postpartum abdominal pain
Introduction
Introduction Pelvic congestion syndrome is characterized by lumbosacral pain and postpartum abdominal pain, radiation to the lower extremities, aggravation after standing for a long time and fatigue. Pelvic Congestion Syndrome, also known as Ovarian Vein Syndrome, is one of the most important causes of gynecological pelvic pain. Because of its wide range of symptoms, the patient's self-conscious symptoms are often inconsistent with objective examinations. Often confused with chronic pelvic inflammatory disease, so these patients are often misdiagnosed as chronic pelvic inflammatory disease or chronic annexitis and long-term cure.
Cause
Cause
First, the pathogenesis of Chinese medicine
According to its clinical manifestations, the disease can be attributed to diseases such as "women's abdominal pain", "tracheal pain", "postpartum abdominal pain" and "under the belt". There is no specific clear discussion on the disease in Chinese medicine, but there are many discourses on its symptoms. For example, the Sui Dynastys Chao Yuanfangs The Sources of Diseases? Womens Miscellaneous Diseases cloud: Small abdominal pain, this cell There is a wind-cooled fight between the collaterals, stopping the lower abdomen, and causing pain due to the virtual stimuli and blood; "Song Dynasty Chen, self-defense "Women's Daquan Liangfang" Yiyun: "Women's abdomen blood stasis, menstrual cramps Wetness, or postpartum embers are not exhausted, so take the wind to cool, for the wind and cold, the blood is cold and it becomes blood stasis." But both are lack of blood. The blood stasis is left in the palace, the blood is not running smoothly, and the pain is not good. Chinese medicine believes that Qi is the handsome of blood, qi is bloody, qi deficiency is unable to promote blood, blood is not smooth, obstruction of meridians, qi stagnation and blood stasis, qi deficiency can be overworked, Shenpi fatigue, shortness of breath, lower abdomen, anal bulge; Qi stagnation see breast pain, upset and irritability; blood stasis, no pain, so see lumbosacral pain, pain after sexual intercourse. In short, the pathological basis of this disease is qi deficiency and blood stasis combined with qi stagnation, qi deficiency-based, qi stagnation and blood stasis as the standard. The virtual reality is mixed with the virtual standard. The formation of blood stasis is often related to the following factors:
1. Liver qi stagnation, blood stasis caused by blood stasis. Internal injuries, seven emotions, liver qi stagnation, poor blood flow, Chong Ren qi qi and blood stasis and cost disease.
2. The damp heat accumulates under the coke and causes blood stasis. Because of the external feeling of dampness, dampness and heat, or rushing to rush, blocking the meridians, sputum cell, poor blood flow, stagnation and cost.
3. Blood loss caused by deficiency. Early marriage, house labor, prolific or physical weakness, resulting in loss of vital energy, blood supply is weak, blood stasis is stagnation, Chong Ren is lost to the sputum and the disease.
Second, the etiology and pathology of Western medicine
(1) Causes
Any factor that causes the pelvic venous blood to flow out of the pelvis is poor or blocked, can lead to pelvic venous congestion. Compared with men, female pelvic circulation is very different in terms of anatomy, circulation dynamics and mechanics. It is easy to form pelvic blood stasis.
1. Anatomical factors: The characteristics of female pelvic circulation are mainly the increase in the number of veins and the weak structure. Generally, two or more veins are accompanied by an artery of the same name, with more anastomotic branches and venous plexus, and the blood flow is slow. For example, the venous uterine vein, vaginal vein and ovarian vein of the pelvic cavity are mostly 2 to 3 veins. With a artery of the same name, the ovarian vein can even be as many as 5 to 6, forming a vine-like venous plexus that bends behind the sides of the uterus until a single ovarian vein is formed before they flow through the pelvic margin. There are many anastomotic branches between the uterus, fallopian tubes and ovarian veins. In the oviductal mesenteric, there are anastomotic branches of the uterine vein and the ovarian vein, and a circular venous circulation is formed, which is then anastomosed to the lateral ovarian venous plexus.
It originates from the pelvic organ mucosa, the muscular layer and the subserosal venous plexus, which are combined into two or more veins and flow to the thick internal iliac vein. The increase in the number of pelvic veins is to accommodate the slow flow of pelvic veins.
