Objective: To compare excisional and ablative treatment modalities for mild (revised American Fertility score 1-2) endometriosis in the management of chronic pelvic pain. Design: A randomized study of excision or abla...Objective: To compare excisional and ablative treatment modalities for mild (revised American Fertility score 1-2) endometriosis in the management of chronic pelvic pain. Design: A randomized study of excision or ablation for mild endometriosis, participants and investigators alike blinded to the treatment modality at the follow-up visit. Setting: District general hospital with a specialist pelvic pain clinic in the United Kingdom. Patient(s): Women presenting with chronic pelvic pain. Intervention(s): Participants were asked to complete a questionnaire detailing symptoms related to chronic pelvic pain and rating their pain on a ranked ordinal scale. Areas of pelvic tenderness were identified and similarly ranked. At laparoscopy they were randomly assigned to excision or ablation of any endometriotic lesions, and the questionnaire was repeated at 6 months. Main Outcome Measure(s): Changes in pain score on a ranked ordinal scale after surgical treatment for mild endometriosis. Result(s): Both treatment modalities produced good symptomatic relief and reduction of pelvic tenderness (67% ). There was no difference in morbidity; one woman in each group became pregnant during the study period. Only two participants reported no relief or a worsening of symptoms or signs. Conclusion(s): This small study showed good symptom relief at 6 months from pelvic pain for the majority of participants irrespective of the treatment modality, but two participants did not improve or got worse. A high pain score before treatment was a predictor of appreciable improvement. Further work is needed to identify women in whom surgical intervention is likely to produce a good response.展开更多
Objective: To determine the efficacy of laparoscopic excision of visually diagnosed endometriosis in the treatment of chronic pelvic pain. Study design: Sixty-two women with chronic pelvic pain and who underwent lapar...Objective: To determine the efficacy of laparoscopic excision of visually diagnosed endometriosis in the treatment of chronic pelvic pain. Study design: Sixty-two women with chronic pelvic pain and who underwent laparoscopic excision of visually diagnosed peritoneal lesions suggestive of endometriosis returned postal questionnaires. The main outcomes measures were change in pelvic pain symptoms measured on a continuous and ordinal scale and patient satisfaction following treatment. Secondary outcomes were quality of life, time off work and use of health service resources. Results: 42/62 (68% ) women with an average follow up time of 13 months (range 6- 38 months)- returned completed outcome questionnaires. The mean amount of pelvic pain was reduced following surgery compared to immediately prior to treatment, regardless of the nature of the pain (P < 0.05). Overall, 67% (95% CI 50- 80% ) of women reported improvement in pain symptoms and 71% (95% CI 55- 84% ) were satisfied with the results of treatment. Satisfaction with treatment was comparable whether the visual diagnosis of peritoneal endometriosis was confirmed histologically or not (62% versus 64% , P = 1.0). Conclusion: Laparoscopic excision of visually diagnosed endometriosis appears to be efficacious in the treatment of women with chronic pelvic pain. The launch of a long-term randomised controlled trial to confirm these provisional results is now required.展开更多
文摘Objective: To compare excisional and ablative treatment modalities for mild (revised American Fertility score 1-2) endometriosis in the management of chronic pelvic pain. Design: A randomized study of excision or ablation for mild endometriosis, participants and investigators alike blinded to the treatment modality at the follow-up visit. Setting: District general hospital with a specialist pelvic pain clinic in the United Kingdom. Patient(s): Women presenting with chronic pelvic pain. Intervention(s): Participants were asked to complete a questionnaire detailing symptoms related to chronic pelvic pain and rating their pain on a ranked ordinal scale. Areas of pelvic tenderness were identified and similarly ranked. At laparoscopy they were randomly assigned to excision or ablation of any endometriotic lesions, and the questionnaire was repeated at 6 months. Main Outcome Measure(s): Changes in pain score on a ranked ordinal scale after surgical treatment for mild endometriosis. Result(s): Both treatment modalities produced good symptomatic relief and reduction of pelvic tenderness (67% ). There was no difference in morbidity; one woman in each group became pregnant during the study period. Only two participants reported no relief or a worsening of symptoms or signs. Conclusion(s): This small study showed good symptom relief at 6 months from pelvic pain for the majority of participants irrespective of the treatment modality, but two participants did not improve or got worse. A high pain score before treatment was a predictor of appreciable improvement. Further work is needed to identify women in whom surgical intervention is likely to produce a good response.
文摘Objective: To determine the efficacy of laparoscopic excision of visually diagnosed endometriosis in the treatment of chronic pelvic pain. Study design: Sixty-two women with chronic pelvic pain and who underwent laparoscopic excision of visually diagnosed peritoneal lesions suggestive of endometriosis returned postal questionnaires. The main outcomes measures were change in pelvic pain symptoms measured on a continuous and ordinal scale and patient satisfaction following treatment. Secondary outcomes were quality of life, time off work and use of health service resources. Results: 42/62 (68% ) women with an average follow up time of 13 months (range 6- 38 months)- returned completed outcome questionnaires. The mean amount of pelvic pain was reduced following surgery compared to immediately prior to treatment, regardless of the nature of the pain (P < 0.05). Overall, 67% (95% CI 50- 80% ) of women reported improvement in pain symptoms and 71% (95% CI 55- 84% ) were satisfied with the results of treatment. Satisfaction with treatment was comparable whether the visual diagnosis of peritoneal endometriosis was confirmed histologically or not (62% versus 64% , P = 1.0). Conclusion: Laparoscopic excision of visually diagnosed endometriosis appears to be efficacious in the treatment of women with chronic pelvic pain. The launch of a long-term randomised controlled trial to confirm these provisional results is now required.
