆腔炎性疾病、间质性膀胱炎、阴部神经痛等。诊治时全面的查体及辅助检查很重要,治疗应采用个体化的方案。

慢性盆腔痛病因及发病率分析

目的探讨女性慢性盆腔痛的病因及其发病率。方法对2010年5月～2011年5月到我院妇科就诊的1 017例慢性盆腔痛患者进行回顾性分析。结果 5 219例普通妇科疾病患者中,慢性盆腔痛就诊者1 017例,占19.5%。5 219例中20～40岁就诊者2 012例,慢性盆腔痛发病率为27.1%;41～55岁就诊者3 207例,慢性盆腔痛发病率为14.7%,两组比较,差异有统计学意义(P<0.05)。1 017例慢性盆腔痛就诊者较常见病因:慢性盆腔炎占35.0%,子宫内膜异位症占28.5%,盆腔肿物占13.2%,盆腔静脉淤血综合征占12.9%。已生育组中盆腔静脉淤血综合征、盆腔肿物所致的慢性盆腔痛的构成比明显大于未生育组,两组比较,差异有统计学意义(P<0.05);未生育组慢性盆腔炎所致的慢性盆腔痛的构成比较生育组高,两组比较,差异有统计学意义(P<0.05);未生育组中子宫内膜异位症和原因不明所致慢性盆腔痛的构成比与已生育组比较,差异无统计学意义(P>0.05)。慢性盆腔痛就诊者中既往有剖宫产手术史者占慢性盆腔痛患者53.0%,顺产者占19.5%,两组比较,差异有统计学意义(P<0.05)。结论慢性盆腔痛常发生在育龄期妇女,其妇科常见原因是慢性盆腔炎、子宫内膜异位症、盆腔肿物及盆腔静脉淤血综合征等。剖宫产术可引起慢性盆腔痛,临床上要严格掌握剖宫产适应证,降低剖宫产率。

腹腔镜诊治子宫内膜异位症相关性慢性盆腔痛的临床研究

目的:评价腹腔镜在子宫内膜异位症(EMT)相关性慢性盆腔痛诊断及治疗中的应用价值。方法:回顾性分析86例EMT相关性慢性盆腔痛患者行腹腔镜手术治疗的效果及疼痛程度与EMT分期及部位的关系。结果:腹腔镜手术治疗EMT相关性慢性盆腔痛疼痛缓解率90.7%。rAFS分期Ⅱ期患者Ⅰ度疼痛占71.4%,Ⅲ期和Ⅳ期患者Ⅱ度以上疼痛占95.5%。单纯卵巢巧克力囊肿和(或)盆腔腹膜EMT患者Ⅰ、Ⅱ度疼痛占88.4%,病灶侵犯宫骶韧带、直肠子宫陷凹和子宫后壁以及深部浸润的EMT患者Ⅱ、Ⅲ度疼痛占93.0%。结论:盆腔子宫内膜异位病灶侵犯宫骶韧带、直肠子宫陷凹、子宫后壁和深部浸润是引起EMT相关性慢性盆腔痛的主要原因,腹腔镜能明确诊断及治疗EMT相关性慢性盆腔痛,治疗效果满意。

P物质在子宫内膜异位症所致慢性盆腔疼痛患者子宫骶韧带中的表达

目的探讨P物质在子宫内膜异位症所致慢性盆腔痛患者子宫骶韧带中的表达。方法选择2013年6月～2014年12月26例因子宫内膜异位症所致慢性盆腔疼痛拟行手术治疗的患者为研究组,同期因妇科疾病需行子宫切除术且无子宫内膜异位症和慢性盆腔痛的33例患者为对照组。术中取骶韧带组织,应用实时荧光定量PCR法及免疫组化SP法检测P物质mRNA和蛋白在2组骶韧带中的相对表达水平。结果研究组骶韧带中P物质mRNA的相对表达量（中位数0.2129,四分位数间距0.6954）和蛋白的阳性面积百分比（25.6531%±7.0761%）明显高于对照组（中位数0.0364,四分位数间距0.1674,20.2915%±4.3665%）（Z=-2.141,P=0.032;t=3.614,P=0.001）。结论子宫内膜异位症所致慢性盆腔痛患者子宫骶韧带中P物质mRNA的相对表达量和蛋白的阳性面积百分比均较无慢性盆腔痛患者高,提示子宫骶韧带中P物质表达增加可能是子宫内膜异位症导致慢性盆腔痛的原因。

针灸治疗子宫内膜异位症盆腔疼痛的研究进展

近年来关于针灸治疗子宫内膜异位症(EMs)研究报道愈多,回顾国内近10年来针灸治疗EMs盆腔疼痛的现状,从致病机理和不同针灸治疗方法等方面,对针灸治疗子宫内膜异位症盆腔疼痛做出概述,为临床治疗子宫内膜异位症提供一定治疗规律及临床指导。

盆痛灵直肠给药治疗子宫内膜异位症盆腔痛的临床观察

目的观察“盆痛灵”方治疗子宫内膜异位症(简称EM)盆腔痛的临床疗效及其对血栓烷B(2TXB2)、6-酮-前列腺素F1(α6-Keto-PGF1α)的影响。方法采用盆痛灵方水煎剂直肠给药治疗EM盆腔痛患者30例,观察用药前后临床症状的改善情况,并在治疗前后采用放免法测定血浆TXB2、6-Keto-PGF1α的浓度。结果近期治愈3例,显效16例,有效9例,无效2例,总有效率为90%,且治疗前经期血浆TXB2、6-Keto-PGF1α水平均增高,中药盆痛灵可显著降低两者水平。结论盆痛灵有明显的镇痛作用,其作用机理可能与改善TXB2、6-Keto-PGF1α水平,协调子宫肌层的活动有关。

腹腔镜配合药物治疗子宫内膜异位症效果分析

目的探讨子宫内膜异位症所致盆腔疼痛的手术治疗方案及腹腔镜术后辅助药物治疗降低复发率的效果。方法回顾性收集147例以盆腔疼痛为主要症状的子宫内膜异位症患者,比较分析腹腔镜及经腹手术术后疼痛的缓解率及单纯腹腔镜手术与术后辅助药物治疗远期疼痛的复发情况。结果腹腔镜手术与经腹手术治疗后疼痛的缓解率为77.36%、75.56%,两组患者术后疼痛缓解率及复发率差异无显著性(P>0.05)。经观察及随访2年,腹腔镜术后加药物组复发率明显低于单纯腹腔镜手术组,差异有显著性(P<0.05)。结论腹腔镜手术可作为以盆腔疼痛为主要症状的子宫内膜异位症患者的首选治疗,术后辅助药物治疗可明显降低疼痛的复发率。