The pelvic vein is thinner than the vein wall in other parts of the body, lacking the outer sheath composed of fascia, no elasticity, most of which have no valve, and some of the maternal valves are often incomplete. Walking through the pelvic loose connective tissue, and the female pelvic venous blood volume is large, it is easy to cause venous congestion around the pelvic cavity, bladder, rectum and anus, causing vascular tortuosity, expansion, and congestion. At the same time, the vulva, cervix, and lower abdominal varicose veins were combined. In addition, the three systemic veins of the bladder, rectum, and genitals communicate with each other, and any systemic disorder can affect the other two systems.
2. Physique factors: Some patients have weak vascular wall tissue due to physical factors, less elastic fibers, poor elasticity, and easy formation of venous stasis.
3.Mechanical factors: due to early marriage and early childbearing, when the genital is not fully mature, the burden is too heavy, or sexual intercourse, frequent pregnancy and pregnancy are prone to pelvic venous congestion, due to the influence of a large number of estrogen and progesterone, plus the uterus Compression of the surrounding veins can cause dilatation of the veins around the uterus. Long-term standing or sedentary position, due to the gravity of the uterus and bladder filling, the uterus body is displaced backwards, which can also affect the pelvic vein outflow. Those who are used to sleeping on the back, most of the pelvic veins are located lower than the inferior vena cava, which is not conducive to the pelvic vein blood flowing out of the pelvic cavity.
4. Tubal ligation: Because the blood supply of the fallopian tube is a dual supply, the arteries originate from the fallopian tube branch and the isthmus branch of the uterine artery, and the funnel is distributed from the umbrella branch of the ovarian artery, and the two are in agreement with each other. The ovarian plexus, part of the cervix vaginal plexus, thus forming a different characteristic of the fallopian tube artery and vein direction. In the process of tubal ligation, if the tubal mesenteric vein or local lesion is damaged, the balance of blood supply is destroyed, which will affect the pelvic venous circulation dynamics. The blood circulation of the vascular network in the mesangium is blocked, causing varicose veins. It can be considered that the injury or local lesion caused by tubal ligation is one of the main factors that cause many factors of pelvic varices.
5. Autonomic dysfunction: Many scholars believe that the main symptoms of this syndrome are easy fatigue, low back pain, sexy discomfort, etc., and insomnia, depression, snoring and pelvic venous congestion are closely related, therefore, the autonomic nervous function is out of balance. Causes pelvic local venous congestion.
6. Other factors: uterine fibroids, chronic pelvic inflammatory disease (especially those who form tubal ovarian cysts), chronic amenorrhea and cervicitis during lactation, etc., can show pelvic venous congestion images during angiography.
(two) pathology
Due to the above factors, some pelvic veins with weak anatomical structure are functionally changed, affecting blood flow, forming congestion and edema, and long-term tissue hypoxia leads to connective tissue hyperplasia or fibrosis, and then between nerve vessels Mutual influence affects the entire genital and breast, and manifests itself as a series of clinical syndromes. The edema of local tissues and related organs caused by congestion begins to be temporary and reversible, and permanent changes can occur after many years or repeated aggravation. Gross pathology can be seen as filling of vulvar veins, vaginal mucosa purple blue coloration, cervical hypertrophy, cervical mucosa often showing valgus erosion, surrounded by mucous purple blue coloring, sometimes seeing filling venules in the posterior lip of the cervix There are many cervical secretions.
Examine
an examination
Related inspection
Pelvic and vaginal B-abdominal plain film abdominal perspective abdominal CT abdominal percussion
1. Vaginal ultrasound color Doppler examination.
2. Laparoscopy: same as open surgery, but because of the pelvic elevation, some cases may not be able to see the varicose veins, but can be differentiated from other lesions such as inflammation.
3. Spiral CT: Recently, it has been reported in the literature that spiral CT is a non-invasive effective method for diagnosing pelvic venous congestion syndrome. When the patient takes deep breathing, he takes a spiral CT image of the artery, which causes an increase in abdominal venous pressure due to deep breathing, resulting in kidney. The venous blood is retrograde, filling the varicose veins around the uterus and ovaries, and the diameter of the varicose veins can be developed by >5 mm. Conventional CT shows only a few dilated veins, independent of pelvic venous congestion syndrome.
