慢性盆底疼痛的诊断及治疗进展课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,慢性原发性盆底疼痛的诊断及治疗进展,Chronic primary Pelvic Pain(CPP),中山大学附属第六医院英丹,慢性原发性盆底疼痛的诊断及治疗进展,1,CPP定义,1、主要发生位置为盆底,盆底:盆腔腹膜以下至会阴皮肤的全部肌肉,筋膜、内脏组织,由上而下依次为:腹膜、,盆内筋膜、盆膈、尿生殖隔、肛门外括约肌,和尿生殖肌群浅层。,P,SuperfrRlI,五 te maniac,CPP定义,2,CPP的概念涵盖了传统意义上的多个概念(,慢性前列腺炎、耻骨直肠肌综合征、盆腔,瘀血综合征、间质性膀胱炎等),涉及三个(肛肠、泌尿、生殖),甚至更,多的系统症状(骨科、内分泌、神经心理,等),症候群交替、并存、规律性不强,CPP的概念涵盖了传统意义上的多个概念(,3,2、主要不适为疼痛(急性、慢性),慢性概念需超过3个月,疼痛提示了什么?,疼痛的意义(W,自我保护机制,提醒机体,避免伤害或潜在的伤害 InJury、 potential,injury)-急性疼痛 Acute pain,或持续性疼痛 chronic or persistent pain,和意的摸績存奢过智發锅械经异常,often represents an aberration of neu,processing (EAU, 2009),2、主要不适为疼痛(急性、慢性),4,CNS对慢性盆底疼痛的调节,产生疼痛意识,反馈调节,延伸,辐射,CNS对慢性盆底疼痛的调节,5,痛觉过敏 Hyperalgesia,isceral,痛觉过敏 Hyperalgesia,6,CNS参与慢性盆底疼痛发生的过程,以膀胱起源为例:,1、急性刺激导致的疼痛引起了中枢神经系统的意识敏化;,An acute pain insult to the bladder can produce,functional changes within the cNs,2、去除刺激后,疼痛仍然存在; pain persists even after,removal of the stimulus,3、中枢功能的改变对“潜在疼痛”作出了适当的应答,如轻微的膀胱扩张或膀胱刺激症状; These central,functional changes may also be associated with a,dysaesthetic(unpleasant sensation response; for,instance, mild distension or stimulation of the bladder,CNS参与慢性盆底疼痛发生的过程,7,4、进一步,引起核心肌群,包括盆,底肌对“扳机点”的痛觉过敏,与此,同时,其它的器官也变得敏感起来,如痛经、性交疼痛、肠易激等;,Furthermore, core muscles,including pelvic muscles, may,become hyperalgesic with multiple,trigger points, while other organs,may also become sensitive. the,uterus with dyspareunia and,dysmenorrhoea, the bowel with,irritable bowel symptoms.,4、进一步,引起核心肌群,包括盆,8,5、这种感觉异常的延伸,在CNS介导下循,环,周而复始,进而发展成为复杂的慢性,盆底疼痛综合征; The spread of abnormal,sensory responses between the organs and,musculoskeletal system is a well-described,consequence of the CNS changes and a,crucial cause of complex chronic pelvic,pains,6、最终,疼痛变成了病,引起,到社会,行为及心理障碍。 