术中的微妙的子宫内膜异位症的检测：A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的
Summary
之亏损的腹膜的的完整性提供了一个新的的的的的范式，，以认识和对待慢性盆腔疼痛的，在与的子宫内膜异位症的的温和的形式的妇女，，并，可以很容易地使用的染料在的时间的腹腔镜检查的术中膀胱灌注检测到的的。
Abstract
子宫内膜异位症是一种常见的的疾病的，影响到40％到70％的的慢性盆腔疼痛的（CPP）和/或不孕不育的的生殖-中年妇女，与的。的目的，这项研究中是，，以的一个蓝色的的染料（亚甲基蓝色的）的，以在与骨盆腔的疼痛，并怀疑的的子宫内膜异位症的的患者中，染色腹膜的的的表面在腹腔镜手术（L / S）期间，，以检测到的损失的腹膜的的完整性中演示了如何使用。将40具有CPP和第5疼痛的的妇女没有的的妇女进行了评价在这个试点项目的研究中。在的L / S期间，浓缩的染料;被喷洒到腹膜表面的，然后吸气和与乳酸化的林格液的解决方案漂洗的。的当地语系化的染料摄取的领域进行了评价提供的存在下，可见的的子宫内膜异位病灶和。的激烈的腹膜的荧光染色的领域手术范围是切除，和一些固定的在2.5％的缓冲的戊二醛中和通过扫描（SEM）电子显微术的检查。在与子宫内膜异位症的和慢性盆腔疼痛的的的妇女较的控件的（85％主场迎战40％的）为中，Blue染料摄取是更多的常见的的的。的的蓝色的STAI的的切除术NED的领域透露子宫内膜异位症的由扫描电镜和与正常的的，的非的-染色法的腹膜相比，以的腹膜的的细胞 – 细胞接触的损失的。受影响的的的腹膜被相关联的与可见的的子宫内膜异位症，在大多数，但并非所有的患者的的植入物的。据报道在80％的受试者中主观的的疼痛缓解。在扫描式电子显微镜的基础上，我们得出这样的结论子宫内膜细胞的远远超出了延伸，可见的植入物的的子宫内膜异位症的，，并出现，以扰乱的底层的的的间皮的的的。因此，，细微病变的子宫内膜异位症的的可能会会引起盆腔的疼痛，由的腹膜的的完整性的中断，允许月经来潮或排卵性的的的血液和，以底层的的的感官神经的相关联的的疼痛的因素访问的。完整的切除术的受影响的腹膜可能提供一个更好的的的的的为子宫内膜异位症的和CPP的的长的-长期的的治疗。这个简单的的的的技术的出现，以改善的微妙的的或不久的的无形的子宫内膜异位症的在与在L / S的CPP的和最小的的的视觉的调查结果的妇女中的检测，，，和可能会服务，以提升诊断的精确度为子宫内膜异位症的在腹腔镜检查JOURNAL。
Protocol
1。病人的选择慢性盆腔疼痛的的妇女与经过一个的历史和的物理的的考试。 的。的疼痛，与的问候到了月经的周期的时序，相关联的的的症状，包括肠易激的投诉或膀胱的投诉的;的本地化顷记下并记录。 有经历腹腔镜检查服务的妇女顷同意为的他们的的组织为的研究中的的子宫内膜异位症的和使用的可能的的切除术的中。 2。腹腔镜技术的<li…
Representative Results
一个例子的微妙的的子宫内膜异位症的那是几乎是看不见的的被中所示： 图1A中JOURNAL。在此之前到应用程序蓝色染料的一个不规则的点画腹膜的面积为受到了赞赏计算机辅助由的腹腔镜光的的反射。在图1B中，的外观后此相同的面积的染色示出了的膀胱（ 图1B）的相同的不规则的图案超过。一旦这个部腹膜的时间被手术切除（ 图1C）它被服从了?…
Discussion
在的妇女的慢性盆腔疼痛的的是一个代价高昂的的和管理不善理解的的的的问题的，1。痛经的的盆腔疼痛的是的最常见的的的的形式，，，影响的的妇女2的的60％，，的青少年3有和72％的的。子宫内膜异位症是一种炎症性的的条件，影响正常的妇女的的5％的，，，但是中存在的多达至与骨盆腔疼痛的的妇女的的70％的。虽然的子宫内膜异位症的作出贡献，以慢性的盆腔疼…
Declarações
The authors have nothing to disclose.
Acknowledgements
，，我们想的安吉拉·Houwing，，以承认的出色的的的技术上的帮助，，，，并帮助与，从葛丽塔布什内尔的的数据收集。
Materials
| Name of the reagent | Company | Catalogue number | Comments (optional) |
| Methylene blue | American Reagent | NDC0517-0310-110 | Mixed 1:200 in saline |
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Citar este artigo
Lessey, B. A., Higdon III, H. L., Miller, S. E., Price, T. A. Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity. J. Vis. Exp. (70), e4313, doi:10.3791/4313 (2012).