4. Pelvic venography: pelvic venography is to inject the contrast agent into the musculocutaneous muscle layer, to develop the uterine vein, ovarian vein and part of the vaginal vein, internal iliac vein, and continuously film at a certain time interval, understand The time when pelvic blood (mainly uterine vein and ovarian vein) flows out of the pelvis is used as a method to assist in the diagnosis of pelvic congestion. When the pelvic venous blood is normal, the contrast agent usually flows out of the pelvis completely within 20s; in the case of pelvic congestion, the venous return rate is significantly slower, and the contrast agent flows out of the pelvis, which takes more than 20s.
5. Radionuclide pelvic blood pool scan: This method is used to diagnose pelvic venous congestion after tubal ligation. The principle is that local varicose veins are formed during pelvic venous congestion, and blood stasis forms a "blood pool", thereby obtaining a scanned image of radioactive readable radionuclide concentration.
6. Position test: When the chest and knee are lying down, the pelvic vein pressure is reduced, no lower abdominal pain or slight pain. If you immediately change your hips and sit tightly on the heel, keep it slightly above the abdomen, due to groin flexion. Tight, the external iliac artery is blocked by blood flow to the femoral artery, so that the blood flow of the internal iliac artery increases, causing the pelvic venous pressure to rise and causing congestion. When the lower abdominal pain returns to the chest and knee, the symptoms are relieved, which is called "positive position test." ".
Diagnosis
Differential diagnosis
The common symptoms of gynecological diseases that tingle in the lower abdomen bring great pain to the patient. Sometimes, the pain is unbearable, and there are many types of abdominal pain, which causes many reasons.
Pre-abdominal pain is mostly cold stagnation, often manifested as abnormal abdominal pain. Dysmenorrhea is one of the common diseases in women.
Before and after menstruation, abdominal pain refers to the pain of dysmenorrhea before menstruation. It is one of the symptoms of dysmenorrhea. Dysmenorrhea refers to women with pain in the lower abdomen or waist, and even pain and lumbosacral. Every time with the menstrual cycle, severe cases can be accompanied by nausea and vomiting, cold sweats, cold hands and feet, and even fainting, affecting work and life.
1. Vaginal ultrasound color Doppler examination.
2. Laparoscopy: same as open surgery, but because of the pelvic elevation, some cases may not be able to see the varicose veins, but can be differentiated from other lesions such as inflammation.
3. Spiral CT: Recently, it has been reported in the literature that spiral CT is a non-invasive effective method for diagnosing pelvic venous congestion syndrome. When the patient takes deep breathing, he takes a spiral CT image of the artery, which causes an increase in abdominal venous pressure due to deep breathing, resulting in kidney. The venous blood is retrograde, filling the varicose veins around the uterus and ovaries, and the diameter of the varicose veins can be developed by >5 mm. Conventional CT shows only a few dilated veins, independent of pelvic venous congestion syndrome.
4. Pelvic venography: pelvic venography is to inject the contrast agent into the musculocutaneous muscle layer, to develop the uterine vein, ovarian vein and part of the vaginal vein, internal iliac vein, and continuously film at a certain time interval, understand The time when pelvic blood (mainly uterine vein and ovarian vein) flows out of the pelvis is used as a method to assist in the diagnosis of pelvic congestion. When the pelvic venous blood is normal, the contrast agent usually flows out of the pelvis completely within 20s; in the case of pelvic congestion, the venous return rate is significantly slower, and the contrast agent flows out of the pelvis, which takes more than 20s.
5. Radionuclide pelvic blood pool scan: This method is used to diagnose pelvic venous congestion after tubal ligation. The principle is that local varicose veins are formed during pelvic venous congestion, and blood stasis forms a "blood pool", thereby obtaining a scanned image of radioactive readable radionuclide concentration.
6. Position test: When the chest and knee are lying down, the pelvic vein pressure is reduced, no lower abdominal pain or slight pain. If you immediately change your hips and sit tightly on the heel, keep it slightly above the abdomen, due to groin flexion. Tight, the external iliac artery is blocked by blood flow to the femoral artery, so that the blood flow of the internal iliac artery increases, causing the pelvic venous pressure to rise and causing congestion. When the lower abdominal pain returns to the chest and knee, the symptoms are relieved, which is called "positive position test." ".
