慢性盆底疼痛的診斷及治療進(jìn)展課件

慢性原發(fā)性盆底疼痛的診斷及治療進(jìn)展ChronicprimaryPelvicPain(CPP)中山大學(xué)附屬第六醫(yī)院英丹CPP定義1、主要發(fā)生位置為盆底盆底:盆腔腹膜以下至?xí)幤つw的全部肌肉筋膜、內(nèi)臟組織,由上而下依次為:腹膜、盆內(nèi)筋膜、盆膈、尿生殖隔、肛門外括約肌和尿生殖肌群淺層。PSuperfrRlI五temaniac●CPP的概念涵蓋了傳統(tǒng)意義上的多個(gè)概念(慢性前列腺炎、恥骨直腸肌綜合征、盆腔瘀血綜合征、間質(zhì)性膀胱炎等)●涉及三個(gè)(肛腸、泌尿、生殖),甚至更多的系統(tǒng)癥狀(骨科、內(nèi)分泌、神經(jīng)心理等)癥候群交替、并存、規(guī)律性不強(qiáng)◆2、主要不適為疼痛(急性、慢性)●慢性概念需超過3個(gè)月疼痛提示了什么?疼痛的意義(W自我保護(hù)機(jī)制,提醒機(jī)體避免傷害或潛在的傷害InJury、potentialinjury)-急性疼痛Acutepain或持續(xù)性疼痛chronicorpersistentpain和意的摸績(jī)存奢過智發(fā)鍋械經(jīng)異常oftenrepresentsanaberrationofneuprocessing(EAU,2009)CNS對(duì)慢性盆底疼痛的調(diào)節(jié)產(chǎn)生疼痛意識(shí)◆反饋調(diào)節(jié),延伸●輻射痛覺過敏HyperalgesiaisceralCNS參與慢性盆底疼痛發(fā)生的過程●以膀胱起源為例:1、急性刺激導(dǎo)致的疼痛引起了中樞神經(jīng)系統(tǒng)的意識(shí)敏化;AnacutepaininsulttothebladdercanproducefunctionalchangeswithinthecNs◆2、去除刺激后,疼痛仍然存在;painpersistsevenafterremovalofthestimulus●3、中樞功能的改變對(duì)“潛在疼痛”作出了適當(dāng)?shù)膽?yīng)答如輕微的膀胱擴(kuò)張或膀胱刺激癥狀;Thesecentralfunctionalchangesmayalsobeassociatedwithadysaesthetic(unpleasantsensationresponse;forinstance,milddistensionorstimulationofthebladder◆4、進(jìn)一步,引起核心肌群,包括盆底肌對(duì)“扳機(jī)點(diǎn)”的痛覺過敏,與此同時(shí),其它的器官也變得敏感起來,如痛經(jīng)、性交疼痛、腸易激等;Furthermore,coremusclesincludingpelvicmuscles,maybecomehyperalgesicwithmultipletriggerpoints,whileotherorgansmayalsobecomesensitive.theuteruswithdyspareuniaanddysmenorrhoea,thebowelwithirritablebowelsymptoms.●5、這種感覺異常的延伸,在CNS介導(dǎo)下循環(huán),周而復(fù)始,進(jìn)而發(fā)展成為復(fù)雜的慢性盆底疼痛綜合征;Thespreadofabnormalsensoryresponsesbetweentheorgansandmusculoskeletalsystemisawell-describedconsequenceoftheCNSchangesandacrucialcauseofcomplexchronicpelvicpains6、最終,疼痛變成了病,引起,≤到社會(huì)行為及心理障礙。Atlast,painbecomestheulnessCPP的特點(diǎn)難于診斷DifficulttodilignoseWANNAPAYEXTRAFORTHEPAINKILLEROR難于治療Difficulttotreat.GETTHEFREEONE?難以治愈Difficulttocure°很多時(shí)候,沒有找到明確的病因,盛對(duì)可能的病因進(jìn)行治療遭遇失敗:Manytimes,etiologynotfoundortreatmentofpresumede