盆腔痛综合征.ppt

　　Pelvic pain syndrome盆腔痛综合征

　　Persistent or recurrent episodic pelvic pain associated with symptoms suggesting lower urinary tract, sexual, bowel or gynaecological dysfunction. No proven infection or other obvious pathology. 持续性或反复发作性盆腔疼痛伴有提示下尿道功能、性功能、肠功能或妇科功能障碍的症状，而无证实的感染或其它明显的病理变化。

　　Pathogenesis It is associated with changes in the central nervous system (CNS) that may maintain the perception of pain in the absence of acute injury. 发病机理 与中枢神经系统在无急性损伤时可维持痛感的变化有关。

　　Pathogenesis These changes may also magnify perception so that nonpainful stimuli are perceived as painful (allodynia) and painful stimuli are perceived as more painful than expected (hyperalgesia). 这些变化也可放大知觉，导致非疼痛性刺激因素引起疼痛(痛觉异常)，疼痛性刺激因素引起超常疼痛(痛觉敏感)。

　　Diagnosis and classification 1.??Prostate pain syndrome Persistent or recurrent episodic prostate pain, associated with symptoms suggestive of urinary tract and/or sexual dysfunction.诊断和分类 1.??前列腺痛综合征 持续性或反复发作性前列腺疼痛伴有提示泌尿道功能和/或性功能障碍的症状，

　　Diagnosis and classification 1.??Prostate pain syndrome No proven infection (sterile cultures of semen, expressed prostatic secretions, and urine collected after prostate massage) or other obvious pathology. It is the same as type Ⅲ prostatitis. 而无证实的感染(精液、挤压出的前列腺分泌物和前列腺按摩后收集的尿液作细菌培养阴性;白细胞数异常或正常)或其它明显的病理变化。相当于Ⅲ型前列腺炎。

　　Diagnosis and classification 2.??Bladder pain syndrome Suprapubic pain is related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency. No proven urinary infection or other obvious pathology. 2.??膀胱痛综合征 与膀胱充盈有关的耻骨上疼痛，伴有昼尿和夜尿次数增多等症状，无证实的尿路感染或其它明显的病理变化。

　　Diagnosis and classification 3.??Vulvar pain syndrome Persistent or recurrent episodic vulvar pain either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. There is no proven infection or other obvious pathology. 3.??外阴痛综合征 持续性或反复发作性外阴疼痛，或与排尿周期有关，或伴有提示泌尿道功能或性功能障碍的症状，而无证实的感染或其它明显的病理变化。

　　Diagnosis and classification 3.??Vulvar pain syndrome It includes, Generalized vulvar pain syndrome: vulval burning or pain that cannot be consistently and tightly localized by point-pressure ‘mapping’ by probing with a cotton-tipped applicator or similar instrument. 包括广泛性外阴痛综合征：外阴灼痛，用棉签等点压探测不能明确定位;

　　Diagnosis and classification 3.??Vulvar pain syndrome Localized vulvar pain syndrome: pain consistently and tightly localized by point-pressure mapping to one or more portions of the vulva (e.g. vestibule). Clinically, pain usually occurs as a result of provocation (touch, pressure or friction). 局限性外阴痛综合征：点压探测能明确疼痛位于外阴(如前庭)的一个或多个部位，临床疼痛常为触、压、摩擦等刺激而触发。

　　EAU classification of chronic urogenital pain syndromes

　　Treatment Electrical stimulation of “four sacral points” (pudendal nerve) is usually used for prostate pain syndrome and vulvar pain syndrome. Electrical stimulation of “four abdominal points” is usually used for bladder pain syndrome. 治疗 前列腺痛综合征和外阴痛综合征一般采用“骶四穴”(阴部神经)电刺激疗法。膀胱痛综合征一般采用“腹四穴”电刺激疗法。

　　Treatment The needling sensation is required to reach the pain site during needle insertion. Vibration at the pain site is required during electroacupuncture, with the pain abating or disappearing. 要求进针时针感达疼痛部位，电针时疼痛部位振动，疼痛减轻或消失。

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