At last, pain becomes the,ulness,5、这种感觉异常的延伸,在CNS介导下循,9,CPP的特点,难于诊断 Difficult to,di,lignose,WANNA PAY EXTRA FOR,THE PAINKILLER OR,难于治疗 Difficult to treat. GET THE FREE ONE?,难以治愈 Difficult to cure,很多时候,没有找到明确的,病因,盛对可能的病因进行,治疗遭遇失败: Many times,etiology not found or,treatment of presumed,etiology fails,医生及病人感觉到非常沮丧;,Physician and patient,frustration,PprogEr Www.KarkaTur -CarTooN. D,CPP的特点,10,慢性盆底疼痛的诊断及治疗进展课件,11,慢性盆底疼痛的诊断及治疗进展课件,12,慢性盆底疼痛的诊断及治疗进展课件,13,慢性盆底疼痛的诊断及治疗进展课件,14,慢性盆底疼痛的诊断及治疗进展课件,15,慢性盆底疼痛的诊断及治疗进展课件,16,慢性盆底疼痛的诊断及治疗进展课件,17,慢性盆底疼痛的诊断及治疗进展课件,18,慢性盆底疼痛的诊断及治疗进展课件,19,慢性盆底疼痛的诊断及治疗进展课件,20,慢性盆底疼痛的诊断及治疗进展课件,21,慢性盆底疼痛的诊断及治疗进展课件,22,慢性盆底疼痛的诊断及治疗进展课件,23,慢性盆底疼痛的诊断及治疗进展课件,24,慢性盆底疼痛的诊断及治疗进展课件,25,慢性盆底疼痛的诊断及治疗进展课件,26,慢性盆底疼痛的诊断及治疗进展课件,27,慢性盆底疼痛的诊断及治疗进展课件,28,慢性盆底疼痛的诊断及治疗进展课件,29,慢性盆底疼痛的诊断及治疗进展课件,30,慢性盆底疼痛的诊断及治疗进展课件,31,慢性盆底疼痛的诊断及治疗进展课件,32,慢性盆底疼痛的诊断及治疗进展课件,33,慢性盆底疼痛的诊断及治疗进展课件,34,慢性盆底疼痛的诊断及治疗进展课件,35,慢性盆底疼痛的诊断及治疗进展课件,36,慢性盆底疼痛的诊断及治疗进展课件,37,慢性盆底疼痛的诊断及治疗进展课件,38,慢性盆底疼痛的诊断及治疗进展课件,39,慢性盆底疼痛的诊断及治疗进展课件,40,慢性盆底疼痛的诊断及治疗进展课件,41,慢性盆底疼痛的诊断及治疗进展课件,42,慢性盆底疼痛的诊断及治疗进展课件,43,慢性盆底疼痛的诊断及治疗进展课件,44,慢性盆底疼痛的诊断及治疗进展课件,45,慢性盆底疼痛的诊断及治疗进展课件,46,慢性盆底疼痛的诊断及治疗进展课件,47,慢性盆底疼痛的诊断及治疗进展课件,48,慢性盆底疼痛的诊断及治疗进展课件,49,慢性盆底疼痛的诊断及治疗进展课件,50,慢性盆底疼痛的诊断及治疗进展课件,51,慢性盆底疼痛的诊断及治疗进展课件,52,慢性盆底疼痛的诊断及治疗进展课件,53,慢性盆底疼痛的诊断及治疗进展课件,54,慢性盆底疼痛的诊断及治疗进展课件,55,慢性盆底疼痛的诊断及治疗进展课件,56,慢性盆底疼痛的诊断及治疗进展课件,57,慢性盆底疼痛的诊断及治疗进展课件,58,慢性盆底疼痛的诊断及治疗进展课件,59,慢性盆底疼痛的诊断及治疗进展课件,60,慢性盆底疼痛的诊断及治疗进展课件,61,慢性盆底疼痛的诊断及治疗进展课件,62,慢性盆底疼痛的诊断及治疗进展课件,63,慢性盆底疼痛的诊断及治疗进展课件,64,慢性盆底疼痛的诊断及治疗进展课件,65,慢性盆底疼痛的诊断及治疗进展课件,66,慢性盆底疼痛的诊断及治疗进展课件,67,慢性盆底疼痛的诊断及治疗进展课件,68,慢性盆底疼痛的诊断及治疗进展课件,69,慢性盆底疼痛的诊断及治疗进展课件,70,慢性盆底疼痛的诊断及治疗进展课件,71,慢性盆底疼痛的诊断及治疗进展课件,72,慢性盆底疼痛的诊断及治疗进展课件,73,慢性盆底疼痛的诊断及治疗进展课件,74,慢性盆底疼痛的诊断及治疗进展课件,75,慢性盆底疼痛的诊断及治疗进展课件,76,慢性盆底疼痛的诊断及治疗进展课件,77,慢性盆底疼痛的诊断及治疗进展课件,78,慢性盆底疼痛的诊断及治疗进展课件,79,慢性盆底疼痛的诊断及治疗进展课件,80,慢性盆底疼痛的诊断及治疗进展课件,81,慢性盆底疼痛的诊断及治疗进展课件,82,慢性盆底疼痛的诊断及治疗进展课件,83,慢性盆底疼痛的诊断及治疗进展课件,84,慢性盆底疼痛的诊断及治疗进展课件,85,慢性盆底疼痛的诊断及治疗进展课件,86,慢性盆底疼痛的诊断及治疗进展课件,87,慢性盆底疼痛的诊断及治疗进展课件,88,慢性盆底疼痛的诊断及治疗进展课件,89,慢性盆底疼痛的诊断及治疗进展课件,90,慢性盆底疼痛的诊断及治疗进展课件,91,慢性盆底疼痛的诊断及治疗进展课件,92,慢性盆底疼痛的诊断及治疗进展课件,93,慢性盆底疼痛的诊断及治疗进展课件,94,慢性盆底疼痛的诊断及治疗进展课件,95,慢性盆底疼痛的诊断及治疗进展课件,96,慢性盆底疼痛的诊断及治疗进展课件,97,慢性盆底疼痛的诊断及治疗进展课件,98,慢性盆底疼痛的诊断及治疗进展课件,99,慢性盆底疼痛的诊断及治疗进展课件,100,慢性盆底疼痛的诊断及治疗进展课件,101,慢性盆底疼痛的诊断及治疗进展课件,102,