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  Česky / Czech version Čes. Gynek., 67, 2002, No. 1, p. 38-46
 
Laparoscopy on Account of Chronic Pelvic Pain: a Retrospective Clinical Study 
Mára M., Fučíková Z., Kužel D., Dohnalová A., Haaková L., Živný J.: 

Gynekologicko-porodnická klinika 1. LF UK a VFN, přednosta prof. MUDr. J. Živný, DrSc. Fyziologický ústav 1. LF UK v Praze – oddělení kybernetiky, přednosta prof. MUDr. S. Trojan, DrSc.
 


Summary:

        Objectives: To analyze the laparoscopic findings in women with chronic pelvic pain (CPP). To verify the possible predictive value of the anamnestic factors for the laparoscopically established diagnosis. Design: A retrospective clinical trial. Setting: Department of Obstetrics and Gynaecology, lst Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. Methods: We realized a detailed analysis of laparoscopies for CPP performed in our clinic in the last 5 years. With the help of statistical analysis (c 2 ) the possible influence of age, previous surgical intervention, history of PID, dysmenorrhea, infertility, and some other factors on endoscopic finding was verified. Results: 480 laparoscopies for CPP were performed from the year 1995 to 1999. The most frequent findings were adhesions (22.3%), endometriosis (20.4%), PID (17.7%), and normal finding (17.7%). In 53% of all cases the operative laparoscopic procedure was done, most frequently the adhesiolysis (62.2%). Only one serious complication during laparoscopy was recorded (0.21%). In women younger than 30 years endometriosis was the most frequent finding (22.8%), in women older than 30 pelvic adhesions were the most often (31.9%). Diversity of findings between the groups was statistically significant (P < 0.0001). In patients with previous operation in pelvis the adhesions were found most frequently (46.2%). Diversity of findings in women with and without previous operation was also significant (P < 0.0001). In women treated for PID, pelvic inflammation was found in 25.8%, but in 22.5% the finding was negative and in 20.2% the endometriosis was diagnosed. In these subgroups (women after and without treatment of PID) the diversity of findings was not significant (P < 0.1). In infertile women, suffering from CPP, PID was found most frequently (41.2%). A suspicion of chronic appendicitis was verified in 64.3%. In patients with dysmenorrhea, as well as in women suffering from dyspareunia, endometriosis was dominant finding (30.4%, resp. 29.1 %). Conclusion: Laparoscopy for CPP is a safe and effective method for verifying and adequate therapy of as yet hidden pathological findings. With the help of anamnestic factors some laparoscopic findings are predictible; although the sensitivity and specificity is very poor.

        Key words: chronic pelvic pain, laparoscopy, laparoscopic finding prediction
       

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